Prevalence and determinants of post-traumatic stress disorder five months after the 2019 huge flooding in Iran

BACKGROUND

Despite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019.

METHODS

An analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants.

RESULTS

Out of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7-28.8%) and was significantly higher in Lorestan province (39.7%, P < 0.001). Determinants of PTSD, were unemployment (adjusted odds ratio [AOR] = 3.53, CI 95%: 1.38-9.00), primary (AOR = 2.44, CI 95%: 1.10-5.41) or high school (AOR = 2.35, CI 95%: 1.25-4.40) education (vs. university), a history of mental disorders (AOR = 2.36, CI 95%: 1.22-4.58), high damage to assets (AOR = 2.29, CI 95%: 1.40-3.75), limited access to health care services after the flood (AOR = 1.95, CI 95%: 1.20-3.19), not receiving compensation for flood damage (AOR = 1.94, CI 95%: 1.01-3.83), high wealth index (AOR = 1.90, CI 95%: 1.23-2.93), and flooded house with a height of more than one meter (AOR = 1.66, CI 95%: 1.02-2.76).

CONCLUSION

Results show a notable prevalence of PTSD, especially in Lorestan province, among adults affected by floods. Determinants of PTSD include unemployment, lower education, psychiatric history, extensive property damage, limited post-flood healthcare access, lack of compensation, and increased flood exposure. We recommend adopting an inclusive screening approach for high-risk groups and developing appropriate therapeutic and supportive interventions.

Psychological impact of the Spring 2019 flood among adult population of Iran

BACKGROUND

From March to April 2019, a flood occurred in several regions of Iran. The most affected provinces were Golestan, Lorestan, and Khuzestan.

AIMS

The present study aimed to determine the prevalence and determinants of psychological distress and depression among the affected adult population 6 months after the event.

METHODS

A cross-sectional household survey with face-to-face interview was carried out on a random sample of 1,671 adults aged above 15 years living in the flood-affected areas from August to September 2019. We applied GHQ-28 and PHQ-9 for the assessment of psychological distress and depression, respectively.

RESULTS

The prevalence of psychological distress and depression were 33.6% (95% CI [29.5, 37.7]) and 23.0% (95% CI [19.4, 26.7]), respectively. Determinants of psychological distress were a history of mental disorders (Adjusted odds ratio [AOR] = 4.7), primary (AOR = 2.9) or high school (AOR = 2.4) education (vs. university), no compensation received (AOR = 2.1), high damage to assets (AOR = 1.8), the house flooded more than 1 m (AOR = 1.8), female gender (AOR = 1.8), and limited access to health care services (AOR = 1.8). Determinants of depression were unemployment (AOR = 5.3) or being a housewife (AOR = 2.7), a history of mental disorders (AOR = 4.1), high damage to assets (AOR = 2.5), no compensation received (AOR = 2.0), the house flooded more than 1 m (AOR = 1.8), limited access to health care services (AOR = 1.8), and high wealth index (AOR = 1.7).

CONCLUSION

The results of this study revealed a high prevalence of psychological distress and depression in the flood-affected adult population. The high-risk group, particularly flood victims who had a history of mental disorders, and those exposed to severe damages of flood, should be prioritized for screening, and mental health services.

Impact of COVID-19 pandemic on relapse of individuals with severe mental illness and their caregiver's burden

Background

The implementation of quarantine and social distancing measures to control the COVID-19 pandemic led to restrictions at the community level and most of in-person psychiatric services were discontinued. This situation could affect the psychopathology of the patients and the burden of their caregivers. The aim of this study was to investigate the effects of COVID-19 pandemic on people with severe mental illnesses (SMIs) and their caregivers' burden.

Method

The study sample consisted of 86 patients with severe mental illness and 86 caregivers. The mental status, relapse rate, and rehospitalization rate of the patients and the general health status and burden of caregivers were investigated in three waves, including before and 3 and 6 months after the COVID-19 pandemic.

Results

The relapse rate of the patients was 14%, 33.7%, and 43% (p = 0.000) and the rehospitalization rate was 4.7%, 7%, and 10.5% in waves 0, 1, and 2, respectively (p = 0.000). Most of the psychopathological scales increased in three waves (p = 0.000). The caregivers' burden and health condition worsened during the nine months of the study as well (p = 0.000).

Conclusion

The COVID-19 pandemic led to the exacerbation of symptoms and increased the relapse rate in people with SMIs. It also worsened the caregivers' condition. People with severe mental illnesses (SMIs) and their caregivers are one of the most vulnerable groups on which the COVID-19 pandemic had a marked negative effect.

Traumatic Events Exposure and Post Traumatic Stress Disorder in Caregivers of Patients with Bipolar Disorder, Bipolar Disorder and Comorbid Post Traumatic Stress Disorder and Multiple Sclerosis

Background

Chronic diseases affect the lives of the patient and caregiver. Caring for a patient with a chronic psychiatric illness, such as bipolar disorder, is a stressful and challenging activity. Caregivers of severe psychiatric patients are the primary victims of violence by patients. Caring for these patients can be very stressful for the caregiver to the extent of experiencing post-traumatic stress symptoms. This study compares the frequency of trauma exposure and PTSD in the caregivers of patients with bipolar disorder type 1(BD-1), bipolar disorder type 1, comorbid post-traumatic stress disorder (BD-1+PTSD), and multiple sclerosis (MS).The MS group served as the control group.

Methods

This cross-sectional study with convenient sampling was conducted at three hospitals in Tehran, Iran, from April 2020 to January 2022. One hundred eighty caregivers answered a clinical demographic questionnaire. We then used the Trauma History Questionnaire (THQ) to assess the frequency of exposure to different types of trauma. Then, the Persian version of the SCID-5, a valid and reliable instrument for psychiatric diagnoses, was used to diagnose PTSD. Chi-square was used for analyzing data.

Results

Exposure to trauma has a significant difference between the groups. BD-1 + PTSD patients' caregivers were exposed to more physical assaults than others (P < 0.0001) There was a significant difference between sexual harassment in the MS group (P = 0.010). There was a significant difference between the three groups in the development of PTSD (P = 0.003). PTSD prevalence in the BD-1 + PTSD caregiver group is more than in other groups. In the caregivers of BD-1+PTSD, the caregiving experience caused traumatic exposure and the development of PTSD in all caregivers.

Conclusion

This study shows that the prevalence of exposure to traumatic events and PTSD is higher in the caregivers of BD-1 patients, especially if the patient has comorbid PTSD. Detecting these symptoms early and using intervention can make the caregiving burden more tolerable.

The Effects of an Empathic Communication Workshop on Internal Medicine Residents' Self-Perceived Empathy and Their Patients' Perception of Physician's Empathy: A Single-Group Experimental Study

Background: Empathetic communication improves the physician-patient relationship and enhances patient and physician satisfaction. This study aims to evaluate the impact of empathic communication skills training on physicians' self-perceived performance and patient satisfaction regarding the empathetic quality of their relationship with their physicians. Methods: In this single-group before-after experimental study, we recruited 50 internal medicine residents at a large teaching hospital. We assessed the residents' empathy using the Jefferson Scale of Empathy before and 3 weeks after an 8-hour workshop on empathic communication skills. We also recruited 50 of their patients before and another 50 patients 3 weeks after the training to assess the patient's perceptions of their physician's empathy using the Consultation and Relational Empathy scale. Physicians' and patients' mean scores on empathetic care at the beginning of the study were then compared using paired t-tests with their scores after the workshop. Results: The residents' mean score on Jefferson Empathy Scale increased from 81.1(95%CI:78.8-83.3) at baseline to 96.8(95%CI:93.6-100) following the workshop (p < 0.001). Before the empathetic communication skills training, patients assessed their doctors' empathy at 68.3(95%CI:63.5-73.2). After the intervention, this improved to 84.9(95%CI:82.2-87.5) (p < 0.001). Conclusion: In this study, both the residents and their patients stated that the residents' empathy skills had significantly improved after an empathetic communication workshop for internal medicine residents.

Systematic review and meta-analysis of the placebo effect in panic disorder: Implications for research and clinical practice

OBJECTIVE

This review aimed to measure the degree of placebo response in panic disorder.

DATA SOURCES

We searched major databases up to 31 January 2021, for randomized pharmacotherapy trials published in English.

STUDY SELECTION

A total of 43 studies met inclusion criteria to be in the analysis (with 174 separate outcome measurements).

DATA EXTRACTION

Changes in outcome measures from baseline in the placebo group were used to estimate modified Cohen's d effect size.

RESULTS

A total of 43 trials (2392 subjects, 174 outcomes using 27 rating scales) were included in the meta-analysis. Overall placebo effect size was 0.57 (95% confidence interval = [0.50, 0.64]), heterogeneity (I²: 96.3%). Higher placebo effect size was observed among clinician-rated scales compared to patient reports (0.75 vs 0.35) and among general symptom and anxiety scales compared to panic symptoms and depression scales (0.92 and 0.64 vs 0.56 and 0.54, respectively). There was an upward trend in effect size over the publication period (r = 0.02, p = 0.002) that was only significant among clinician-rated scales (r = 0.02, p = 0.011). There was no significant publication bias, Egger's test (p = 0.08).

CONCLUSION

We observed a substantial placebo effect size in panic disorder. This effect was more prominent for some aspects of panic disorder psychopathology than for others and was correlated with the source of the assessment and publication year. This finding has implications both for research design, to address the heterogeneity and diversity in placebo responses, and for clinical practice to ensure optimal quality of care.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO, CRD42019125979.

Correction to: Automatic COVID-19 detection mechanisms and approaches from medical images: a systematic review

[This corrects the article DOI: 10.1007/s11042-022-12952-7.].

Automatic COVID-19 detection mechanisms and approaches from medical images: a systematic review

Since early 2020, Coronavirus Disease 2019 (COVID-19) has spread widely around the world. COVID-19 infects the lungs, leading to breathing difficulties. Early detection of COVID-19 is important for the prevention and treatment of pandemic. Numerous sources of medical images (e.g., Chest X-Rays (CXR), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI)) are regarded as a desirable technique for diagnosing COVID-19 cases. Medical images of coronavirus patients show that the lungs are filled with sticky mucus that prevents them from inhaling. Today, Artificial Intelligence (AI) based algorithms have made a significant shift in the computer aided diagnosis due to their effective feature extraction capabilities. In this survey, a complete and systematic review of the application of Machine Learning (ML) methods for the detection of COVID-19 is presented, focused on works that used medical images. We aimed to evaluate various ML-based techniques in detecting COVID-19 using medical imaging. A total of 26 papers were extracted from ACM, ScienceDirect, Springerlink, Tech Science Press, and IEEExplore. Five different ML categories to review these mechanisms are considered, which are supervised learning-based, deep learning-based, active learning-based, transfer learning-based, and evolutionary learning-based mechanisms. A number of articles are investigated in each group. Also, some directions for further research are discussed to improve the detection of COVID-19 using ML techniques in the future. In most articles, deep learning is used as the ML method. Also, most of the researchers used CXR images to diagnose COVID-19. Most articles reported accuracy of the models to evaluate model performance. The accuracy of the studied models ranged from 0.84 to 0.99. The studies demonstrated the current status of AI techniques in using AI potentials in the fight against COVID-19.

Randomized controlled trial for the efficacy of three versus five sessions of grief counseling on the psychological aspects following COVID-19 bereavement: A study protocol

BACKGROUND

During the COVID-19 pandemic, many people have experienced traumatic losses and therefore are at risk of developing complicated grief regarding the restrictions on the performance of routine mourning rituals. This study is a randomized controlled trial for assessing the efficacy of three versus five sessions of grief counseling on grief intensity, psychological distress, and quality of life of grief among bereaved people due to COVID-19.

METHODS

A total of 120 bereaved people, due to COVID-19, will be enrolled in this multi-center randomized controlled trial after assessment for inclusion and exclusion criteria. Following the informed consent procedure, participants will be allocated into two groups equally by the Stratified Balanced Block Randomization, one of them delivering a three-session grief counseling intervention and the other delivering a five-session grief counseling intervention. The intervention will be delivered by trained psychologists via in-person individual sessions. The primary outcome is grief intensity, and the secondary outcomes are psychological distress, quality of life, and satisfaction of the participants. These outcomes will be measured by the Grief Intensity Scale (GIS), the General Health Questionnaire-28 (GHQ-28), the Short Form Health Survey-12 (SF-12), and the Client Satisfaction Questionnaire (CSQ-8), respectively. The assessments will be done at three time points, one before the intervention and the others 1 month and 3 months after the intervention. The data will be analyzed using the SPSS V.18 and Stata V.11 software. The analysis approach will be "intention to treat."

DISCUSSION

Results of this study can be applied for selecting the most suitable intervention leading to the prevention of complicated grief and the maintenance and promotion of the mental health of bereaved people due to COVID-19.

CLINICAL TRIAL REGISTRATION

[irct.ir], identifier [IRCT20200505047305N1].

HIV prevalence among men who have sex with men in Iran: A systematic review and meta-analysis

Background: The need for informed policymaking highlights the importance of data on human immunodeficiency virus (HIV) prevalence on key populations. In this systematic review and meta-analysis, we aimed to provide an overview of HIV prevalence in men who have sex with men (MSM) in Iran.

Methods: We searched literature published between January 2008 and December 2019 to identify studies reporting the prevalence of HIV infection or acquired immunodeficiency syndrome (AIDS) in a population of adult Iranian men with history of sexual contact with other men. We employed Metaprop command in Stata to pool proportions from different studies.

Results: Among the 16 studies retrieved, 2 were performed on MSM population directly, 7 among people who inject drugs, 4 among prisoners, 2 among the homeless, and 1 among methamphetamine users. HIV prevalence was 7% (95% CI, 5%-10%) based on the meta-analysis, although noticeable heterogeneity existed because of target population, study year, and study location, which imposed limitations to provide a robust summary measure for the prevalence of HIV.

Conclusion: There is a potential risk of observing a high prevalence of HIV in MSM that could hamper the results of various preventive strategies and their achievements in other subpopulations.

Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence

BACKGROUND

Bipolar disorder is a common psychiatric disorder with a massive psychological and social burden. Research indicates that treatment adherence is not good in these patients. The families' knowledge about the disorder is fundamental for managing their patients' disorder. The purpose of the present study was to investigate the knowledge of the family members of a sample of Iranian patients with bipolar I disorder (BD-I) and to explore the potential reasons for treatment non-adherence.

METHODS

This study was conducted by qualitative content analysis. In-depth interviews were held and open-coding inductive analysis was performed. A thematic content analysis was used for the qualitative data analysis.

RESULTS

The viewpoints of the family members of the patients were categorized in five themes, including knowledge about the disorder, information about the medications, information about the treatment and the respective role of the family, reasons for pharmacological treatment non-adherence, and strategies applied by families to enhance treatment adherence in the patients. The research findings showed that the family members did not have enough information about the nature of BD-I, which they attributed to their lack of training on the disorder. The families did not know what caused the recurrence of the disorder and did not have sufficient knowledge about its prescribed medications and treatments. Also, most families did not know about the etiology of the disorder.

CONCLUSION

The lack of knowledge among the family members of patients with BD-I can have a significant impact on relapse and treatment non-adherence. These issues need to be further emphasized in the training of patients' families. The present findings can be used to re-design the guidelines and protocols in a way to improve treatment adherence and avoid the relapse of BD-I symptoms.

The prevalence of attention deficit hyperactivity disorder in Iran: An updated systematic review

Background: Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children and adolescents. There is a controversy over the true prevalence of ADHD in Iran, the knowledge of which is crucial for allocating health care resources and identifying research priorities. This is an updated systematic review of the prevalence of ADHD in Iranian children and adolescents. Methods: For this systematic review, PubMed/Medline, Web of Science, Scopus, PsycINFO, IranPsych, IranMedex, Irandoc, Google Scholar, and grey literature were reached for publications between January 1990 and December 2018 that reported prevalence estimates of ADHD in Iran. Parallel independent assessments were conducted. The Quality Assessment Checklist for Prevalence Studies was used to assess the overall quality of studies. Results: A total of 34 original studies covering 33 621 Iranian children, adolescents, and adults were included. The included studies were mostly conducted on the population of preschool, elementary, middle, and high school-aged children as well as adolescents. Also, 6 studies addressed university students. Prevalence estimates of ADHD reported varied substantially across the studies and offered a range of heterogeneous data. Conclusion: Overall, making exact comparisons among studies was not easy because the assessment method and the type of sampling could impact prevalence estimates. These factors need to be considered when comparing data from different studies.

Prevalence of cigarette smoking among college students in Iran: An updated systematic review and meta-analysis of observational studies

Background: Cigarette smoking is known as a gateway drug for illicit drug use in youth. The objective of this study is to assess the prevalence of cigarette smoking in the college students in Iran.

Methods: We searched electronic databases including Scopus, Medline/PubMed, Google Scholar and Web of Science, and national databases such as Magiran, Scientific Information Database, Iranmedex, Medlib, Irandoc, and IranPsych from 1946 to 21st July 2018 without any language restriction using a proper search strategy. We used a random effect model to calculate the pooled prevalence of cigarette smoking in college students in Iran. Chi-square test and I2 index were used to evaluate the heterogeneity between the studies. We used the meta-regression and subgroup analysis to assess the potential source of heterogeneity. Stata software, version 11 (StataCorp, TX) was used for all statistical analysis.

Results: We included 60 eligible articles in our study. The pooled prevalence of cigarette smoking at least once in the lifetime was 19% (95%CI: 17-22). The I2 index indicated considerable between-study heterogeneity (I2 =98%, p<0.001). The pooled prevalence of cigarette smoking at least once in the lifetime in males and females was 28% (95% CI: 23-34) and 9% (95% CI: 6-13), respectively. In multivariable meta-regression, a significant association was shown between the year of study (β=-13.1, p=0.011) and sampling method (β=-12.8 p=0.017) and daily use in the last month.

Conclusions: Increasing prevalence of smoking among Iranian university students is an important health priority. Increasing preventive and health education programs are recommended.

Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.

METHODS

GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.

FINDINGS

The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older.

INTERPRETATION

Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.

FUNDING

Bill & Melinda Gates Foundation.

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study

BACKGROUND

While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

METHODS

In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

RESULTS

GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

CONCLUSIONS

GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017

BACKGROUND

Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

METHODS

We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

FINDINGS

In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

INTERPRETATION

Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Prevalence of major depressive disorder in the general population of Iran: A systematic review and meta-analysis

Background: Major depressive disorder (MDD) is the most common psychological disorder and affects many people worldwide. Surveying the prevalence of mental disorders, especially general disorders, such as major depressive disorder, is highly important for health professionals and policymakers. Due to a wide variation of studies concerning the prevalence of major depressive disorder in Iran, the present study was conducted to integrate such results. Methods: To conduct this study, English (PubMed/Medline, Scopus and Web of Science) and Persian (MHRN, Noormgs, Magiran, Iran-Medex, Irandoc, and SID) databases, from 1990 to 2018, were explored. All articles related to the point prevalence of depressive disorders in the general population of Iran were reviewed. The inclusion criteria of the present study were as follow: cross sectional studies based on general populations; the expression of the point prevalence rate and incidence of major depressive disorder for people over 15 years; and the use of a structured or semi-structured clinical interview for diagnosis of the disorder. Studies that were not original (such as review studies) and those that did not represent general populations were excluded from the study. To analyze the data obtained from this study, the second version of Comprehensive Meta-Analysis (CMA) software was used. The total point prevalence was calculated using the meta-analysis method, and the I2 index was used to measure the heterogeneity of the studies. Results: Of 6734 studies, 30 studies with a total sample size of 37 867 were finally included based on proposed inclusion and exclusion criteria. The sample included 20641 women (55%), and 17 226 (45%) men. In the present meta-analysis study, due to significant heterogeneity (I=97.1%, p=0.001) among studies, the randomized method was used, and the total point prevalence was 4.1% (CI: 3.1% 5.5%). The overall point prevalence of major depressive disorder was 4.8% (CI: 3.6% -5.6%) in women and 2.3% (CI: 1.6% -3.6%)in men, which indicated that the incidence of this disorder was 1.95 times more in women than in men. Conclusion: This meta-analysis study found a considerable prevalence of major depressive disorder among Iranian participants and revealed that the point prevalence of the disease was more than two-fold in women compared to men. Considering these findings and the high burden of this disorder for communities, the need to formulate and implement prevention and treatment programs is highly required.

Evaluation of Timeliness, Simplicity, Acceptability, and Flexibility in Child Mortality Surveillance System for Children Aged 1-59 Months in Iran

Background:

Child mortality surveillance system (CMSS) for children aged 1–59 months is a critical issue in the prevention of mortality. This surveillance system like other health programs needs to be evaluated. Therefore, this study aims to evaluate CMSS in Iran.

Methods:

This evaluation was performed from March 2015 to March 2016 based on selected criteria for assessing the public health surveillance system proposed by the Centers for Disease Control and Prevention. Selected criteria examined in this study included timeliness, simplicity, acceptability, and flexibility. These criteria were evaluated in two ways. First, it included the use of a researcher-made questionnaire. The questionnaires were completed by 100 experts on CMSS. Second, to perform a more exact evaluation of these criteria, 24 of these experts were selected for the focus group.

Results:

In this study, the response rate was 91% (42% hospital-based and 49% primary care-based). In the timeliness section, 49% of the experts believed that approvals of the child mortality committees have not been sent within the designated time frame; hardware, software, and questionnaires were reported as effective factors in this respect. The structural and administrative problems were effective in simplicity domain and the experts of mortality registration and mood of relatives were effective in acceptability domain. The flexibility of the system was high and appropriate.

Conclusions:

The findings of the present study reveal that CMSS has some limitations and problems in the timeliness, simplicity, and acceptability criteria, which can be resolved. But this program has an appropriate situation in terms of flexibility.

Burden experienced by caregivers of schizophrenia patients and its related factors

Background: Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family.

Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers, selected from the outpatient department of a psychiatric hospital in Tehran, Iran, using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Spearman correlation coefficient and linear regression method. Data were analyzed using SPSS software (Version 21) and significance level was set at p< 0.05.

Results: The level of burden experienced by most of primary caregivers was higher than moderate. The scores obtained in the subscales of emotional over involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers, respectively, and the scores had a significant direct correlation with the burden experienced by the caregivers. The findings of multiple linear regression showed that lower family income (β= -0.33, p< 0.001), higher duration of disorder (β= 0.19, p= 0.006), and younger age at onset of the disorder (β= -0.26, p= 0.001) were predictive of higher burden of disease on caregivers.

Conclusion: Based on the results, some demographic factors of the primary caregivers, patients, and their family significantly affected the burden experienced by the primary caregivers. Most of the caregivers had high expressed emotions and a significant direct association existed between the expressed emotions and the burden experienced.

Attitudes and Performance of Cardiologists Toward Sexual Issues in Cardiovascular Patients

Introduction

The aim of the present study was to evaluate the attitudes and performance of cardiologists regarding sexual issues in patients with cardiovascular diseases.

Methods

A nationwide survey was conducted in a sample of cardiologists, representative of Iranian cardiologists, in 2015.

Main Outcome Measures

Appropriate questionnaires were developed and used to ask participants about their attitudes, performance, and barriers regarding discussing sexual issues with patients with cardiovascular disease.

Results

The study population consisted of 202 cardiologists (138 men and 63 women) with a mean age of 44.25 years (SD = 8.45). Overall, 93.15% of cardiologists agreed with the importance of discussing sexual issues with their patients with cardiovascular diseases. Almost 76.7% of cardiologists agreed they had a responsibility to deal with patients' sexual problems, and 79.9% of them were aware of the association of cardiovascular disease with sexual problems of cardiac patients, but only 33% of them were confident in their knowledge and skills in this regard. Only 10.6% of cardiologists reported they frequently or always assessed sexual problems with their patients, but 51.50% of them stated they were responding to patients' questions about sexual problems. There was a significant association between performance and responsibility.

Conclusion

The results of this study indicate a gap between cardiologist's attitudes and their actual performance and that their professional responsibility to address patients' sexual issues is a significant parameter for better performance.

Obstructive sleep apnea syndrome and non-arteritic anterior ischemic optic neuropathy: a case control study

BACKGROUND

Sleep apnea is temporary cessation or absence of breathing during sleep. Significant increase in blood pressure is clinically seen in apneic episodes. The aim of this study was to examine sleep apnea syndrome as a risk factor for non- arthritic anterior ischemic optic neuropathy (NAION) in a case control study.

METHODS

Nineteen NAION patients (9 men and 10 women) and 31 age and sex matched control participants (18 men and 13 women) were evaluated for obstructive sleep apnea syndrome (OSAS). Full night polysomnography was performed and proportion of OSAS was compared between the NAION patients and the control group. Other risk factors for NAION such as hypertension, diabetes, hyperlipidemia, ischemic heart disease and tobacco consumption were also evaluated. Chi square test and independent samples t-test were used for statistical analysis.

RESULTS

OF the 19 NAION patients, 18 (95%) had OSAS, and of the control group 13 (41.9%) had OSAS. The frequency of OSAS was significantly higher among NAION patients compared to the controls (p< 0.001). The Mean Respiratory Disturbance Index (RDI) was 37.65/h SD= 37.61/h in NAION patients and it was 15.05/h SD= 11.97/h (p= 0.018) in controls. The frequency of diabetes and hypertension was significantly higher in the NAION patients than in controls.

CONCLUSION

based on the results of this study, it seems that there is an association between NAION and OSAS.

National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran: 1990 - 2013, study protocol

BACKGROUND

The measurement of population-based dimensions of mental disorders and their effects on the population health is one of the major public health concerns.  There is some evidence on the trend and point estimations of mental disease and substance abuse for many specific groups of Iranian population but there is a progressive requirement to documents on their exposure distribution at sub-national level, information about their trends, and their effects on the population health. 

METHODS

The present protocol is aimed to provide the standards of data collection and methodology processes for estimating the trends of selected mental disorders and their attributed burden at national and sub-national levels. For nine categories of mental disorders, we will estimate 1990 to 2013 trends of prevalence, Years of Life Lost due to premature mortality (YLLs), and Years Lived with Disability (YLDs) and Disability-Adjusted Life Years DALYs by sex, age group, and province. We will also quantify the uncertainty intervals for the estimates of interest.

CONCLUSION

The study of National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran provides valuable convincing evidences for policy makers and other stakeholders for more evidence-based priority setting, resource allocation, interventions, service providing, and evaluation at both national and sub-national levels. The results also could be used for future complementary global, regional, national, and sub national studies.

A Multi-Center Randomized Controlled Trial of Adding Brief Skill-Based Psychoeducation to Primary Needle and Syringe Programs to prevent Human Immunodeficiency Virus: Study Protocol

OBJECTIVES

Our objective was to design an RCT in order to assess the effects of adding a brief skill-based psychoeducation (PE) to routine Needle and Syringe Programs to reduce injection and high risk sexual behaviors associated with Human Immunodeficiency Virus (HIV) infection among referrals of Drop-in Centers (DICs).

METHOD/DESIGN

This was a randomized control trial with the primary hypothesis that adding skill-based PE to the routine needle syringe program (NSP) provided in the DICs would be more effective in reducing injection and high risk sexual behaviors associated with HIV infection compared to the routine programs. We intended to randomly allocate 60 patients per group after obtaining informed written consent,. The intervention group receive a combination of brief psychoeducation consisting two individual sessions of skill-based education concerning blood borne viral infection, specifically HIV. The control group received the routine primary NSP services provided in DIC. Study assessments were undertaken by a psychologist at baseline, 1 and 3 months after recruitment. The primary outcome measure was the comparison of the trend of alterations in high risk sexual and injection behaviors associated with HIV infection during 3 months after the initiation of the intervention between the two groups. Secondary outcome measures included the comparison of HIV/AIDS related knowledge and client satisfaction in the participants.

DISCUSSION

This paper presents a protocol for an RCT of brief skill-based PE by a trained psychologist to reduce the sexual and injection related high risk behaviors among drug users who received primary NSP services in DIC. This trial tried to investigate the efficacy of the intervention on increasing HIV/AIDS related knowledge and client satisfaction. The results of different indicators of high risk behaviors will be discussed.

Correlates of mental health service utilization in married women in tehran 2011

OBJECTIVE

There are disparities in mental health services (MHS) utilization within and between populations and several factors are studied as its potential correlates. Identifying those correlates would help health policy makers to adjust service provision with characteristics of their community. To evaluate demographic, socioeconomic and system correlates of MHS utilization among married women from Tehran, Iran.

METHODS

A household survey of 615 married women residents of 22 municipal districts of Tehran selected via a cluster sampling method. All subjects were asked about health services utilization during last one and 12 months as well as need and access for MHS, demographic and socioeconomic factors. Independent correlates of MHS use were determined with logistic regression analysis.

RESULTS

Total 615 women, mean±SE age and duration of marital life of 42.6±0.9 and 22±0.8 years, respectively were selected, rate of MHS utilization during last one and 12 months were 5.2% and 10.1% respectively. 23.6% of women reported having mental illness and 19.3% and 17.9% had need for MHS and access to outpatient health services, respectively. Logistic regression models showed that need for MHS (OR:5.25, 95%CI:2.7-10.1), access to outpatient services (OR:2.17, 95%CI:1.04-4.52), smoking (OR:3.4, 95%CI:1.16-10.2) and crowding index (OR:0.69, 95%CI:0.48-0.99).

CONCLUSIONS

Rate of MHS utilization in women are low considering the near to estimated rate of perceived illness. Bridging the gap between perceived illness and need for services, then providing better access to services in areas with higher crowding index and higher rates of smoking in residents should considered in any mental health promotion programs.

DECLARATION OF INTEREST

None.

Silicosis among Stone- Cutter Workers: A Cross-Sectional Study

BACKGROUND

Production process of most factory-made products is harmful to our health and environment. Silica is the most important stone used in stone cutting factories. Numerous researches have reported respiratory diseases due to the inhalation of these particles in various occupations. Silicosis is a disease with typical radiographic pattern caused as the result of inhalation of silica particles. According to the intensity of exposures and onset of initiation of clinical symptoms silicosis is classified into three groups of acute, chronic and accelerated forms. The present study evaluated silicosis among stone cutter workers.

MATERIALS AND METHODS

This cross sectional study was performed on stone cutter workers in Malayer city (Azandarian) between 2008 and 2009. Respiratory data of our study participants were collected with a respiratory questionnaire and performing spirometry tests and chest radiography.

RESULTS

Among our participants, 16 silicosis cases were diagnosed by radiographic changes. Among them, 10 workers had exposure for more than three years and 6 workers were smokers. Eleven workers had an abnormal radiographic pattern on their chest x-rays. Seven workers had obstructive and 4 workers had restrictive spirometric patterns.

CONCLUSION

Prevalence of silicosis was high among our understudy workers and preventive strategies are required to control it.

Advanced paternal age is a risk factor for schizophrenia in Iranians

BACKGROUND

Since 1958 many, but not all studies have demonstrated that paternal age is a risk factor for schizophrenia. There may be many different explanations for differences between studies, including study design, sample size, collection criteria, heterogeneity and the confounding effects of environmental factors that can for example perturb epigenetic programming and lead to an increase in disease risk. The small number of children in Western families makes risk comparisons between siblings born at different paternal ages difficult. In contrast, more Eastern families have children both at early and later periods of life. In the present study, a cross-sectional population study in an Iranian population was performed to compare frequency of schizophrenia in younger offspring (that is, older paternal age) versus older offspring.

METHODS

A total of 220 patients with the diagnosis of schizophrenia (cases) from both psychiatric hospitals and private clinics and 220 individuals from other hospital wards (controls), matched for sex and age were recruited for this study. Patients with neurological problem, substance abuse, mental retardation and mood disorder were excluded from both groups.

RESULTS

Birth rank comparisons revealed that 35% vs 24% of the cases vs the controls were in the third or upper birth rank (P = 0.01). Also, the mean age of fathers at birth in case group (30 ± 6.26 years) was significantly more than the control group (26.45 ± 5.64 years; P = 0.0001). The age of 76 fathers at birth in case group was over 32 versus 33 fathers in control group. Individuals whose fathers' age was more than 32 (at birth) were at higher risk (2.77 times) for schizophrenia versus others (P < 0.0001, 95% CI 1.80 to 4.27). The maternal age at parturition of the case versus controls groups was 26.1 ± 5.41 vs 25.07 ± 4.47 (P = 0.02). Logistic regression analysis suggests that maternal age is less likely to be involved in the higher risk of schizophrenia than advanced parental age.

DISCUSSION

This study demonstrates a relationship between paternal age and schizophrenia in large families of an Iranian population. Arguments have been put forth that DNA bases changes or epigenetic changes in sperm account for the increased risk associated with older fathers. However, it would not be surprising that both de novo germline mutations and epigenetic changes contribute to disease occurrence because DNA replication and DNA methylation are closely linked at both the macromolecular level (that is, methylation closely follows replication), and at the metabolic level (both processes require folate), and susceptible to modulation by the environment. Further research on samples such as those collected here are needed to sort out the contributions of de novo mutations versus epigenetic changes to schizophrenia.

Prevalence of Parasomnia in School aged Children in Tehran

OBJECTIVES

Parasomnias can create sleep disruption; in this article we assessed parasomnias in school-aged children in Tehran.

METHODS

In spring 2005, a total of 6000 sleep questionnaires were distributed to school-aged children in 5 districts of Tehran (Iran). A modified Pediatrics sleep questionnaire with 34 questions was used.

RESULTS

Parasomnias varied from 0.5% to 5.7% among the subjects as follows: 2.7% sleep talking, 0.5% sleepwalking, 5.7% bruxism, 2.3% enuresis, and nightmare 4%. A group of children showed parasomnias occasionally- this was 13.1% for sleep talking, 1.4% for sleepwalking, 10.6% for bruxism, 3.1% for enuresis and 18.4% for nightmares.

CONCLUSION

A high proportion of children starting school suffer from sleep problems. In many cases this is a temporary, developmentally related phenomenon, but in 6% of the children the disorder is more serious and may be connected with various stress factors and further behavioral disturbances.

Clinical and course indicators of bipolar disorder type I with and without opioid dependence

BACKGROUND

The existing evidence about the clinical situations of the bipolar patients with opioid dependence is scarce. The present study was carried out to compare the clinical features and course of the bipolar disorder type I regarding the two subgroups of opioid dependent and non-dependent.

METHODS

There were 178 adult patients with bipolar disorder type I consecutively referred to the Iran Hospital of Psychiatry, Tehran, Iran, from January 2008 to January 2009 who enrolled in the study. The Persian Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), HDRS-17, and Y-MRS were administered for all patients. Other clinical information was gathered through the face-to-face interviews with the probands and the hospital records. The T test, Chi square test and logistic regression were used to analyze the data.

RESULTS

The mean age of probands were 33.6 ± 11.1 years old and they were mostly male. Among the evaluated indices, the factors gender, anxiety disorders comorbidity, non-adherence, and positive family history were different significantly and independently from the other studied factors between opioid dependent and non-dependent bipolar patients.

CONCLUSIONS

Despite some differences, the opioid dependent and non-dependent bipolar patients did not have any significant difference regarding most of the examined clinical and course indices.