Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019.

BACKGROUND: Tuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relationship with the human development index (HDI). METHODS: The present study is an ecological study aiming at investigating the incidence and mortality of tuberculosis in Iran during the years 2010 to 2019. The related data were extracted from the Global Burden of Disease (GBD) website. The spatial pattern attributed to tuberculosis in the provinces of Iran was analyzed using ArcGIS software. In this study, the two-variable correlation method was used to analyze the data extracted to study the correlation between Tuberculosis and HDI. RESULT: Based on the results recorded in GBD, the incidence of tuberculosis in 2010, that is, 14.61 (12.72, 16.74), declined compared to 2019, namely 12.29 (10.71, 14.09). The age-standardized mortality rate which was 1.63 (1.52, 1.73) in 2010, has decreased compared to 2019: 1.17 (1.07, 1.32). The incidence and mortality rates of tuberculosis in Iran in all age groups have decreased in 2019 compared to 2010. The highest incidence and mortality among tuberculosis patients were recorded in Sistan and Baluchistan and Golestan provinces. The results indicated that there was a negative and significant correlation between the mortality rate of tuberculosis and the human development index in 2010 (r = -0.509, P-value = 0.003) and 2019 (r = -0.36, P-value = 0.001); however, this correlation between incidence and human development index was not significant (p > 0.05). CONCLUSION: Since mortality is mostly observed in areas with low HDI, health system policymakers must pay more attention to these areas in order to improve care and perform screenings to diagnose and treat patients thus reducing the mortality rate of tuberculosis and preventing an increase in its incidence in Iran.

Burden of prostate cancer and relationship with the human development index (HDI) in Asia: A study of Global Burden disease in 2019.

Background: Prostate cancer (PC) ranks as the second most commonly diagnosed neoplasia and the fifth cause of death in men with cancer, with an increasing trend in incidence. Methods: All accessible data sources from the 2019 Global Burden of Disease study were used to estimate the prevalence, mortality and disability-adjusted life years (DALY) and burden prostate cancer in Asia from 1990 to 2019. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs) and DALYs. All estimates were presented as counts and age-standardized rates per 100 000 population, with uncertainty intervals (UIs). Concentration Index analysis and Concentration Curve were used to determine the relationship between Prostate cancer burden and human development index. Results: The results showed that the percentage of changes in the incidence in 1990-2019 was positive in all countries of the Asian continent except for Afghanistan and Kyrgyzstan. The results of the concentration index showed that the incidence and mortality of prostate cancer is more concentrated in countries with a high HDI level. Examining the DALY, YLL and YLD index also showed the value of concentration index, which shows that DALY, YLL and YLD of prostate cancer are more concentrated in countries with high HDI level. Conclusion: Given that burden of prostate cancer are increasing in most Asian countries and are mostly concentrated in the HDI drawers, obtaining accurate estimates in these countries to prepare for the potential change in public health burden due to this disease which is very important.

A population-based and symptom-based COVID-19 prevalence survey.

The current study aimed to determine the community-based COVID-19 prevalence and compare the symptom-based and test-based prevalence rates in the Omicron peak (February 20 to March 20, 2022) to assess community involvement and provide effective healthcare. This cross-sectional and population-based study examined the prevalence of COVID-19 from February 20 to March 20, 2022, in the city of Khomein in Markazi Province (located in central Iran) through random cluster sampling. The period prevalence of recurrent Omicron symptoms was 37.69%. Factors such as residence in urban areas (OR = 1.25, 95% CI: 0.95-1.66), number of COVID-19 vaccine doses (OR = 0.80, 95% CI: 0.67-0.95), the interval of last vaccination dose (OR = 1.04, 95% CI: 0.97-1.11) and a history of COVID-19 (OR =1.20, 95% CI: 1.04-1.39) were among the most important risk factors for Omicron. Ongoing efforts to vaccinate high-risk populations as well as stronger actions to diminish the Omicron consequences are fundamental obligations of the health system.

Opium Use and the Risk of Liver Cancer: A Case-Control Study.

Limited evidence is available to acknowledge the association between opium use and liver cancer. In a case-control study, we recruited 117 cases of primary liver cancer (PLC) and 234 age and sex-matched neighborhood controls from 2016 to 2018. We calculated odds ratios (OR) for opium use and 95% confidence intervals (95% CI), using conditional logistic regressions. Compared with non-users the adjusted OR (AOR, 95% CI) for opium use was 6.5 (95% CI, 2.87-13.44). Compared with people who had no history of use, a strong dose-response effect of opium use was observed by amount of use (AOR, 10.70; 95% CI, 3.92-28.70). Cumulative use of opium also indicated that using over 30 gr-year could increase the PLC risk dramatically (AOR, 11.0; 95% CI, 3.83-31.58). Those who used opium for more than 21 years were highly at risk of PLC (AOR, 11.66; 95% CI, 4.43-30.67). The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking). PREVENTION RELEVANCE: The results of this study indicate that opium use dramatically increased the risk of liver cancer. Because opioids are increasing for medical and non-medical use globally; accordingly, severe health consequences such as liver cancer have to be investigated widely.

The Incidence and Geographical Distribution of Brucellosis in Iran Using Geographic Information System and Prediction of its Incidence in 2021.

BACKGROUND: Brucellosis is one of the most challenging health issues in many developing countries including Iran. The purpose of this study is to investigate the incidence and geographical distribution of brucellosis using Geographic Information System (GIS) and to predict its incidence in Iran in 2021. METHOD: This is a descriptive-analytical cross-sectional study, which contains spatial and climatic information along with the prevalence rate of brucellosis in Iran. Disease information was obtained from the National Center for Infectious Diseases Management during 2011-2015. Then, Arc GIS version 9.3 was used to plot the geographical maps for the incidence and frequency of the disease. Using the Raster calculator tool, the disease prediction map for the future was plotted. For proper spatial distribution of hot and cold spots, Getis-Ord-Gi statistic was employed. FINDINGS: The highest incidence of brucellosis during 2009-2015 was observed in the western provinces of Iran (North Khorasan, South Khorasan and Razavi Khorasan provinces). The incidence of brucellosis in Iran decreased from 2009 to 2011 but it exhibited an increasing trend from 2011 to 2014. The provinces of Kurdistan, Lorestan, Ilam, Zanjan and Kermanshah may be among the hot spots in terms of brucellosis incidence in 2021. CONCLUSION: We predicted significant variations in brucellosis risk distribution in Iran in the coming years. In the western and northwestern provinces, which are among the high risk areas for the incidence of this disease in the future, this disease can pose a serious health threat to the residents of these areas.

Epidemiology incidence and geographical distribution of Pertussis using GIS and its incidence prediction in Iran in 2021.

Background: Pertussis is a respiratory tract infection caused by Bordetella pertussis, which causes inflammation of the lungs and respiratory tract. The purpose of this study was to investigate the incidence and geographical distribution of pertussis using the geographic information system (GIS) and to predict its incidence in Iran in 2021. Methods: This was a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, the ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, the disease prediction map was drawn. using the Raster Calculator tool. Results: The results showed that the highest incidence of pertussis during 2009-2015 was in Zanjan, Qom, Mazandaran, and Qazvin provinces. The incidence of pertussis in Iran increased from 0.74 in 2009 to 1.53 in 2015. Based on the modeling results for Iran, Qom, Mazandaran, Tehran, Qazvin, and Zanjan provinces, with 76.76%, 73.69%, 66.32%, 30.94% and 24.18% of their areas (Km2), are at high risk for pertussis in the coming years, respectively. Conclusion: The incidence of the disease has been increasing in recent years, indicating the emergence of the disease in Iran. The modeling maps show that the Iranian provinces of Qom, Tehran, Zanjan, and Qazvin are at risk of the disease incidence in the coming years, indicating the need for planning, appropriate interventions and more precise implementation of the vaccination program against the disease.

Epidemiology incidence and geographical distribution of leptospirosis using GIS and its incidence prediction in Iran in 2021.

Background: Leptospirosis is known as a public health problem in developing and developed countries. The aim of this study was to investigate the incidence and geographical distribution of leptospirosis using the Geographic Information System (GIS) and to predict its incidence in Iran in 2021. Methods: This was a descriptive analytical study. Information on leptospirosis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, The ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn. Results: The results showed that the highest incidence of leptospirosis during 2009-2015 was observed in Gilan, Mazandaran, and Golestan provinces, respectively. The incidence of the disease had an increasing trend from 2013 to 2015. Based on the results of the modeling in Iran, the provinces of Gilan, Mazandaran, and Golestan, with 72.18%, 8.54%, and 4.95% of their area, respectively, have the largest areas at a high-risk for leptospirosis in the coming years. Conclusion: The prevalence of leptospirosis is affected by geographical and climatic conditions of every region; thus, the incidence of the disease is higher in the provinces located at the Caspian coastal side and in some regions in Semnan province. Hence, if health authorities pay more attention to developing health plans to prevent the disease, the risk of disease in these areas will be reduced in the future.

Epidemiology incidence and geographical distribution of Meningitis using GIS and its incidence prediction in Iran in 2021.

Background: Meningitis is classified as a medical emergency where the identification and early treatment of bacterial meningitis can eliminate serious consequences, such as hearing loss, memory problems, learning disabilities, brain damage, seizures, and death. The purpose of this study was to investigate the incidence and geographical distribution of meningitis using Geographic Information system (GIS) and to predict its incidence in Iran in 2021. Methods: This was a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Then, the disease prediction map was drawn using the Raster Calculator tool. Results: The results showed that the highest incidence of meningitis during 2010-2015 was in Qazvin, Qom, and Kurdistan provinces. The incidence of meningitis in Iran increased from 9.77 in 2010 to 10.33 in 2015. Based on the modeling results for Iran, Qom, Qazvin, Kurdistan, Hamadan, and Mazandaran provinces with 78.89%, 74.68%, 70.07%, 43.97%, and 22.93% of their areas (Km2) are at high risk for meningitis in the coming years, respectively. Conclusion: According to the results of this study, it can be concluded that Qom, Qazvin, Kurdistan, Hamedan, and Mazandaran provinces are at risk of the disease. Monitoring vaccination in high-risk groups can partially prevent the incidence of the disease in these areas.

Maternal risk factors for low birth weight infants: A nested case-control study of rural areas in Kurdistan (western of Iran).

Infant mortality is among the most important indicators of health and development in global communities. One of the causes of neonatal mortality is low birth weight. This study aims at evaluating the risk factors for LBW in infants. This study was carried out using a nested case-control study in rural areas of Kurdistan province in Western Iran in 2015. The selection of case and control groups was based on the nesting using the risk set sampling approach. In total, 182 and 364 subjects were selected for the case group and the control group respectively. Data analysis was performed using the Stata-12 software with the point and spatial estimation of OR using the conditional logistic regression method. The multivariate logistic regression analysis performed shows that the maternal gestational age, the mother's health history during pregnancy, any medication abuses by the mother, any mental stress during pregnancy, are LBW risk factors (P < 0.05). Prevention of LBW is possible by identifying effective factors and performing appropriate interventions in infants with low birth weight.

Opium use as an independent risk factor for pancreatic cancer: A case-control study.

BACKGROUND: Pancreatic cancer (PC) is ranked as the seventh leading cause of cancer deaths worldwide. The current study was conducted to explore the correlation between the use of opium and its derivatives (opium) and PC in Iran. METHODS: In this case-control study which was conducted in Kerman province, south east part of Iran; 176 patients with PC, and 352 healthy individuals as the control group were matched in terms of age, sex, and place of residence. A structured questionnaire including questions of opium usage, alcohol usage, cigarette smoking, and diet was used to collect the data. The relation between the use of opium and PC was adjusted for tobacco smoking, education, daily intake of fruit, vegetables, red meat, and hydrogenated fats and analyzed using the conditional logistic regression. RESULTS: There was a positive relationship between the opium use and the increased risk of PC (Adjusted Odds Ratio (AOR) = 4.33, 95 % CI: 2.09-8.95), which was even stronger than its association with cigarette smoking (AOR = 1.67, 95 % CI: 0.86-3.24), although their difference was not statistically significant. A significant dose-response relation was detected between the use of opium; as the relation was stronger in heavy users (AOR low users = 4.93, 95 % CI: 1.79-13.54 and AOR heavy users = 5.10, 95 % CI: 2.10-12.35). Moreover, PC was higher among participants starting the use of opium at a younger age than those who started opium at an older age (AOR = 8.03, 95 % CI: 3.19-20.23). CONCLUSION: This study demonstrated that opium use is associated with a high and strong risk of PC as an independent risk factor. Further studies should be done to reduce the use of opium in Iran and other world countries.

Geographical distribution of Typhoid using Geographic Information System (GIS) during 2009-2014 in Iran.

Background: Salmonella induced infections remain one of the most important health problems worldwide. The purpose of this study is to investigate the incidence and geographical distribution of typhoid using GIS and to predict its incidence in Iran in 2021. Methods: This study is a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency Therefore, using the Raster Calculator tool, the disease prediction map was drawn. Results: The results showed that the highest incidence of typhoid during 2009-2014 was in Kermanshah, Lorestan, Hamadan, Kurdistan, and Ilam provinces. The incidence of typhoid in Iran increased during 2009-2010. The annual incidence of typhoid decreased from 0.85 per 100,000 in 2010 to 0.5 in 2014. Based on the modeling results for Iran, Kermanshah, Lorestan, Kurdistan, Ilam and Hamadan provinces with 92.17%, 46.56%, 31.74%, 25.62% and 22.96% of their areas (Km2) are at high risk for typhoid in the coming years, respectively. Conclusion: Considering that the provinces of Kermanshah, Lorestan, Kurdistan, Ilam, and Hamadan are at risk of typhoid incidence in the coming years in Iran, and given that salmonella infections have a direct relationship with the individual's health status and individual's environmental health and socioeconomic status, improving the health status and disease control in carriers as well as improving the socio-economic status of the population living in these areas can prevent the disease in the years to come.

Geographical distribution of Anthrax using Geographic Information System (GIS) during 2010-2015 in Iran.

Background: Anthrax is a zoonotic infectious disease that is still considered as a health problem in developing countries. Therefore, the aim of this study was to investigate the incidence and geographical distribution of anthrax using the Geographic Information System (GIS) and predict its incidence in Iran in 2021. Methods: This study is descriptive analytical study. Information on anthrax was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn. Results: The highest incidence of anthrax during 2010-2015 was observed in the provinces of Kurdistan, North Khorasan, and Chaharmahal and Bakhtiari, respectively. The trend of the incidence of anthrax in Iran had increased from 2010 to 2013, while its incidence decreased in 2014. Based on the results of modeling in Iran, the provinces of Kurdistan, West Azarbaijan, Tehran, and Zanjan, respectively, with 37.16%, 33.83%, 16.78%, and 10.49% of their area (km2) had the highest risk of anthrax disease in the country in the year 2021. Conclusion: Since the provinces of Kurdistan, West Azerbaijan, Tehran, and Zanjan are among the high-risk areas in the country in the coming years, the cooperation between the veterinary organization and the health care system and the vaccination of livestock in these areas can significantly help to control and prevent the disease.

Worldwide incidence and mortality of ovarian cancer and Human Development Index (HDI): GLOBOCAN sources and methods 2018.

OBJECTIVE: Ovarian cancer is known as the seventh most common cancer among women, accounting for about 4% of all cancers associated with the females. METHOD: This is a descriptive cross-sectional study based on cancer incidence data and cancer mortality rates from the Global Cancer Data in 2018. The incidence and mortality rates were estimated and ovarian cancer distribution maps for world countries were drawn. To analyze data, correlation and regression tests were used to evaluate association between its incidence and mortality with human development index (HDI). RESULTS: Results revealed a direct and significant correlation between ovarian cancer incidence (R = 0.409, P < 0.0001) and mortality (R = 0.193, P < 0.05) with HDI. It also projected a direct and significant correlation between incidence with Gross National Income per 1,000 capita (GNI), mean years of schooling (MYS), life expectancy at birth (LEB) and expected years of schooling (EYS) (P < 0.0001). The findings also demonstrated a direct and significant correlation between mortality and GNI, MYS, LEB as well as EYS (P < 0.05). The linear regression model showed that a higher MYS [B = 0.2, CI 95%: (-0.03, 0.5)] can significantly augment the incidence of ovarian cancer while an increased MYS [B = 0.2, CI 95% (0.03, 0.4)] can induce mortality. CONCLUSIONS: Given the direct and significant correlation between ovarian cancer incidence and mortality with HDI, attention to risk factors in these countries can be effective in curbing its incidence and mortality.

Aspects of Epidemiology, Pathology, Virology, Immunology, Transmission, Prevention, Prognosis, Diagnosis, and Treatment of COVID-19 Pandemic: A Narrative Review.

Undoubtedly, COVID-19 pandemic is one of the largest pandemics and one of the biggest international challenges for health-care system of various countries in the world. This is a narrative review study based on the studies published related with different aspects of COVID-19. The highest numbers of active cases are in the USA, Brazil, India, Russia, South Africa, as well as Colombia and the disease surveillance system must operate more quickly, timely, effectively, and sensitively in these countries. What is clear is that the SARS-CoV-2 basic reproduction number is significantly higher than one and its transmission power is extremely high. In general, it can be stated that mortality and fatality risk due to COVID-19 in men, age increase, severity of disease, systemic disease, as well as inadequate access to the sufficient health-care services will increase. There is currently no specific treatment and effective vaccine for COVID-19. The novel coronavirus pandemic is more consistent with the epidemiological triangle model, which emphasizes that the disease is the result of the interaction of three factors of host, agent, and environment. Therefore, prevention and treatment activities should focus on cutting the virus transmission chain. The main way to deal with viral epidemics is prevention. The emerging of this ruthless virus has once again reminded us that communicable diseases should never be underestimated and forgotten. Considering the rapid transmission of COVID-19, the health-care authorities and workers should consider timely detection and safeguards to prevent the transmission to healthy individuals.

Crude incidence, age-specific incidence, and standardized incidence rates of leukemia in children under 14 years of age in Iran: an updated meta-analysis.

BACKGROUND: Cancer is the second leading cause of death in children aged 0-14 years and leukemia is the most prevalent of them among children in the world and Iran. Estimating cancer incidence is a vital tool in epidemiology and subsequent cancer control programs. The aim is to evaluate the crude incidence, age-specific incidence and standardized incidence rates of leukemia in these children in Iran through a meta-analysis. METHODS: This is a systematic review and meta-analysis between 1950 and 2019. We searched national (Iran Medex, Mag Iran and Scientific Information Database) and international (Google Scholar, PubMed, Science Direct, Scopus, and the Web of Sciences) databases for this purpose. The quality of articles was evaluated using the guidelines checklist for critically appraising studies of the incidence of a health problem. After the quality assessment the random effect meta-analysis was used to estimate the incidence rates in overall and based on sex. RESULTS: A total of 382 articles were identified in the search phase and finally, 15 studies were included. The crude incidence rate in the total population using the Random effect model was estimated at 29.29 (CI %95, 25.74-32.84) per one million children aged 0-14 years. This rate was 34.72 (CI %95, 28.85-40.59) in boys and 24.89 (CI %95, 20.28-29.5) in girls. According to the results, three provinces of Fars (51.48), Golestan (40.86) and Qazvin (35.82) had the highest prevalence, respectively. CONCLUSION: Given that the incidence of leukemia in boys is higher than in girls and it is more drastic in some Iranian provinces, further attention should be dedicated to risk factors in boys and high risk locations in Iran to help prevent of incidence of this disease.

Risk Factors Associated with Low Birth Weight Among Infants: A Nested Case-Control Study in Southeastern Iran.

BACKGROUND: Mortality rate in low-birth-weight infants is almost 30 times more than that in those with normal weight, so the birth of low-birth-weight infants is one of the most serious health problems in the world. Therefore, this nested case-control study was conducted to investigate the risk factors associated with low birth weight among infants in the rural population of Kerman province. METHODS: This nested case-control study was performed in rural areas of Kerman province, southeastern Iran. Case (n = 155) and control (n = 310) groups were selected using risk set sampling. Data were analyzed through Point and distance estimation (OR, CI) using conditional logistic regression method by Stata-12 software. RESULTS: The results of multivariate analysis showed that maternal BMI [OR = 0.3, CI 95% (0.1, 0.9)], gestational age [OR = 3.8, CI 95% (0.9, 6.1)], history of stillbirth [OR = 4.8, CI 95% (1.3, 11)], history of pregnancy bleeding [OR = 3.7, CI 95% (0.7, 9)], pregnancy craving [OR = 3, CI 95% (1.1, 3.8)], and the level of health workers' care [OR = 0.4, CI 95% (0.1, 0.9)] are the risk factors affecting LBW in infants (P < 0.05). CONCLUSIONS: Low birth weight is a multifactorial phenomenon. Therefore, raising public awareness, providing nutritional counseling to pregnant mothers, regular referral to health homes to receive health care, and identifying risk factors and referral to higher level specialists and health centers can be effective in reducing the risk of birth of LBW infants.

The association between incidence and mortality of brain cancer and human development index (HDI): an ecological study.

BACKGROUND: Brain cancer is a rare and deadly malignancy with a low survival rate. The present study aims to evaluate the epidemiology of brain cancer and its relationship with the human development index (HDI) worldwide. METHODS: This is an ecological study. The data on cancer incidence and cancer mortality was extracted from the World Bank for Cancer in 2018 (GLOBOCAN 2018). The incidence, mortality rate, and brain cancer distribution maps were drawn for different countries. We used correlation and regression tests to examine the association of incidence and mortality rates of brain cancer with HDI. The statistical analysis was carried out by Stata-14 and a significance level of 0.05 was considered. RESULTS: According to the results of Global Cancer Registry in 2018, there were 18,078,957 registered cases of cancer in both sexes, of which 29,681 were related to brain cancer. The highest incidence (102,260 cases, 34.4%) and mortality (77,815 cases, 32.3%) belonged to very high HDI regions. Results showed that incidence (r = 0.690, P < 0.0001) and mortality rates (r = 0.629, P < 0.001) of brain cancer are significantly correlated with HDI. We also observed a positive correlation between brain cancer incidence and Gross National Income (GNI) (r = 0.346, P < 0.001), Mean Years of Schooling (MYS) (r = 0.64, P < 0.001), TABLE (LEB) (r = 0.66, P < 0.001) and Expected Years of Schooling (EYS) (r = 0.667, P < 0.001). Results also revealed that mortality rate was significantly correlated with GNI (r = 0.28, P < 0.01), MYS (r = 0.591, P < 0.01), LEB (r = 0.624, P < 0.01), and EYS (r = 0.605, P < 0.01). CONCLUSION: The results of the study showed that the incidence and mortality of brain cancer in countries with higher HDI levels is higher than countries with lower HDI levels, so attention to risk factors and action to reduce it in countries with higher HDI levels in controlling this cancer in this Countries are effective.

Quality of life in people with transsexuality after surgery: a systematic review and meta-analysis.

BACKGROUND: Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a systematic review and meta-analysis about the quality of life (QoL) of individuals during the post transsexual surgery period. METHODS: We searched major biomedical electronic databases, including Scopus, Google Scholar, Psychological Information Database (PsycInfo), Web of Science, PubMed, Excerpta Medica dataBASE (EMBASE), and ProQuest, for all relevant literature published in English up to December 2019. The included papers required to be cross sectional studies that reported quality of life in people with transsexuality post surgery. After selecting eligible studies, 2 authors extracted data of each study independently and resolved any inconsistency by consensus with the third reviewer. The risk of bias was assessed by 2 independent research experts by the Newcastle-Ottawa Scale (NOS). RESULTS: In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis. The pooled mean of quality of life in transsexual individuals was obtained to be 70.45 (95%CI 55.87-85.03) and 59.17 (95%CI 48.59-69.74), based on World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36), respectively. Also, the results of the subgroup analysis for the weighted mean quality of life in male to female and female to male showed that the mean quality of life in female to male was 57.54 (95%CI 42.24-72.84) and it was 62.47 (95%CI 45.94-79.00) in male to female, based on SF36 questionnaire. Moreover, the weighted mean quality of life in female to male was 69.99 (95%CI 43.76, 96.23) and it was 70.65 (95%CI 53.11, 88.19) in male to female, based on WHOQoL-BREF questionnaire. CONCLUSION: The results of this systematic review may support the approaches to transsexuality that facilitates sex reassignment. In this review, the means of quality of life after surgery were not compared to the means of quality of life before surgery or even before hormonal therapy which was due to inadequate number of primary studies.

Epidemiology of the Incidence and Mortality of Pancreas Cancer and its Relationship with the Human Development Index (HDI) in the World: An Ecological Study in 2018.

OBJECTIVE: Pancreatic cancer is one of the leading causes of mortality in developed countries and a lethal malignant neoplasm worldwide. This study aims to evaluate the epidemiology of pancreatic cancer incidence and mortality and its relationship with HDI. METHODS: This is a descriptive cross-sectional study that is based on cancer incidence data and cancer mortality rates derived from the GLOBOCAN in 2018. The incidence and mortality rates of Pancreas as well as Pancreas cancer distribution maps were derived for world countries. The data analysis was conducted using a correlation test, and regression tests were used to evaluate the correlation of the incidence and mortality of Pancreas with HDI. The statistical analysis was carried out by Stata-14, and a significance level of 0.05 was considered. RESULTS: The highest incidence of pancreatic cancer was reported in Asia with 214499 (46.7%) cases and the lowest incidence was related to Oceania with 4529 cases (0.99%). The results showed a positive and significant correlation between incidence (r = 0.764, P <0.0001) and mortality (r = 0.771, P <0.0001) of pancreatic cancer and the HDI index. The results of ANOVA revealed that the highest mean incidence was related to the very high HDI (P <0.0001) and the highest mortality was connected to the very high human development (P <0.0001). The results exhibited that incidence was positively and significantly correlated with GNI (r = 0.497, P <0.0001), MYS (r = 0.746, P <0.0001), LEB (r = 0.676, <0.0001) and EYS (r = 0.738, P <0.0001). Also, a significant positive correlation was found between mortality and GNI (r = 0.507, P <0.0001), MYS (r = 0.745, P <0.0001), LEB (r = 0.679, <0.0001), and EYS (r = 0.748, P <0.0001). CONCLUSION: Given the higher incidence and mortality of pancreatic cancer in countries with HDI, it is necessary to pay a greater attention to risk factors and appropriate planning to reduce these factors and minimize the impact and mortality rate of this disease.