Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis.

OBJECTIVES: The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms. METHODS: In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment. RESULTS: After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators' attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place. CONCLUSIONS: Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.

Sodium-glucose cotransporter 2 inhibitors: A comprehensive review from cells to bedside.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2is) are oral medications approved for type 2 diabetes mellitus. Interestingly, during recent years, they have been promisingly considered as new medications for cardiovascular and kidney diseases. However, the mechanisms underlying these new benefits are not fully understood. Thanks to the discovery of multiple modes of action, the simple picture about mechanisms of action of SGLT2is has become more and more complex. Besides their effects in diabetes, there is increasing evidence for their beneficial effects in heart failure and chronic kidney diseases. In addition, many studies have provided evidence for the fruitful effects of SGLT2is in atherosclerotic cardiovascular disease. In this study, we present mounting evidence for the complex action modes of SGLT2is and their current applications in clinical practice.

Non-alcoholic fatty liver disease and dairy products consumption: Results from FASA Persian cohort study.

Background/objectives: There are limited data on the association between dairy products consumption and nonalcoholic fatty liver disease (NAFLD). This study was conducted to evaluate the association between total intake of different dairy products and fatty liver index (FLI), a marker of subclinical fatty liver. Methods: A total of 7,540 adults were included in this population-based cohort study. Dairy products consumption was evaluated by a validated interview questionnaire for food intake frequency. The FLI was calculated using the standard formula. Liver enzyme levels, lipid profiles, glycemic profiles and demographic characteristics were recorded for all participants. Univariate and multiple logistic regression models were used to respectively assess the mean percentage difference of mean FLI and odds ratios (ORs) for subclinical NAFLD across quantiles of dairy consumption. Results: The mean age of all participants was 48.81 ± 9.631 years. FLI measurements for men and women were 26.71 ± 23.39 and 39.99 ± 26.64 respectively, which was significantly higher in women (P < 0.05). Multiple logistic regression analysis demonstrated that the amount of milk consumption was an independent preventive predictor of FLI (OR = 0.96; 95% CI: 0.94-0.99), conversely, it did not predict higher levels of liver enzymes. In term of cheese intake, participants in the third tertile of cheese intake had significantly lower FLI than lower tertiles (P = 0.01). However, there wasn't any significant association between cheese intake and the odds of FLI in the multivariate model (P > 0.05). We didn't find any significant association between yogurt consumption and NAFLD indicators (P > 0.05). Conclusion: Higher milk consumption was inversely associated with FLI. However, there wasn't any significant association between other types of dairy products and NAFLD indicators.

Geographic Distribution and Estimating the Childhood Cancer Incidence in Iran: Three-Source Capture-Recapture Analysis on National Registries Data.

Background: Cancers seldom happen in childhood age and awareness of accurate cancer incidence is essential in order to preventive programs. This study aimed to estimate the childhood cancer incidence in Iran using the three-source capture -recapture method. Methods: Total new cases of childhood cancer reported by three national data sources of MAHAK charity database, pathology reports and clinical records in Iran were enrolled in this study. The common cases among three sources were determined using data linkage method. The childhood incidence rate per 1 million populations was estimated based on three-source capture-recapture method. We used BIC, G2 and AIC statistics to select the best-fit model. Arch GIS was used to determine geographic distribution. Results: Overall, 2567 childhood cancer was included by three sources of registries. The total estimated number of childhood cancer was 5388 (95% CI: 4742.15-6228,14). The higher estimated incidence rate was Leukemia, Lymphoma by 94.91 and 24.80 per 1 million populations and the lower incidence was liver and retinoblastoma with 2.35 and 7.01 per 1 million populations. Provinces of Ardabil and Kohgiluyeh with an incidence rate of 420.01 and 404.61 per 1 million populations had a higher incidence rate and Mazandaran and Ilam with an incidence rate of 60.87 and 66.88 per 1 million populations had the lowest incidence. The overall completeness of the childhood cancer registry based on three-source was 48%. Conclusion: The low-quality childhood cancer registration system highlights the needs for urgent screening programs for early detection in the high prevalent area in Iran.

Estrogen replacement therapy: effects of starting age on final height of girls with chronic kidney disease and short stature.

INTRODUCTION: We investigated the age of starting Estrogen replacement therapy as a key parameter for reaching near normal Final Height (FH) in Chronic Kidney Disease (CKD) girls with growth retardation. METHOD: This open label, quasi-experimental designed and matched controlled clinical trial was performed on CKD girls with short stature and later onset of puberty or delayed puberty according to clinical and laboratory investigations. Participants of group 1 and 2 had been treated with Growth Hormone (GH), and Ethinyl Estradiol (EE). EE was administered from 11 and 13 yrs. old in groups 1 and 2 respectively. Group 3 was selected from patients that did not accept to start GH or EE till 15 years old. The effect of the age of starting EE on FH, GH therapy outcomes, bone density, and calcium profile were evaluated. RESULT: Overall, 16, 22, and 21 patients were analyzed in groups 1, 2, and 3 respectively. Mean Mid-Parental Height (MPH) had no significant difference between the 3 groups. GH therapy significantly enhanced mean FH in groups 1 and 2 in comparison with group 3 (ß = - 4.29, p < 0.001). Also, multivariable backward linear regression illustrated significant negative association between FH and age of starting EE (ß = 0.26, p < 0.001). Mean Para Thyroid Hormone (PTH), mean femoral and lumbar bone density were significantly enhanced after GH and EE therapy (p value: < 0.001). CONCLUSION: We recommend starting EE from 11 yrs. old in CKD short stature girls who have no clinical and laboratory sign of sexual maturity at 11 yrs. to enhance the cost effectiveness of GH therapy.

Predictors of critical COVID-19 in an Iranian population: Age and disabilities play a special role.

Background: Ever since coronavirus disease 2019 (COVID-19) has emerged as a global public health problem, risk factors for severe disease have been reported in studies from Western countries. However, apart from studies of Chinese origin, few reports are available on COVID-19 severity among the Asian population. This study investigates potential risk factors for development of critical COVID-19 in an Iranian population. Methods: In this retrospective cohort study, we included all adults with COVID-19 from 2 tertiary centers in Iran who had been diagnosed between February 20 and April 1, 2020, in either inpatient or outpatient settings. "Critical COVID-19" was proposed when a hospitalized patient was scheduled for admission to intensive care unit, assisted by mechanical ventilation, or pronounced dead. We used univariable and multivariable logistic and linear regression models to explore the potential risk factors associated with critical COVID-19, admission to hospital, and length of hospital stay. Results: Of the 590 recruited patients, 427 (72.4%) were hospitalized, 186 (31.5%) had critical COVID-19, and 107 (18.2%) died. In the multivariable regression analysis, age >60 years and physical/mental disabilities were associated with critical COVID-19 (odds ratio (OR), 2.33 and 7.03; 95% CI, 1.51-3.60 and 2.88-17.13, respectively); and history of renal, heart, or liver failure was associated with both COVID-19 hospitalization (OR, 4.13; 95% CI 1.91-8.95; p<0.001) and length of hospital stay (Beta 1.90; 95% CI, 0.76-3.04; p=0.001). Conclusion: Age >60 years and physical/mental disabilities can predict development of critical COVID-19 in the Iranian population. Also, the presence of renal, heart, or liver failure might predict both COVID-19 hospitalization and length of hospital stay.

The effectiveness of vibration therapy for muscle peak torque and postural control in individuals with anterior cruciate ligament reconstruction: a systematic review and meta-analysis of clinical trials.

OBJECTIVE: This study aimed to review and summarize the existing evidence on the effectiveness of vibration therapy (VT) in comparison with conventional rehabilitation in anterior cruciate ligament (ACL)-reconstructed patients considering muscle peak torque and postural control. METHODS: We searched available online databases for relevant studies published up to February 2020. All randomized clinical trials investigating the effect of VT on quadriceps peak torque, hamstring peak torque, and postural control (closed-eye and open-eye) were included. Overall, 13 clinical trials with a total sample size of 407 participants were included for the meta-analysis. We used the pooled mean difference with random effects model for meta-analyses. We assessed the heterogeneity of the studies using the I2 and Cochran's Q test. Meta-regression analysis was used to assess the source of heterogeneity. RESULTS: We found that VT significantly improved hamstring peak torque [weighted mean difference (WMD) 12.67, 95% CI 4.51-20.83] and quadriceps peak torque (WMD 0.11, 95% CI -0.06 to 0.29). However, subgroup analysis showed a significant increase in mentioned muscles' peak torque in studies employing interventions including both local muscle vibration (LMV) and vibration frequency higher than 100 Hz (WMD 20.84, 95% CI 11.75-29.93). With regard to postural control, we observed a significant improvement only in open-eye mediolateral postural control (WMD 0.26, 95% CI -1.26 to 1.77). CONCLUSION: This study suggests that VT, especially LMV type with vibration frequency higher than 100 Hz, can be effective in rehabilitation of ACL-reconstructed patients. Although improvement in the peak torque of hamstring and quadriceps muscles was seen, there was no significant improvement in postural control, especially closed-eye, in comparison with conventional rehabilitation. LEVEL OF EVIDENCE: 1. HIGHLIGHTS: Vibration therapy can increase hamstring peak torque in individuals with ACL reconstruction. Local muscle vibration type in comparison with whole-body vibration is recommended for ACL-reconstructed patients. Vibration frequency higher than 100 Hz is preferred in ACL-reconstructed rehabilitation.

Accuracy of oxygen saturation index in determining the severity of respiratory failure among preterm infants with respiratory distress syndrome.

BACKGROUND: To evaluate the severity of respiratory failure among newborns with respiratory distress syndrome (RDS), oxygenation index (OI) has been implemented. In the present study, we assessed the accuracy of oxygen saturation index (OSI) in determining the severity of respiratory failure. METHODS: A cross-sectional study was carried out in the NICUs of two Iranian Hospitals (Tehran, Iran) in 2018. Preterm neonates with RDS entered the study. Immediately after admission, the severity of RDS was determined based on RDS scoring system. Then, 2 CC of arterial blood was withdrawn and sent to laboratory determining blood gases. Simultaneously, the level of peripheral capillary oxygen saturation (SpO2) was read using pulse oximeter and recorded. OI and OSI were measured using the formulae. Receiver Operating Characteristic curve, Kappa agreement coefficient and accuracy, sensitivity and specificity was used to compare the OI and OSI results. RESULTS: In the study, 95 neonates were considered. Based on ROC curves, the appropriate cut off with AUC = 0.99 for severe respiratory failure was OSI >8. The sensitivity, specificity, negative predicted value, and positive predicted value for the OSI Cut off >8 were 100, 98, 0.97 and 100%, respectively. The overall accuracy and Kappa agreement between OSI and OI was 0.96 and 0.98%, respectively. CONCLUSION: Our results showed that OSI with high sensitivity, specificity values could predict the severity of respiratory failure in preterm neonates with RDS.

Serum irisin levels in metabolically healthy versus metabolically unhealthy obesity: A case-control study.

Background: Metabolically healthy obese (MHO) individuals appear to be protected or more resistant to the progression of obesity-related metabolic disorders. Hormonal regulation associated with adipose or muscular tissues such as irisin and leptin may facilitate the healthy metabolic profile of MHO cases. In this case-control study, the differences between serum level of irisin was investigated in metabolically unhealthy obese (MUO) and metabolically healthy obese (MHO) individuals. Methods: The study participants included obese individuals with metabolic syndrome (MetS) (n=51) and 2 control groups that included weight matched cases without MetS (n=51) and normal weight cases without MetS (n=51). Diagnosis of MetS was made based on the Adult Treatment Panel III (ATPIII) criteria. Serum levels of leptin and irisin were determined by enzyme-linked immune-sorbent assay (ELISA) kit. Receiver Operator Characteristic (ROC) curve, multiple linear regression, and one-way ANOVA analysis were used in SPSS 16 software. Significant level was set at 0.05. Results: Based on the statistical analysis, serum levels of irisin were 2.91±1.6, 3.14±1.4, and 4.47±3.23 (ng/mL) in MUO, MHO, and nonobese metabolically healthy participants, respectively (P = 0.001). Also, serum levels of leptin were 14.06±12.4, 11.2±9.3, and 7.09±7.1 (ng/mL) in MUO, MHO, and nonobese metabolically healthy cases, respectively (p=0.002). After adjusting for demographic variables, a significant association was found between irisin and study groups (ß = 0.77, P = 0.001), weight (ß=-0.03, p=0.014), BMI (ß=-0.11, p=0.006), TG (ß=-0.003, p=0.025), fat mass (ß=-0.04, p=0.046), and fat free mass (ß=0.08, p=0.014). Conclusion: Obese patients with/without MetS had lower level of irisin than normal weight participants.

The effects of green coffee extract supplementation on glycemic indices and lipid profile in adults: a systematic review and dose-response meta-analysis of clinical trials.

BACKGROUND: The role of coffee consumption in the risk of cardiovascular diseases has been debated for many years. The current study aimed to summarize earlier evidence on the effects of green coffee extract (GCE) supplementation on glycemic indices and lipid profile. METHODS: We searched available online databases for relevant clinical trials published up to October 2019. All clinical trials investigating the effect of GCE supplementation, compared with a control group, on fasting blood glucose (FBG), serum insulin, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were included. Overall, 14 clinical trials with a total sample size of 766 participants were included in the current meta-analysis. RESULTS: We found a significant reducing effect of GCE supplementation on FBG (weighted mean difference (WMD): -2.35, 95% CI: - 3.78, - 0.92 mg/dL, P = 0.001) and serum insulin (WMD: -0.63, 95% CI: - 1.11, - 0.15 µU/L, P = 0.01). With regard to lipid profile, we observed a significant reduction only in serum levels of TC following GCE supplementation in the overall meta-analysis (WMD: -4.51, 95% CI: - 8.39, - 0.64, P = 0.02). However, subgroup analysis showed a significant reduction in serum TG in studies enrolled both genders. Also, such a significant reduction was seen in serum levels of LDL and HDL when the analyses confined to studies with intervention duration of ≥8 weeks and those included female subjects. In the non-linear dose-response analyses, we found that the effects of chlorogenic acid (CGA) dosage, the main polyphenol in GCE, on FBG, TG and HDL were in the non-linear fashions. CONCLUSION: In conclusion, we found that GCE supplementation improved FBG and serum levels of insulin and TC. Also, there was a significant improvement in other markers of lipid profile in some subgroups of clinical trials.

The effect of green coffee extract supplementation on anthropometric measures in adults: A comprehensive systematic review and dose-response meta-analysis of randomized clinical trials.

BACKGROUND AND AIM: Two meta-analyses summarized data on the effects of green coffee extract (GCE) supplementation on anthropometric measures. However, the accuracy of those meta-analyses is uncertain due to several methodological limitations. Therefore, we aimed to conduct a comprehensive systematic review and dose-response meta-analysis to summarize all available evidence on the effects of GCE supplementation on anthropometric measures by considering the main limitations in the previous meta-analyses. METHODS: We searched available online databases for relevant publications up to January 2020, using relevant keywords. All randomized clinical trials (RCTs) investigating the effects of GCE supplementation, compared with a control group, on anthropometric measures [including body weight, body mass index (BMI), body fat percentage, waist circumference (WC) and waist-to-hip ratio (WHR)] were included. RESULTS: After identifying 1871 studies from our initial search, 15 RCTs with a total sample size of 897 participants were included in the systematic review and meta-analysis. We found a significant reducing effect of GCE supplementation on body weight (weighted mean difference (WMD): -1.23, 95 % CI: -1.64, -0.82 kg,P < 0.001), BMI (WMD: -0.48, 95 % CI: -0.78, -0.18 kg/m2, P = 0.001), and WC (WMD: -1.00, 95 % CI: -1.70, -0.29 cm, P = 0.006). No significant effect of GCE supplementation on body fat percentage and WHR was seen. In the dose-response analyses, there was no significant association between chlorogenic acid (CGA) dosage, as the main polyphenol in green coffee, and changes in anthropometric measures. CONCLUSION: We found that GCE supplementation had a beneficial effect on body weight, BMI and WC. It provides a cost-effective and safe alternative for the treatment of obesity. Additional well-designed studies are required to further confirm our findings.

Effects of zinc supplementation on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: Findings on the effects of zinc supplementation on the lipid profile in patients with type 2 diabetes mellitus (T2DM) are conflicting. The current comprehensive systematic review and meta-analysis aimed to summarize available evidence in this regard. METHODS AND RESULTS: After a systematic search in the online databases, we included the randomized controlled trials (RCTs) investigating the effect of zinc supplementation on lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)] in patients with T2DM. Altogether, 9 studies with a total sample size of 424 patients with T2DM were included in the analysis. Combining 9 effect sizes from 9 RCTs, we found a significant lowering effect of zinc supplementation on serum levels of TG (weighted mean difference (WMD): -17.08, 95% CI: -30.59, -3.58 mg/dL, P = 0.01) and TC (WMD: -26.16, 95% CI: -49.69, -2.62 mg/dL, P = 0.02). Although the overall effect of zinc supplementation on LDL-C levels was not significant, a beneficial effect was seen in studies that administered <100 mg/d zinc. Based on the non-linear dose-response analysis, a greater reduction in serum levels of TC and LDL-C following zinc supplementation was seen at <12 weeks' duration of intervention. Unlike the overall effect size, we found a significant increasing effect of zinc supplementation on serum HDL-C concentrations in most subgroups of RCTs according to the subgroup analyses. CONCLUSION: We found that zinc supplementation may beneficially influence lipid profile in patients with T2DM.

The Prevalence and Incidence of Hemolytic Uremic Syndrome in Iran, a Systematic Review and Meta-analysis.

HUS is a leading cause of AKI in infants. Though new classification of HUS is based on underlying disease, it traditionally defines as diarrhea positive (typical) and negative (atypical). We have no figure of the incidence and prevalence of HUS, the underlying disease and the outcome in Iranian patients. This meta-analysis of Iranian studies deals with this matter. We used relevant medical search engines and national databases from 1985 to 2019. We searched manually to detect admissible cross references. All studies assessed for the aspects and the risk of distort by three appraisers. Metaprop package of STAT applied to calculate point prevalence, proportion, and incidence with 95% confidence intervals. A total of 27 articles and one abstract of congress containing 7084 cases met all the inclusion criteria and qualified for the final analysis. Considering 1397 patients with HUS over 33 years of study, the pooled prevalence was 28% (95% CI: 15 to 44) and 18.38 pmp (0.55 pmp/y). In children less than 15 years, the prevalence was 79.82 pmp (2.41 pmp/y). Between 1985 and 2019, atypical HUS was identified in 488 patients with the prevalence of 27.88 pmp (annual prevalence of 0.84 pmp/y of children aged less than 15 years old). The incidence was 9.4 pmp (0.28 pmp/y), contributed to 9.9% (95% CI: 3 to 20) of AKI, and 5.48% (95% CI: 3.5 to 7.9) of CKD and ESRD. The rate of HUS diagnosis was increasing during the previous four decades. HUS consists of a significant number of AKI and ESRD. It needs further prospective longitudinal study.

Prevalence of Hookah Smoking among University Students in Iran: A Meta-Analysis of Observational Studies.

BACKGROUND: The rise in popularity of waterpipe smoking among younger people cause increase its deleterious effects on health in recent years. The aim of this study was to estimate the pooled prevalence of water-pipe smoking in university students in Iran. METHODS: We performed the literature search from 1946 to January 21, 2019, in several international and national databases such as Medline/PubMed, Web of Science, Scopus, Google Scholar, Magiran, Iranmedex, and IranPsych. To investigate the between-study heterogeneity we used the chi-squared test and I2 index. We used a random-effects model to estimate the pooled prevalence of water-pipe smoking. The potential source of heterogeneity was assessed by subgroup analysis and meta-regression. RESULTS: According to the eligibility criteria, we included 37 relevant studies in our meta-analysis. The pooled prevalence of lifetime water-pipe smoking was 25% (95% CI: 22-29) and in male and female subgroups was 37% (95%CI: 30-45), 17% (95%CI: 15-19) respectively. The pooled prevalence of water-pipe smoking in last year was 21% (95%CI: 16-25) and in last month was 8% (95%CI: 5-11). Results of meta-regression analysis showed that there was not any significant association between suspected variables and the prevalence of water-pipe smoking. CONCLUSION: The higher prevalence rate of water pipe smoking among university students indicates the emergency need for planning preventive program.

Survival rates of patients with breast cancer in countries in the Eastern Mediterranean Region: a systematic review and meta-analysis.

BACKGROUND: Breast cancer is the fourth leading cause of death and disability in the Eastern Mediterranean Region (EMR); although the incidence is lower than in the developed regions, there has been an increasing trend in recent decades. AIMS: Our aim was to calculate the pooled survival rate of patients with breast cancer in the EMR. METHODS: We searched electronic databases from 1946 to 19 January 2018, without language restrictions. We used a random effect model to estimate pooled 1-, 3-, 5- and 10-year survival rates for patients with breast cancer. Chi-squared and I² index were used to assess between-study heterogeneity. Subgroup analysis and meta-regression were used to investigate the potential source of heterogeneity. RESULTS: We found 80 articles eligible for inclusion in our review. The pooled 1-, 3-, 5- and 10-year survival rates in women with breast cancer in the EMR were 0.95, 0.80, 0.71, and 0.56, respectively. The I² index indicated considerable between-study heterogeneity (all I² > 50%). The 5-year survival rate in the male subgroup was 0.63. The 5-year survival rate of women with breast cancer in age groups ≤ 39, 40-64, and 65+ years were 0.74, 0.76 and 0.58, respectively. There was a statistically significant association between the Human Development Index (ß = 9, P = 0.01) and decade of study (ß = 8.2, P = 0.04) and 5-year survival rate. CONCLUSIONS: The survival rate of women with breast cancer in those countries in the EMR which have better health care systems improved in the past decade; women aged 40-64 years had the best survival rate.

Geographic Distribution of Active Medical Specialists in Iran: A Three-Source Capture-Recapture Analysis.

BACKGROUND: Estimation of health workforce supply becomes problematic when there is no knowledge about the number of active specialists. The aim of this study is to estimate active specialists and their geographic accessibility in Iran. METHODS: We enrolled all medical specialists from the Iranian Ministry of Health database (14151), national hospitals survey (28898) and Continuing Medical Education registries (13159) in 2015. Duplicate records across the three registries were identified based on the similarity of national ID codes and medical council codes. The number of active medical specialists was estimated by three-source capture-recapture method using Stata 12 software. RESULTS: A total of 33,416 specialists were identified from three sources. We estimated the number of specialists at 39127 (95% CI: 38823.6-39448.4) in 2015. Of these, 45.4% pertained to the province of Tehran while only less than 1.8% of specialists were in the provinces of Ilam (0.50%), South Khorasan (0.56%) and Kohgiloye and Boyerahmad (0.59%). The estimated ratio for specialists was 4.9 per 10000 population and ranged from 9.2 per 10000 in Tehran to 1.5 per 10000 population in Sistan and Balochestan. The overall completeness of data registries by three sources was 85.4%. CONCLUSION: The current distribution of specialists appears to be imbalanced. It is suggested to adopt appropriate policies to improve the distribution and maintenance of medical specialists in different parts of Iran.

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 (ß=-13.1, p=0.011) and sampling method (ß=-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.

Dietary Glycemic Index and Glycemic Load and the Risk of Prostate Cancer: An Updated Systematic Review and Dose-Response Meta-Analysis.

A meta-analysis in 2015 revealed no significant association between glycemic index (GI), glycemic load (GL), and prostate cancer. Moreover, until now, no study has examined the dose-response association of GI, GL, and prostate cancer yet. The online databases were searched by two independent researchers for relevant publications up to Jan. 2019, using relevant keywords. Nine studies including five prospective and four case-control studies were included in the current systematic review and meta-analysis. These studies have included 290,911 individuals. We found a significant positive dose-response association between dietary GI and prostate cancer (Pnonlinearity = 0.03). Comparing individuals in the highest category of GI with those in the lowest category, no significant association was found between GI and prostate cancer (combined effect size: 1.08, 95% CI: 0.97-1.19, P = 0.17). Furthermore, no significant association was seen between dietary GL and prostate cancer in both dose-response analysis and when comparing the highest versus lowest categories of GL (combined effect size: 1.03, 95% CI: 0.91-1.16, P = 0.65). In conclusion, we found a significant positive dose-response association between dietary GI and prostate cancer. However, significant association was not seen for dietary GL.

The burden of road traffic injuries in the northeast of Iran: the result of a population-based registry.

BACKGROUND: Road traffic injuries (RTIs) are an important public health problem around the world, with the majority of RTIs occurring in low- and middle-income countries. This study aimed to determine disability-adjusted life years (DALY) of RTIs in the northeast of Iran. METHODS: In this cross-sectional study, we used the death registration system to calculate years of life lost (YLL) due to RTIs. To determine the years lost due to disability (YLD), hospital records of all people injured in road accidents were used. To estimate DALY, we used YLD and YLL to calculate DALY according to the Global Burden of Disease (GBD) 2003 guideline and the age/sex composition of the population was taken from the Statistical Centre of Iran (SCI) in 2016. All collected data entered into Excel software and performed calculations. RESULTS: Our findings showed that a total of 3403 RTIs and 132 deaths were recorded in 2016. The DALY was 38 per 1,000 of which 26.9 per 1,000 were related to YLL and 11.1 per 1,000 were related to YLD. The highest YLL rate in both sexes was in the 15-29 and 30-44 age groups with 49.8 per 1,000 and 46.0 per 1,000, respectively. This reflects a sex ratio of DALY in males (57.7 per 1,000) to females (8.6 per 1,000) was 6.7. CONCLUSIONS: It seems to be necessary, appropriate effective intervention programs and periodic evaluations are required regarding prevention and reducing traffic accidents mostly in middle-aged men.

Carbohydrate quantity and quality affect the risk of endometrial cancer: A systematic review and dose-response meta-analysis.

BACKGROUND: Data on the association of dietary intake of total carbohydrates as well as dietary glycemic index (GI) and glycemic load (GL) with risk of endometrial cancer are contradictory. Therefore, we conducted a systematic review and dose-response meta-analysis of observational studies to summarize available findings in this field. METHODS: The online databases were searched for relevant publications to May 2018 using relevant keywords. RESULTS: Overall, eight prospective cohort and five case-control studies with a total sample size of 734,765 individuals, aged ≥18 years, and 8466 cases of endometrial cancer were included. Although the overall association between dietary intake of total carbohydrates and risk of endometrial cancer was non-significant, we found a significant positive association in some subgroups of cohort studies including those with ≥10 years' duration of follow-up (combined effect size: 1.29, 95% CI: 1.09-1.53, P = 0.003) and studies with sample size of ≥50,000 participants (combined effect size: 1.24, 95% CI: 1.08-1.43, P = 0.002). In addition, a non-linear dose-response relationship was found in this regard after considering the estimates from cohort studies (Pnonlinearity = 0.002). Combining effect sizes from case-control studies showed a significant positive association between dietary GI and risk of endometrial cancer; such that a-10 unit increase in GI was associated with a 4% greater risk of endometrial cancer (combined effect size: 1.04, 95% CI: 1.02-1.05, P < 0.001). There was also a significant positive association between dietary GL and risk of endometrial cancer in some subgroups of cohort studies and also in non-linear dose-response analysis. CONCLUSIONS: Although the overall associations of dietary total carbohydrate intake, GI, and GL with risk of endometrial cancer were not significant, there were significant positive associations in some subgroups of the included studies, particularly those with high quality. There was also a dose-response association between dietary total carbohydrate intake, GI and GL, and risk of endometrial cancer.