National and sub-national prevalence, trend, and burden of end stage renal diseases (ESRD) in Iran 1990-2013; the study protocol.

BACKGROUND: End Stage Renal Diseases (ESRD) imposes a huge economic burden on the health system; however, there is a serious lack of data related to ESRD, especially at Sub-national level, in Iran. Calculating the burden of ESRD at National and Sub-national level provides an opportunity to apply cost-effective interventions for the purpose of prevention and treatment. The current study protocol aims to explain the general structure and methods that will be used in the burden of ESRD study in Iran from 1990 to 2013. METHODS: The prevalence, incidence, mortality and geographical and socioeconomic inequality trend of ESRD will be calculated through a comprehensive systematic review of published and unpublished data. Years of Life Lost due to premature mortality, and Years Lived with Disability and Disability-Adjusted Life Years (DALYs) will be quantified for ESRD by gender, age group, and province with their uncertainly intervals. "Spatio-Temporal" and "Bayesian multilevel autoregressive" will be applied to deal with data scarcity and misalignment problem which exist in the data sources. DISCUSSION: The findings of the burden of ESRD study will be useful to organize preventive, treatment also research priorities at national and sub-national levels in Iran. Better understanding of the magnitude of ESRD burden is essential to prevent the progression of chronic kidney diseases to the end stage phase which is considered as a devastating illness.

Bone Mineral Changes and Cardiovascular Effects among Female Athletes with Chronic Menstrual Dysfunction.

PURPOSE: Oligo/amenorrhea, as a part of the Female Athlete Triad has adverse effects on the athlete's bone mineral density (BMD) and cardiovascular system. Hypoestrogenism, due to suppression of hypothalamus-pituitary axis (HPA) as a result of energy imbalance, is the possible cause of the Triad. This study was designed based on following up and reassessment of elite female athletes who were diagnosed as menstrual dysfunction about two years ago. METHODS: THIS STUDY WAS CONDUCTED IN THREE PHASE SECTIONS: 1) Reassess the pattern of menstrual cycle among athletes who reported menstrual dysfunction about two years ago; 2) Bone mineral density was measured twice in the same machine and same center with a two-year interval; 3) The laboratory data including blood glucose, lipid profile and inflammatory markers was assessed in phase 3. RESULTS: BMD of athletes did not change significantly after 25.5 months of oligomenorrhea P (spine) = 0.2, P (femur)=0.9. Mean of all cardiovascular factors was in the normal range except for high density lipoprotein (HDL) which was 49.28 (SD=9.18), however, most of the athletes had abnormalities in their lipid profile. Inverse relationship between the increase in the BMD of spine and total cholesterol (r =-0.49, P=0.04), Apolipoprotein A (r = -0.51 P=0.04), and very low density lipoprotein (VLDL) (r =-0.66, P=0.009). Also correlation between BMD of spine and HbA1C (r =-0.70, P=0.003) were significant. CONCLUSION: Findings of this study show that negative changes in BMD and cardiovascular biomarkers of female athletes with functional hypothalamic menstrual dysfunction could occur if proper therapeutic intervention (including increase in calorie intake, decrease in exercise load or hormonal replacement) will not consider.