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.

The association between workload and quality of work life of nurses taking care of patients with COVID-19.

BACKGROUND: The COVID-19 epidemic has brought significant changes and complexities to nurses' working conditions. Given the crucial role of health workers, particularly nurses, in providing healthcare services, it is essential to determine the nurses' workload, and its association with the quality of work life (QWL) during COVID-19 epidemic, and to explain the factors predicting their QWL. METHODS: A total of 250 nurses, who provided care for patients with COVID-19 in Imam Hossein Hospital of Shahrud, and met the inclusion criteria, were considered the samples in the present cross-sectional study in 2021-2022. Data were collected using the demographic questionnaire, NASA Task Load Index (TLX), and Walton's QWL questionnaire, which were analyzed using SPSS26 and based on descriptive and inferential statistical tests. A p-value less than 0.05 was considered significant for all cases. RESULTS: The nurses' mean scores of workload and QWL were 71.43 ± 14.15 and 88.26 ± 19.5, respectively. Pearson's correlation test indicated a significant inverse relationship between workload and QWL (r=-0.308, p < 0.001). The subscales with the highest perceived workload scores were physical demand and mental demand (14.82 ± 8.27; 14.36 ± 7.43), respectively, and the subscale with the lowest workload was overall performance (6.63 ± 6.31). The subscales with the highest scores for QWL were safety and health in working conditions and opportunity to use and develop human capabilities (15.46 ± 4.11; 14.52 ± 3.84), respectively. The subscales with the lowest scores were adequate and fair compensation, work and total living space (7.46 ± 2.38; 6.52 ± 2.47), respectively. The number of children (ß = 4.61, p = 0.004), work experience (ß= -0.54, p = 0.019), effort (ß = 0.37, p = 0.033) and total workload (ß= -0.44, p = 0.000) explained 13% of the variance of nurses' QWL. CONCLUSIONS: The study's findings showed that a higher workload score is associated with nurses' lower perception of QWL. In order to improve the QWL of nurses, reducing the physical and mental demands of their workload and strengthening overall performance is necessary. Additionally, when promoting QWL, adequate and fair compensation and the work and living space should be considered. The researchers suggest that hospital managers should make more significant efforts to develop and promote the QWL of nurses. To achieve this goal, organizations can pay attention to other influential factors, primarily by increasing organizational support.

Spatial distribution and temporal trend of drug-related deaths in the Islamic Republic of Iran during 2014-2017.

Background: Research suggests that there is an increasing trend in drug-related deaths worldwide: an estimated 69 000 individuals lose their lives due to substance abuse annually. Aims: To determine the geographical pathology of drug-related deaths in the Islamic Republic of Iran and to evaluate incidence trends, with a focus on identifying high- and low-risk regions. Methods: For this ecological study, we collected data from the 2 main sources (the Legal Medicine Organization and the Ministry of Health and Medical Education) responsible for registering substance-related deaths during 2014-2017. Data analysis was conducted using Joinpoint regression analysis, Global Moran's I and Anselin Local Moran's I. Results: Of the 12 386 drug-related deaths in 2014-2017, most occurred during the summer months; 7162 of these were among middle-aged individuals. The mean age of children and adolescents who died of substance abuse was 5.2 [standard deviation (SD) 4.6] years. In the young adult group, mean age at death was 20.7 (SD 2.5) years; it was 34.2 (SD 5.4) years for adults and 55.6 (SD 9.8) years for older adults. Changes in mortality rate peaked in 2017 (annual percentage change = 0.52); in the last months of the study period there was a nonsignificant decrease (annual percentage change = -6.99) in the incidence (average annual percentage change = -0.5; 95% confidence interval: -3.2, 2.3). Conclusion: Deaths due to substance abuse will remain a huge public health problem unless policy- and decision-makers determine why this problem continues to increase despite the extensive efforts on regulation and find ways to mitigate it.

Effect of anthropometric and demographic factors on musculoskeletal disorders in nurses' aides.

BACKGROUND: Nurses' aides usually face various stressors, making them prone to musculoskeletal disorders (MSDs). OBJECTIVE: This study evaluates the effect of ergonomic and anthropometric indices, postural risk, and demographic variables on MSDs in nurses' aides. METHODS: Demographic variables, anthropometric dimensions, postural risk level (RL), and related percentiles of 75 nurses' aides were examined using Quick Exposure Check (QEC) software, caliper, and body map questionnaire. Pearson correlation coefficient, univariate and multivariate tests were used to analyze the data. RESULTS: The results showed that the RL of QEC in both groups of males and females was 73.67±22.34 (RL = 4) and 65.34±18.38 (RL = 3), respectively. The level of MSDs in the lumbar, thigh, and leg areas was higher than in other areas. Also, increasing age and work experience, and BMI were significantly associated with increasing disorders in the hands, wrists, and shoulders, respectively (P < 0.05). The results showed that an increase in some anthropometric indices such as body height, buttock, knee, popliteal height, abdomen depth, standing grip access limit, sitting grip access limit increased disorders in the hands and wrists. Also, MSDs were predicted in different areas of the nurses' aides' bodies using regression models, which was significant in the hands, wrists, elbows, legs, and shoulders (P < 0.05). CONCLUSIONS: The results showed that there was a significant difference between male and female nurses in most aspects of anthropometry and the risk level of QEC. Therefore, it is necessary to pay attention to anthropometric dimensions, and demographic diversity to design tools and workstations.

A Comprehensive Review on Various Aspects of SARS-CoV-2 (COVID-19) Vaccines.

This is a comprehensive review based on the published papers in the field of COVID-19 vaccines and vaccination. Many efforts have been made to develop vaccines to combat this pandemic. Since December 2020, more than 200 vaccines have been tested in various research stages and in clinical trials on humans, of which eight vaccines reached phase four clinical trials in humans and approved by FDA and EUA. After the Pfizer-BioNTech vaccine that had the highest efficacy (95%), the efficacy of the other vaccines are as follows: Moderna 94.5%, Sputnik V 91%, Novavax 89.7%, Sinopharm 79.3%, Oxford/AstraZenaca 70.4%, Johnson and Johnson 66.9%, and Sinovac 50.7%. At present, protein-based vaccines, with 35% of all available COVID-19 vaccines, are the most common technique in the vaccine production, and then there are vaccines of non-replicating viral vector (13.3%), mRNA1 (12.1%), DNA (10.2%), replicating viral vector (9.8%), and inactivated vaccines (8.2%). The most frequently recognized adverse effects within 7 days of each vaccine dose involved fever, fatigue, headache, chill, and myalgia. The mRNA-based vaccines were associated with a higher occurrence of local side effects (78.3 vs. 70.4%; Sig. = 0.064), whereas the viral vector-based vaccine was associated with a higher prevalence of systemic side effects (87.2 vs. 61%; Sig. < 0.001). Based on the evidence and articles in the field of vaccination, AstraZeneca-Oxford and Sinopharm vaccines reported the highest and lowest side effects, respectively. Because of being emerging, pathogenicity, and high infectivity of COVID-19, vaccination against the disease to prevent its incident rate and decrease the prevalence rate is recommended immediately. Being informed of various aspects of the existing vaccines such as efficacy, effectiveness, safety, etc.can accelerate to make effective and useful choices and consequently have a vaccinated community against the epidemic.

Spatial analysis and geoclimatic factors associated with the incidence of acute lymphoblastic leukemia in Iran during 2006-2014: An environmental epidemiological study.

BACKGROUND AND OBJECTIVES: The present study aims to determine the cumulative incidence rate of acute lymphoblastic leukemia (ALL), the degree of spatial autocorrelation and clustering of ALL, the hotspot and coldspots of ALL and geoclimatic conditions affecting the incidence of ALL in Iran and to draw a comparison between global and local regression models. MATERIALS AND METHODS: In this ecological study, an exploratory-etiologic multiple-group method has been adopted to investigate all children under 15 years of age with ALL in Iran during 2006-2014. Data analysis was performed using Mann Whitney U, Pearson correlation coefficients (PCCs), Global Moran's I, Optimized hotspot analysis (OHSA), Global Poisson regression (GPR), Geographically Weighted Poisson Regression (GWPR) at a significant level of α = 0.05. RESULTS: The cumulative incidence rate of ALL was estimated at 21,315 per 100,000 Iranian children under 15 years of age. The value of Global Moran's I index was estimated 0.338 and significant (<0.001 P-value). Coldspots were observed in north and northwest of Iran and hotspots were identified in south, southwest and mid-east of Iran. In the present study, Max Temperature of Warmest Month (MTWM) and Direct Normal Irradiation (DNI) were risk factors and Precipitation of the Coldest Quarter (PCQ) and Altitude (AL) were protective factors in the incidence of ALL, even though the non-stationarity of local coefficients and local t-values was clear. GWPR, by capturing and applying spatial heterogeneity and spatial autocorrelation, had a greater performance and goodness of fit than GPR. DISCUSSION: ALL has created spatial clusters in Iran. The incidence of ALL is the result of synergistic interaction between environmental, infectious, geographical and genetic risk factors. It is recommended to use of local models in ecological studies.

Identification of high-risk and low-risk clusters and estimation of the relative risk of acute lymphoblastic leukemia in provinces of Iran during 2006-2014 period: A geo-epidemiological study.

BACKGROUND: The present study was conducted to determine the epidemiological status, identify high-risk and low-risk clusters, and estimate the relative risk (RR) of acute lymphoblastic leukemia (ALL) in provinces of Iran. MATERIALS AND METHODS: This is an ecological study carried out using an Exploratory Multiple-Group design on 3769 children under 15 years of age with ALL from 2006 to 2014. Data analysis was performed using Mann-Whitney U, Global Moran's I and Kuldorff's purely spatial scan statistic tests at a significance level of 0.05. RESULTS: The average annual incidence rate of ALL during 2006-2014 period was 2.25/100,000 children under 15 years of age. The most likely high-risk cluster with log-likelihood ratio (LLR) =327.47 is located in the southwestern part of Iran with a radius of 294.93 km and a centrality of 30.77 N and 50.83 E, which contained 1276 patients with a RR of 2.56. It includes Fars, Bushehr, Kohgiluyeh and Boyer-Ahmad, Khuzestan and Chahar Mahall and Bakhtiari provinces. On the other hand, the most likely low-risk cluster with 517 patients, and a RR 0.49 and LLR = 227.03 was identified in the northwestern part of Iran with a radius of 270.38 km and a centrality of 37.25 N and 49.49 E. It includes Zanjan, Qazvin, Gilan and East Azerbaijan, Ardabil, Alborz and Tehran provinces. CONCLUSION: High-risk clusters were observed in Southwestern, central, and eastern Iran, while low-risk clusters were identified in Northern and Western Iran.

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.

Prevalence and determinant factors of anemia in children aged 6-12 months after starting an iron supplement in the east of Iran.

OBJECTIVE: Anemia in infants is a common problem, with regular iron supplementation the suggested policy for prevention and control of anemia. The aim of this study was to determine the prevalence and the determining factors of anemia as well as the benefits of regular iron supplementation in 6- to 12-month-old children. DESIGN/SETTING/SUBJECTS: In this cross-sectional study, 897 children aged from 6 to 12 months cared for at the Tabas Health Centers, affiliated with Birjand University of Medical Sciences, South Khorasan, Iran, were enrolled in the study. Demographic and anthropometric data as well as the level of hemoglobin were collected through interviews and laboratory tests, respectively. Data analysis was performed using SPSS-22 and stata-13. Chi2, polychromic PCA, and logistic regression were used. The statistical significance level was 0.05. RESULT: The prevalence of anemia, according to the WHO criterion for hemoglobin, was 36.8% (95% CI, 33.6-40.0). Its prevalence showed a decreasing trend as age and duration of iron supplement increased. Each 1-month increase in infant age was associated with a decreased risk of anemia [OR=0.88 (95% CI, 0.80-0.98)]. Anemia was not significantly different between genders. Individuals in the highest category for parity (≥3) were at a 2.3-fold greater risk of anemia compared with the lowest category [OR=2.35 (95% CI, 1.43-3.84)]. In contrast, individuals in the highest category for maternal age (>35 years) had a 62% lower risk of anemia compared with the reference category (<25 years) [OR=0.38 (95% CI, 0.20-0.72)]. CONCLUSION: Implementation of an iron supplementation plan in Iran has decreased anemia among 6- to 12-month-old children.