Socioeconomic inequalities in employees' health-enhancing physical activity: Evidence from the SHAHWAR cohort study in Iran.

BACKGROUND: Increasing level of physical activity (PA) among working population is of particular importance, because of the high return of investment on employees' PA. This study was aimed to investigate socioeconomic inequalities in Health-Enhancing Physical Activity (HEPA) among employees of a Medical Sciences University in Iran. METHODS: Data were extracted from the SHAHWAR Cohort study in Iran. Concentration index (C) and Wagstaff decomposition techniques were applied to determine socioeconomic inequality in the study outcomes and its contributors, respectively. RESULTS: Nearly half of the university employees (44.6%) had poor HEPA, and employees with high socioeconomic status (SES) suffered more from it (C = 0.109; 95% CI: 0.075, 0.143). Also, we found while poor work-related PA (C = 0.175; 95% CI: 0.142, 0.209) and poor transport-related PA (C = 0.081, 95% CI: 0.047, 0.115) were more concentrated among high-SES employees, low-SES employees more affected by the poor PA at leisure time (C = -0.180; 95% CI: -0.213, -0.146). Shift working, and having higher SES and subjective social status were the main factors that positively contributed to the measured inequality in employees' poor HEPA by 33%, 31.7%, and 29%, respectively, whereas, having a married life had a negative contribution of -39.1%. The measured inequality in poor leisure-time PA was mainly attributable to SES, having a married life, urban residency, and female gender by 58.1%, 32.5%, 28.5%, and -32.6%, respectively. SES, urban residency, shift working, and female gender, with the contributions of 42%, 33.5%, 21.6%, and -17.3%, respectively, were the main contributors of poor work-related PA inequality. Urban residency, having a married life, SES, and subjective social status mainly contributed to the inequality of poor transport-related PA by 82.9%, -58.7%, 36.3%, and 33.5%, respectively, followed by using a personal car (12.3%) and female gender (11.3%). CONCLUSIONS: To reduce the measured inequalities in employees' PA, workplace health promotion programs should aim to educate and support male, urban resident, high-SES, high-social-class, and non-shift work employees to increase their PA at workplace, and female, married, rural resident, and low-SES employees to increase their leisure-time PA. Active transportation can be promoted among female, married, urban resident, high-SES, and high-social-class employees and those use a personal car.

The Risk Assessment of Patient Handling in Hospitals of Northeast of Iran.

The study aim was to determine the risk of Manual patient handling (MPH) in Shahroud public hospitals, Iran. A cross-sectional study was performed in Imam Hossein (IHospital) and Bahar (BHospital) with 21 wards. MPH risk assessment was performed using MAPO (Movement and Assistance of Hospital Patient) index. The ratio of operator to disabled patient (NC/Op and PC/Op), lifting, minor aid, wheelchair, environmental, and training factor are evaluated to calculate MAPO index. Among studied wards 57%, 33.3%, and 9.5%, respectively, were in the high, moderate, and low risk exposure level. The maximum MAPO score were 16.7 in CCU of IHospital. Emergency ward of BHospital had the highest score of 9.8 and PC/OP ratio 17.5. The most risk factors were minor aid (90.5%), lifting factor (71.4%), and PC/OP (66.7%). Immediate ergonomic action is recommended.

Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019.

Background: Injury poses a major threat to health and longevity in adults aged 50 years or older. The increased life expectancy in the Eastern Mediterranean region warrants a further understanding of the ageing population's inevitable changing health demands and challenges. We aimed to examine injury-related morbidity and mortality among adults aged 50 years or older in 22 Eastern Mediterranean countries. Methods: Drawing on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we categorised the population into adults aged 50-69 years and adults aged 70 years and older. We examined estimates for transport injuries, self-harm injuries, and unintentional injuries for both age groups, with sex differences reported, and analysed the percentage changes from 1990 to 2019. We reported injury-related mortality rates and disability-adjusted life-years (DALYs). The Socio-demographic Index (SDI) and the Healthcare Access and Quality (HAQ) Index were used to better understand the association of socioeconomic factors and health-care system performance, respectively, with injuries and health status in older people. Healthy life expectancy (HALE) was compared with injury-related deaths and DALYs and to the SDI and HAQ Index to understand the effect of injuries on healthy ageing. Finally, risk factors for injury deaths between 1990 and 2019 were assessed. 95% uncertainty intervals (UIs) are given for all estimates. Findings: Estimated injury mortality rates in the Eastern Mediterranean region exceeded the global rates in 2019, with higher injury mortality rates in males than in females for both age groups. Transport injuries were the leading cause of deaths in adults aged 50-69 years (43·0 [95% UI 31·0-51·8] per 100 000 population) and in adults aged 70 years or older (66·2 [52·5-75·5] per 100 000 population), closely followed by conflict and terrorism for both age groups (10·2 [9·3-11·3] deaths per 100 000 population for 50-69 years and 45·7 [41·5-50·3] deaths per 100 000 population for ≥70 years). The highest annual percentage change in mortality rates due to injury was observed in Afghanistan among people aged 70 years or older (400·4% increase; mortality rate 1109·7 [1017·7-1214·7] per 100 000 population). The leading cause of DALYs was transport injuries for people aged 50-69 years (1798·8 [1394·1-2116·0] per 100 000 population) and unintentional injuries for those aged 70 years or older (2013·2 [1682·2-2408·7] per 100 000 population). The estimates for HALE at 50 years and at 70 years in the Eastern Mediterranean region were lower than global estimates. Eastern Mediterranean countries with the lowest SDIs and HAQ Index values had high prevalence of injury DALYs and ranked the lowest for HALE at 50 years of age and HALE at 70 years. The leading injury mortality risk factors were occupational exposure in people aged 50-69 years and low bone mineral density in those aged 70 years or older. Interpretation: Injuries still pose a real threat to people aged 50 years or older living in the Eastern Mediterranean region, mainly due to transport and violence-related injuries. Dedicated efforts should be implemented to devise injury prevention strategies that are appropriate for older adults and cost-effective injury programmes tailored to the needs and resources of local health-care systems, and to curtail injury-associated risk and promote healthy ageing. Funding: Bill & Melinda Gates Foundation.

Association of Social Determinants of Health and Road Traffic Deaths: A Systematic Review.

OBJECTIVE: This study aims to review systematically the association of social determinants of health (SDH) and road traffic deaths (RTD) within scientific literature. METHODS: A search strategy was designed and run in EMBASE, PubMed via MEDLINE, Scopus, Web of Science, and Cochrane library. Through title, abstract, and full-text screening, all English original papers (except ecological studies) which studied social determinants of health and fatal injuries were included. Papers which studied association between RTD and the education, income, rural settlement, and marital status were evaluated and the related data was extracted from the full-texts. RESULTS: Eleven articles out of 7,897 primary results were selected to be included in the study. Among eight papers studied education, seven confirmed a negative association between years of schooling and RTD. Two out of three articles reported no association between income leveland RTD. Among three papers studied rural settlement, two approved a positive relationship between this determinant and RTD. Both articles studied marital status, confirmed an association between this determinant and RTD. CONCLUSION: A few papers studied association of social determinants of health (SDH) and RTD. There was an inverse relationship between education and RTD. The evidence for such an association between income, rural settlement, and marital state was scarce. Further investigations are recommended through original research.

Trends in the drowning mortality rate in Iran.

OBJECTIVE: The WHO estimates the global incidence of death by drowning to be about 300 000 cases per year. The objective of this study was to estimate the trend in mortality due to drowning in all provinces of Iran in all age groups and both genders from 1990 to 2015. STUDY DESIGN: The National and Subnational Burden of Diseases (NASBOD) project is a comprehensive project in Iran. It is based on the Global Burden of Disease study and includes novel methods to estimate the burden of diseases in Iran. METHODS: This study used the results of the mortality rate due to drowning as part of NASBOD and investigated the causes behind the mortality rates. The data set recorded mortality rates by 19 age groups and two genders with the corresponding subnational pattern during the time period from 1990 to 2015. RESULTS: The drowning mortality rate decreased in Iran from 1990 to 2015. From 1990 to 2015, the annual percentage change for males and females was -5.28% and -10.73%, respectively. There were 56 184 male and 21 589 female fatalities during the study period. The highest number of deaths was seen in 1993 with 4459, and the lowest number of fatalities was observed in 2015 with 903 deaths. CONCLUSION: Our data showed a decline in drowning mortality in Iran from 1990 to 2015, but the rates and declines varied by province. Our findings are of great importance to health officials and authorities in order to further reduce the burden of drowning.

Determinants of international variation in the prevalence of disabling wrist and hand pain.

BACKGROUND: Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP). METHODS: Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain). RESULTS: After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86). CONCLUSION: Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.

National Spinal Cord Injury Registry of Iran (NSCIR-IR) - a critical appraisal of its strengths and weaknesses.

The National Spinal Cord Injury Registry of Iran (NSCIR-IR) is a not-for-profit, hospital-based, and prospective observational registry that appraises the quality of care, long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran. Benchmarking validity in every registry includes rigorous attention to data quality. Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid. We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries. In summary, the steering committee, funded and maintained by the Ministry of Health and Medical Education of Iran, the international collaborations, continued staff training, suitable data quality, and the ethical approval are considered to be the strengths of the registry, while limited human and financial resources, poor interoperability with other health systems, and time-consuming processes are among its main weaknesses.