Deaths of despair-associated mortality rates globally: a 2000-2019 sex-specific disparities analysis.

OBJECTIVES: The aim of this study was to explore sex-specific disparities in rates of deaths of despair across 183 countries from 2000 to 2019. STUDY DESIGN: Secondary analysis of cross-sectional population-level data. METHODS: Data were obtained from the World Health Organization Health Inequality Data Repository. We analysed data on mortality due to alcohol, drug-use disorders, and self-harm (as a proxy for suicide). We calculated the average rate of deaths of despair by year and sex, trends in these rates, and cause-specific mortality trends. We then fitted mixed-effect generalised linear models to compare mortality rates by sex and country. RESULTS: Analyses revealed significant disparities by sex, with a 3.3-fold higher rate among men than among women globally (95% confidence interval: 3.1-3.5, P < 0.001). There was a significant decline in deaths of despair globally and among both sexes during the assessed period (5% per 5 years). Lesotho, Belarus, the US, the Russian Federation, Guyana, and Slovenia ranked among the top 10 countries out of 183 with the highest mortality rates for both sexes. Canada, the Republic of Korea, Belgium, and Finland were countries with the highest mortality rates among women, whereas Ukraine, Lithuania, Mongolia, and Eswatini have the highest rates among men. In the US, 5-year mortality rates increased by 35% for women and 21% for men: drug-use mortality showed a significant increase over time, whereas suicide rates decreased for both sexes in the given country. Additionally, mortality rates from alcohol use decreased among women. CONCLUSIONS: This global analysis shed light on health disparities by sex in deaths of despair, especially concerning trends in the US. It identified countries and groups in need of targeted mental health and substance-use programs. Moreover, the disparities by sex revealed in this analysis suggest that mental health and substance-use interventions and programs may need to be more attentive to sex and/or gender, such as inequitable social norms and restrictive forms of masculinities, which have been shown to be contributing factors to deaths of despair.

Determinants of COVID-19 vaccine acceptance in healthcare workers in Iran: National Survey.

BACKGROUND AND AIM: It seems that acceptance of COVID-19 vaccination is the most effective way to tackle the COVID-19 pandemic now. Health care workers (HCWs) are one of the most important groups who are at risk for COVID-19 infection. This study aimed to assess the COVID-19 vaccine acceptance among HCWs in Iran and its determinants. METHODS: A cross-sectional survey was carried out among 3600 HCWs in Iran. Data were collected through a self-administered questionnaire by a trained team from February to March 2021. Multi-stage cluster sampling method was used for selecting respondents of the study. Multivariate logistic regression analysis was used to determine the key factors of COVID-19 vaccine acceptance among participants. P-value < 0.05 was considered statistically significant. RESULTS: Out of the 3536 respondents, 2191 (62.1%) intended to uptake the COVID-19 vaccine. Only about 10 percent of respondents said they did not trust any vaccine (domestic or foreign). Willing to accept a COVID-19 vaccine was relatively high among males, doctors, and those who had a history of hospitalization due to COVID-19 infection. The multivariate regression analysis showed respondents who were 40-50 years (aOR: 1.56; 95% CI: 1.47-1.66), had a history of COVID-19 infection (aOR: 0.85; 95% CI: 0.83-0.88), and hospitalized due to COVID-19 infection (aOR: 2.18; 95% CI: 1.97-2.39), were significantly associated with vaccine acceptance (p < 0.05). CONCLUSION: Our study showed moderate acceptance of COVID-19 vaccination in the HCWs in the Islamic Republic of Iran. The most important factor in the acceptance of the COVID-19 vaccine by the health staff is having a history of hospitalization. Further training and justification of health personnel is needed to increase the acceptance of COVID 19 vaccine.

Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in Iran: a mixed-methods systematic review.

BACKGROUND: Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women's, family members', and health professionals' preferences for CS in Iran. METHODS AND FINDINGS: In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38-5.50%; χ2 = 1117.39; df = 28 [p < 0.00001]; I2 = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86-5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74-3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: 'Women's factors', 'Health professional factors', andex 'Health organization, facility, or system factors'. CONCLUSION: Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the "health sector evolution policy". Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS.

Effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing the mode of delivery in pregnant women: a study protocol for a randomized controlled trial.

BACKGROUND: Cesarean section is an important surgical procedure, when normal vaginal delivery imposes a risk to mother and/or baby. The World Health Organization states the ideal rate for Cesarean section to be between 10 and 15% of all births. In recent decades, the rate has been increased dramatically worldwide. This paper explains the protocol of a randomized controlled trial that aims to compare the effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing mode of delivery in pregnant women. METHODS: A four-armed, parallel-design randomized controlled trial will be conducted on pregnant women. One hundred and twenty women will be randomly assigned to four groups including three intervention groups and one control group. The intervention groups included the following: (1) motivational interviewing; (2) face-to-face information, motivation, and behavioral skills model; and (3) information, motivation, and behavioral skills model provided using a mobile application. The inclusion criteria include being literate, being in gestational age from 24 to 32 weeks, being able to speak Persian, having no complications in the current pregnancy, having no indications for Cesarean section, and having enough time to participate in the intervention. The primary outcome of the study is the mode of delivery. The secondary outcomes are women's intention to undergo Cesarean section and women's self-efficacy. DISCUSSION: The interventions of this protocol have been programmed to reduce unnecessary Cesarean sections. Findings may contribute to a rise in normal vaginal delivery, and the effective intervention may be extended for use in national Cesarean section plans. TRIAL REGISTRATION: Iran Randomized Clinical Trial Center IRCT20151208025431N7 . Registered on December 07, 2018.