The study of mental health status of people with epilepsy during the COVID-19 pandemic: A systematic review and meta-analysis study.

INTRODUCTION: The COVID-19 pandemic has affected the lives of people with epilepsy (PWE) in various ways. This systematic review and meta-analysis aims to assess the mental health status and prevalence of mental disorders including depression, anxiety, stress, and psychological distress among PWE. Furthermore, this study evaluates changes in sleep patterns and presence of sleep disturbances among them. The findings of this systematic review can help health organizations, policymakers, and health workers to better prepare and respond to future health crises for PWE and other chronic disease patients. METHOD: This systematic review was prepared using PRISMA reporting guidelines. We systematically searched PubMed, Web of Science, Scopus and Cochrane Library databases for studies that reported data on mental health parameters including depression, anxiety, stress, psychological distress, quality of life, and sleep quality, during the pandemic until May 2023. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software. RESULTS: In our study, a total of 61 carefully selected studies were analyzed, yielding valuable insights into the prevalence and impact of various mental health indicators among PWE. The findings revealed that a significant proportion of PWE experienced distressing psychological symptoms, with depression being reported by 34% of participants. Additionally, anxiety was prevalent among 43% of individuals, while stress symptoms were reported by 49% of respondents. Moreover, a substantial portion of PWE, approximately 38%, reported experiencing poor sleep quality, further underscoring the multifaceted nature of the challenges faced by this population. These findings highlight the need for targeted interventions and comprehensive support systems to address the mental health concerns and sleep disturbances faced by individuals living with epilepsy. CONCLUSION: The findings revealed that a substantial number of PWE experience symptoms of depression, anxiety, stress, and poor sleep quality. These results emphasize the importance of considering mental health and sleep assessments as integral components of care for individuals with epilepsy. The study underscores the need for further research and targeted interventions to address the mental health burden faced by this population. By prioritizing and addressing these challenges, healthcare providers can enhance the overall well-being and quality of life for individuals living with epilepsy.

Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran.

BACKGROUND: Defining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework. METHODS: The first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards. RESULTS: Analysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations. CONCLUSIONS: We developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.

The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990-2019.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. The present study reported the burden of COPD, and its attributable risk factors, in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex and socio-demographic index (SDI). METHODS: Data from the Global Burden of Disease (GBD) 2019 study were used to report the burden of COPD in the MENA countries. The prevalence, deaths, and disability-adjusted life-years (DALYs) were presented as counts and age-standardised rates per 100,000 population, with their associated 95% uncertainty intervals (UIs). RESULTS: In 2019, the regional age-standardised point prevalence and rates of death due to COPD were 2333.9 (2230.1, 2443.6) and 26.1 (22.2, 29.5) per 100,000, which represent a 30.6% (28.2%, 33.0%) increase and an 18.0% (2.8%, 30.9%) decrease, respectively, since 1990. The regional age-standardised DALY rate in 2019 was 649.1 (574.6, 717.7) per 100,000, which had decreased by 11.8% (0.9%, 21.1%) since 1990. Turkey had the highest age-standardised point prevalence in 2019 [3287.1 (3187.4, 3380.3)], while Afghanistan had the highest age-standardised death [40.4 (24.2, 52.6)] and DALY [964.5 (681.8, 1203.2)] rates. The regional age-standardised point prevalence, death and DALY rates in 2019 increased with advancing age and were higher in males in almost all age groups. There was a U-shaped association between SDI and the burden of COPD over the period 1990 to 2019. Moreover, in 2019 smoking (43.7%), ambient particulate matter pollution (22.8%) and occupational particulate matter (11.4%) had the largest proportion of attributable DALYs for both sexes. CONCLUSIONS: COPD is one of the leading causes of death and disability in the MENA region, although the age-standardised burden has decreased over the last 30 years. Nevertheless, COPD accounted for a substantial number of deaths and DALYs, especially among the elderly. Programs targeting risk factors, like smoking, should be taken into consideration.

Viewpoint changes of medical sciences graduates in evaluating the performance of faculty members: a qualitative study.

BACKGROUND: This study aimed to identify which dimensions of faculty members' evaluation criteria changed from the viewpoint of students after their graduation, and to determine the effective factors in changing their viewpoints. METHODS: This study was carried out through the qualitative approach and with conventional content analysis method. The target population included all graduates who accomplished their job duty and had a working experience of 2-4 years. A purposive sampling technique with maximum variation used to recruit and interview. Twenty-eight in depth semi-structured interviews were conducted in Tabriz University of Medical Sciences (TBZMED), Iran. The data were analyzed using content analysis. RESULTS: The data analysis led to the development of two themes and 8 categories. The two types of changes in the viewpoint that were experienced by graduates in evaluating the performance of faculty members were: individual and environmental. Individual factors included the responsibility of graduates, social maturity, personal experience, intellectual maturity, understanding the causes of teachers' behaviors, and understanding the importance of evaluation. The environmental factors were applicability of learning experiences in the work environment and workplace conditions. CONCLUSION: From the perspective of graduates, the importance of some evaluation criteria in the educational, professional, and personal dimensions changed over their study period due to some factors, such as personal experience, experiences in the work environment, workplace conditions, and intellectual maturity.

The Relationship of COVID-19 Morbidity and Mortality with the History of Influenza Vaccination.

Background: COVID-19 is currently the leading global health issue. Low- and middle-income countries (LMICs) face challenges in supplying COVID-19 vaccines. To assess an adjunctive preventive measure for COVID-19 burden, we aimed to evaluate the relationship of influenza vaccination in the previous year with outcomes of COVID-19 in affirmed cases after adjustment for relevant factors. Methods: This prospective study was conducted using the provincial registry of confirmed COVID-19 cases in East-Azerbaijan province in North-West of Iran. The main outcomes were COVID-19 mortality and hospitalization. The influenza vaccination history in 2019 was collected by phone calls. Data analysis was done by SPSS software version 16, separately for healthcare workers and the general population. The logistic regression model was applied to compare the covariates in influenza vaccinated versus unvaccinated patients. Results: From 1 March to 10 October 2020, 17,213 positive COVID-19 cases were registered, of which 916 patients were included. A total of 88 patients (9.6%) deceased due to COVID-19. Two hundred subjects (21.8%) reported receiving the influenza vaccine during the past year. Healthcare workers had a significantly higher vaccination rate than the general population (28.9% vs. 7.1%; p<0.001). After adjustment for socioeconomic and health covariates, the vaccinated cases in the general population had 84% lower odds of death (OR: 0.16; 95%CI: 0.05-0.60; p=0.017). In multivariate analysis, the influenza vaccination history in the previous year was not significantly related to the lower COVID-19 hospitalization rate. Conclusion: The flu vaccination rate was not optimal in our community. The flu vaccination can be an independent preventing factor for COVID-19 mortality in the general population. The influenza vaccine can be considered as an effective adjutant preventive countermeasure for the COVID-19 burden.

Nongovernmental organizations and social aspects of COVID-19 pandemic: A successful experience in health policy.

Background: This study aimed to provide information on activities and experiences of Nongovernmental organizations in Tabriz regarding COVID-19 to develop a framework for effective measures and actions for other communities based on relevant achievements and experiences. Method: The Social determinants of health research center of Tabriz University of Medical Sciences coordinated the NGOs to deal with the consequences of COVID-19 disease by announcing, inviting, developing networks and preparing aims and objectives and action plans in participation with the NGOs. Results: This cooperation and synergy among NGOs led to following results: providing public health education, fund raising to provide health service and food items for vulnerable families, advocacy by writing letters to the governor and the City Council and emphasizing the needs for controlling the epidemics. Conclusion: NGOs can increase public awareness, change social policies, and provide services and facilities to the vulnerable groups of people to deal with these problems.

Evaluation of the health promotion standards in governmental and non-governmental hospitals in East-Azerbaijan.

Background: Considering the importance of assessing the program of health promotion hospitals (HPH) for elucidating the compliance with the standards, the present study aimed to evaluate the health promotion standards in governmental and nongovernmental hospitals of East-Azerbaijan. Methods: In the present cross-sectional study, all hospitals in East-Azerbaijan province in 2018 were recruited. The Persian validated World Health Organization (WHO) a self-assessment questionnaire was sent to the director of each hospital and invited to corporate with the study. Self-assessment questionnaire consists of 40 measurable elements that assess management policy, patient's assessment, patient information and intervention, promoting health work placed and continuity and cooperation. Independent sample ttest was conducted to compare the mean score of each standard across hospitals type, location, and size. A significance level of 0.05 was used. Results: Hospitals total HPH score was 56.06±21.27 (out of 100). Among five standards, Standard 3 had the highest score (66.85±18.80), and Standard 4 had the lowest score (47.79±19.12). The capital cities' hospitals had a significantly higher score in Standard 5 (p=0.02). Non-governmental hospitals had a significantly higher score in standard 4 (p=0.02). There were no significant differences in all five standards of HPH between hospitals with ≤200 and >200 beds (p>0.05). Conclusion: The hospitals in East-Azerbaijan-Iran had moderate compliance with HPH program, and they need to improve their performance especially in the field of providing healthy workplace and offering proper education and health-promoting services to patients after discharge.

Health promoting hospitals in Iran: Persian translation, cultural adaptation, content and face validation of selfassessment form of the standards of health promoting hospitals affiliated to the World Health Organization.

Background: According to the World Health Organization, hospitals should assess their internal wards to improve health promotion services using self-assessment tools. To achieve this goal, standards of health promoting hospitals have been developed by the World Health Organization, and measurable elements and indicators have been defined to facilitate the practical application of these standards in planning, implementation, and evaluation of health promotion in hospitals. Moreover, a form has been developed for this self-assessment. Considering linguistic and cultural differences in various countries, standards must be written in equivalent texts and, then, their content and face validity should be examined. Performing this process in a systemic and scientific way can guarantee that the same tools have been used, and thus the results obtained from different hospitals are comparable. Methods: After the preparation phase (considering research aim, obtaining permission from the original designers, and determining the time), the following activities were done: translating the form from its original language to the target language, combining and compiling initial translations to a single translation, reversing the final version of the translation from the target language to the original language, obtaining cognitive information, revising and concluding, and determining the content and face validity of the translated form and final report. After filling in the form, face validity was calculated using impact score formula. Content validity was measured using content validity ratio (CVR) and content validity index (CVI). Results: After calculating the impact score, all 40 items showed a high impact score greater than 1.5, representing the fact that all items are important. The minimum value of CVR for each of the 40 items was estimated to be 0.64; CVI of all items was greater than 0.79. Conclusion: Given the input of the standards of health promoting hospitals affiliated to the World Health Organization in National Accreditation of Iranian hospitals, the form was translated and found to be valid according to content and face validity and is available in Persian to be used in Iranian hospitals (Appendix 1).

Prevalence of depression, anxiety, and stress and associated reasons among Iranian primary healthcare workers: a mixed method study.

BACKGROUND: Different mental disorders may be associated with many work-related factors to which primary health care workers (PHCWs) are exposed. The current research aims to measure the rates of depression, anxiety, and stress among PHCWs, and their associated causes in primary health care (PHC) settings. METHODS: An explanatory sequential mixed methods design was employed in this research from January 2021 to January 2022 in Tabriz, Iran's PHC centers. First, this study followed an online-based cross-sectional survey using a self-reported questionnaire. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) and questions on demographic and work-related characteristics were completed by 303 frontline PHCWs during the quantitative phase. In the qualitative phase, a semi-structured interview was held with 12 PHCWs who had the highest level of depression, anxiety, and stress to identify the reasons and sources of mental health prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-26. A content analysis was performed to analyze qualitative data. RESULTS: The results showed that self-reported stress, anxiety, and depression had a prevalence of 40.3%, 42.9%, and 42.6%, respectively. Symptoms of at least one mental disorder were experienced by 54% of respondents, while 28% had all three. Major sources of stress, anxiety, and depression among PHCWs were working environment conditions, organizational policies, job-related reasons, and interpersonal relations. CONCLUSIONS: The results of current study indicated that PHCWs experienced high levels of depression, anxiety, and stress. The main factors and reasons that contributed to these mental health issues among PHCWs were work environment conditions, organizational policies, job-related reasons and interpersonal relations. Therefore, interventions should be implemented to promote mental health of PHCWs. This can include measures such as psychological screening, supportive care, workload management, flexible scheduling, and access to mental health resources. Additionally, training programs can be implemented to enhance resilience and coping skills among healthcare professionals.

Uncovering the knowledge gap: A web-based survey of healthcare providers' understanding and management of dengue fever in East Azerbaijan, Iran.

BACKGROUND: Dengue fever (DF) is increasingly recognized as one of the world's major mosquito-borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Appropriate and timely diagnosis and risk stratification for severe disease are crucial in the appropriate management of this illness. Healthcare providers (HCPs) play a key role in dengue fever diagnosis, management and prevention. The present study was conducted to determine the knowledge, attitudes and practices (KAP) among HCPs in East Azerbaijan Province, Iran. METHODS: A cross-sectional survey among 948 HCPs, using a structured questionnaire, was conducted in East Azerbaijan Province from May to July 2022. Data analysis was undertaken using descriptive methods, the Chi-square test or Fisher's exact test, and logistic regression. A P-value <0.05 was considered for statistical significance. RESULTS: Out of the 948 (68.5% female) respondents, 227 were physicians and 721 were health professionals. The knowledge level of DF was found to be largely inadequate in the present study population (80.4%). The physician vs. health professional were a significant factor in differentiating attitude scores. The mean practice score regarding DF prevention and control measures among respondents was 8.40±1.97. CONCLUSION: The findings call for urgent continuous education and training courses to increase KAP levels and increased capacity and capability for DF prevention and control. This is of outmost importance for the first point of care of DF patients.

Scoping review of outpatient health services utilization among women.

BACKGROUND: Health services utilization, as one of the mechanisms of the health system, guarantees a healthy life and improves well-being for everyone. AIMS: The aim of this study was to identify factors affecting the use of outpatient health services among women. METHODS/DESIGNS: This scoping review examined the studies related to outpatient health services utilization (OHSU) and its determinants among women. This review was conducted on English language studies published between 2010 and 2023 (All searches were conducted on 20 January 2023). Studies available in databases such as Web of Science, MEDLINE (PubMed), Scopus, Wiley library, Proquest, and Google Scholar were searched manually. Selected keywords and their equivalents were used to search for related articles in each database. RESULTS: A total of 18 795 articles were identified, of which 37 met the inclusion criteria. Findings showed that age, marital status, level of education, employment status, income level, socioeconomic status, rape experience, health insurance, health status, ethnicity, living in rural areas, quality of services, area of residence, having a purpose in life and access to health services affect OHSU among women. CONCLUSIONS: The results of the present review showed that in order to achieve the universal goals of health services coverage and health service utilization, it is necessary for countries to provide insurance coverage to the maximum number of people. Also, policies should change in favor of the elderly, poor and low-income, low-educated, rural, ethnic minority, and chronically ill women and provide them with free preventive health services.

The burden of neck pain in the Middle East and North Africa region, 1990-2019.

Background: Neck pain is a common cause of disability across the world. The objective of the present study was to present a thorough investigation of the burden caused by neck pain in the Middle East and North Africa (MENA) region, by country, sex, age group and socio-demographic index (SDI). Methods: The data on the burden of neck pain, encompassing its prevalence, incidence and years lived with disability (YLDs), were extracted from the Global Burden of Disease (GBD) 2019 study. These findings are reported as age-standardised numbers and rates (per 100,000), accompanied by 95 % uncertainty intervals (UIs). Results: The age-standardised point prevalence of neck pain in 2019 was 3066.7 (95 % UI: 2407.8 to 3894.3) per 100,000, with an age-standardised incidence rate of 649.2 (509.2-829.2) in the MENA region, neither of which have changed since 1990. The age-standardised YLD rate of neck pain was 303.0 (201.5-438.8) per 100,000 population in 2019. The highest YLD rate of neck pain was found in Iran [423.5 (280.3-609.8)] and the lowest in Kuwait [215.0 (141.0-314.1)]. The highest number of prevalent cases were seen in the 45-49 age-group for both sexes in 2019, but overall females had a higher point prevalence than males. Furthermore, over the study period (1990-2019) there was no clear and consistent relationship between the SDI and the burden of neck pain. Conclusion: Although the burden of neck pain has largely remained stable over the past three decades, the prevalence and morbidity in the MENA region remains high. Preventive and rehabilitative programs should be implemented that firstly target middle-aged females and males.

The burden of vision loss in the Middle East and North Africa region, 1990-2019.

BACKGROUND: The loss of vision is a substantial public health concern that has important implications for an individual's quality of life. The primary objective of this research was to document the burden of vision loss in the Middle East and North Africa (MENA) region, spanning the years 1990-2019, by age group, sex, underlying cause and sociodemographic index (SDI). METHODS: Publicly available data concerning the burden of vision loss were acquired from the Global Burden of Disease study 2019. The data encompassed all 21 countries within the MENA region for the period spanning 1990 to 2019. The estimates were reported as raw counts and age-standardised rates per 100,000, accompanied by their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2019, MENA had an age-standardised point prevalence of 7040.0 (95% UI: 6195.0, 8002.7) and an YLD rate of 314.5 (222.1, 427.6) per 100,000 for vision loss, which were 11.1% (-12.5, -9.7) and 24.3% (-27.6, -20.8) lower, respectively, than in 1990. In 2019, Afghanistan [469.6 (333.0, 632.8)] had the largest age-standardised YLD rate and Turkey [210.7 (145.3, 290.9)] had the lowest. All countries showed a decrease in the age-standardised point prevalence and YLD rate between 1990 and 2019, except for Oman, Afghanistan, and Yemen. Furthermore, in 2019 the largest number of prevalent cases and YLDs were found in the 65-69 age group. Also in 2019, the age-standardised YLD rates in MENA exceeded the global averages for most age groups, for both males and females. In 2019, refractive disorders were the most common types of vision loss among children, adolescents, and middle-age adults in MENA, while near vision loss and cataracts were the most common among older adults. Finally, the burden of vision loss had a slightly negatively association with SDI over the period 1990-2019. CONCLUSION: Although the burden of vision loss has decreased over the last three decades, the prevalence remains high. These results underscore the importance of healthcare policymakers taking action to implement preventive measures, especially among the elderly and those living in low socioeconomic countries, to decrease the attributable burden in MENA.

Moving shared decision-making forward in Iran.

Although there have been breakthroughs in patients' rights and informed consent legislation in Iran during the last few years, there is still no policy regarding shared decision-making (SDM). Besides, SDM training and clinical implementation initiatives remain scarce within the country. In this article, we aim to provide an update on the current state of SDM in Iran and discuss future directions. Lastly, we propose an SDM model adapted to the Iranian context, through a consensus-building process with Iranian clinicians and SDM experts, to assist in its implementation in a culturally sensitive manner.

Compliance with education on evidence-based oral hygiene principles among dental students and staff: a best practice implementation project.

OBJECTIVES: This study aims to assess compliance with evidence-based criteria regarding oral hygiene principle education provided for children and adolescents in the Tabriz Faculty of Dentistry. INTRODUCTION: Oral health problems might lead to lowering the quality of life amongst children and adolescents; so, providing education regarding oral health principles is of great importance. METHODS: Eight audit criteria were assessed using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GriP) audit and feedback tool. Barriers were identified and dental students and staff were instructed by the team members and asked to educate children and adolescents referred to orthodontic department about oral hygiene practices. Changes in audit criteria were collected by direct observation and interview and reported using descriptive statistics. RESULTS: In the follow-up phase, the percentage of patients who were advised to brush their teeth with fluoride toothpaste twice a day, floss daily, and seek regular dental check-ups increased, as compared with the baseline audit (37, 43 and 33%, respectively). Professional fluoride application, fissure sealant and individualized intervention and/or prevention treatment plans increased by 30, 35 and 15%, respectively in the follow-up phase; while advice on diet and risks of alcohol, tobacco and smoking increased by 93%. CONCLUSION: The use of standard clinical audit tools in dentistry wards causes improvement in the compliance with providing oral hygiene principle instructions among dental students and staff. Standard tools can increase the effectiveness of corrective interventions by identifying weaknesses in patient care process.

Burden of polycystic ovary syndrome in the Middle East and North Africa region, 1990-2019.

Polycystic ovary syndrome (PCOS) is one of the most important contributing factors to infertility. In this study, we report the burden of PCOS by age and sociodemographic index (SDI) for the 21 countries in the Middle East and North Africa (MENA) region. Publicly available data on the point prevalence, incidence and years lived with disability (YLDs), from 1990 to 2019, were retrieved from the Global Burden of Disease (GBD) 2019 study for the 21 countries in MENA. The results are presented with age-standardised numbers and rates per 100,000 population, along with their corresponding 95% uncertainty intervals (UIs). In 2019, the age-standardised point prevalence and incidence rate for PCOS in the MENA region were 2079.7 (95% UI: 1392.0 to 2812.3) and 77.2 (95% UI: 51.6 to 105.4) per 100,000, respectively, which represents a 37.9% (95% UI: 31.7 to 45.0) and a 33.7% (95% UI: 27.7 to 40.3) increase since 1990, respectively. Also in 2019, the age-standardised YLD rate of PCOS in this region was 18.7 (95% UI: 7.8 to 37.9) per 100,000 women, which has increased by 36.1% (95% UI: 29.4 to 43.4) since 1990. Kuwait [25.4 (10.7, 51.2)] had the highest age-standardised YLD rate, while Afghanistan [10.8 (10.1, 49.2)] had the lowest. Moreover, the largest increase in the YLD rate, from 1990 to 2019, was seen in Sudan [90.3% (64.1, 120.9)], whereas no country decreased during the measurement period. The total prevalent number and point prevalence of PCOS (per 100,000) were both highest in the 20-24 age group. The prevalence of PCOS was highest among women of reproductive age, but decreased rapidly after 45 years of age. Moreover, at the country level there was a positive association between SDI and the age-standardised YLD rates of PCOS. The growing prevalence and burden of PCOS in the MENA region highlights the need to implement cost-effective preventive programs, especially for women in their third decade of life, and in MENA countries with higher SDI levels.

The Burden of Osteoarthritis in the Middle East and North Africa Region From 1990 to 2019.

Objective: We aimed to report the most current data on the prevalence, incidence, and years lived with disability (YLDs) associated with osteoarthritis (OA) for the 21 countries and territories located in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, cause, and sociodemographic index (SDI). Methods: Publicly available data from the Global Burden of Disease 2019 study were used to report the OA-related burden. Estimates are reported as counts and age-standardized rates, along with their corresponding 95% uncertainty intervals (UIs). Results: In 2019, the age-standardized prevalence of OA in MENA was 5,342.8 per 100,000 (95% UI: 4,815.9-5,907.8), which is 9.3% higher than in 1990 (8.1-10.5%). Similarly, the age-standardized annual incidence of OA per 100,000 was 430.4 (382.2-481.9), demonstrating a 9.4% increase since 1990 (8.3-10.5). OA was the cause of 185.4 (92.8-370.2) age-standardized YLDs per 100,000 in 2019, which was 10% higher than in 1990 (8.7-11.4). Saudi Arabia, Kuwait, and Iran had the highest OA burden in MENA, while Yemen, Afghanistan, and Sudan had the lowest burden. In all MENA countries, OA affected more women than men, had an increasing burden with increased age, and had the highest impact on the knee, hip, and hand joints, respectively. OA was also positively associated with the SDI. Conclusion: The burden of OA increased over 1990-2019 in the MENA region. The study emphasizes the importance of early preventative approaches in order to control any future health, economic, and quality of life crises imposed by OA in this region.

The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990-2019.

Stroke is one of the leading causes of mortality and morbidity across the globe. Providing comprehensive data on the burden of stroke in the Middle East and North Africa (MENA) could be useful for health policy makers in the region. Therefore, this article reported the burden of stroke and its attributable risk factors between 1990 and 2019 by age, sex, type of stroke, and socio-demographic index. Data on the point prevalence, death, and disability-adjusted life-years (DALYs), due to stroke, were retrieved from the Global Burden of Disease study 2019 for the 21 countries located in the MENA region from 1990 to 2019. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals (UIs). In 2019, the regional age-standardised point prevalence and death rates of stroke were 1537.5 (95% UI: 1421.9-1659.9) and 87.7 (78.2-97.6) per 100,000, which represent a 0.5% (- 2.3 to 1.1) and 27.8% (- 35.4 to - 16) decrease since 1990, respectively. Moreover, the regional age-standardised DALY rate in 2019 was 1826.2 (1635.3-2026.2) per 100,000, a 32.0% (- 39.1 to - 23.3) decrease since 1990. In 2019, Afghanistan [3498.2 (2508.8-4500.4)] and Lebanon [752.9 (593.3-935.9)] had the highest and lowest age-standardised DALY rates, respectively. Regionally, the total number of stroke cases were highest in the 60-64 age group and was more prevalent in women in all age groups. In addition, there was a general negative association between SDI and the burden of stoke from 1990 to 2019. Also, in 2019, high systolic blood pressure [53.5%], high body mass index [39.4%] and ambient particulate air pollution [27.1%] made the three largest contributions to the burden of stroke in the MENA region. The stroke burden has decreased in the MENA region over the last three decades, although there are large inter-country differences. Preventive programs should be implemented which focus on metabolic risk factors, especially among older females in low SDI countries.

The burden of rheumatoid arthritis in the Middle East and North Africa region, 1990-2019.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0-135.7) and an annual incidence rate of 5.9 (5.2-6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2-136.7), with an age-standardised rate of 19.0 (13.9-24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7-28.2). The highest point prevalence was found in females aged 50-54, and in males aged 45-49. The highest number of DALYs was observed in the 50-54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.

A Qualitative Study on the Establishment of an Interpersonal Violence Registry System in Iran.

Establishment of an interpersonal-violence registry system (IPVRS) is a promising initiative to tackle violence. This qualitative study aimed to fill the gap in knowledge regarding the feasibility of establishing the IPVRS in the East-Azerbaijan province of Iran. This qualitative study using content analysis was conducted to explore the importance, challenges, and facilitating factors of establishing the IPVRS from the viewpoints of stakeholders. Forty-six individuals from the Forensic Medical Organization, the University, the Welfare Organization, the Training and Education Organization, hospitals, and primary health centers participated in the study. Six themes and 13 sub-themes were identified. The importance of the establishment of the IPVRS was sub-categorized into two main themes, including violence as a public health priority and severe consequences of violence including intensive health and social outcomes and high use of medical services. The most critical challenges of establishing the IPVRS were categorized into two main themes including victims' under-reporting due to financial difficulties as well as psychosocial barriers and structural barriers such as organizational barriers and methodological challenges. Inter-sectoral partnership was identified as the main facilitating factor in the successful establishment of the IPVRS. The participants recommended improving the development of the IPVRS by stepwise development of the program, resource absorption from other beneficiary organizations, and making more coverage in the registry system. In conclusion, the establishment of the IPVRS is identified as an effective strategy to tackle violence-related issues. Close collaboration with different governmental and non-governmental sectors and the gradual development of the registry system can pave the way for establishing the IPVRS. This study has several implications for identifying potential challenges and facilitators of the IPVRS applicable to other developing countries with similar contexts.