Analyzing the trend of mortality due to traffic and nontraffic accidents: a study in the north of Iran.

Background: Examining the raw and standardized mortality rates is the primary strategy for improving life expectancy and human health in society through identifying risk factors and dealing with the factors that cause them. Objectives: This study examined the trend of mortalities due to traffic and nontraffic accidents. Methods: This cross-sectional study examines the registered mortalities during the years 2016-2022 in the form of a census in the health department's death registration and classification system. Mortality was analyzed as raw and standardized mortality in each 100 000 population. Results: Out of 18 265 deaths during 2016-2022, 1305 (7.15%) were related to accidents and incidents. The age-standardized total mortality rate in the first year was 32.9, and in the final year of the study, it was 33.3 per 100 000 people; although there are fluctuations, this trend is upward (P.trend=0.021). Also, the age-standardized traffic death rate in the first year is 19, and in the final year is 12 per 100 000 people; this decreasing trend was not statistically significant (P.trend=0.061). The incidence of age-standardized intentional nontraffic deaths was 1.7 in the first year of the study interval and 9.8 in the last year in 100 000 people, which showed an upward trend (P.trend<0.001). Conclusion: In light of the generally increasing trend of accidents, especially nontraffic accidents, universal and well-rounded measures are necessary for safety matters and reducing mortality.

Comparison of Word Catheter and Marsupialization in the Management of Bartholin's Glands: A Systematic Review and Meta-Analysis.

OBJECTIVE: There is no consensus on the best option for the management of Bartholin's gland abscesses. This systematic review and meta-analysis aimed to compare the Word catheter placement and marsupialization methods in the management of women with a cyst or abscess of the Bartholin's glands. DATA SOURCES: The PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases, as well as Google Scholar, were searched to retrieve articles published between January 1990 and July 2023, comparing the Word catheter treatment with marsupialization for women with a cyst or abscess of the Bartholin's glands. STUDY SELECTION: Both observational studies and randomized controlled trials (RCTs) were included in this meta-analysis. DATA EXTRACTION AND SYNTHESIS: After the review, out of 9 relevant articles, only 4 (2 observational studies and 2 RCTs) were included in this meta-analysis, providing the data of 735 patients (396 in the Word catheter group vs. 339 in the marsupialization group). The data was extracted from the selected articles, using a data extraction form. Comparison of the Word catheter and marsupialization methods suggested that the risk of recurrence was approximately 7.6% in the Word catheter group and 9.4% in the marsupialization group. The findings indicated no significant difference in the recurrence of cysts or abscesses when comparing the Word catheter treatment with marsupialization (odds ratio = 0.99, 95% confidence interval: 0.29-3.43, P = 0.990, I2 = 77%). CONCLUSION: This meta-analysis found no significant difference in the rate of recurrence between the Word catheter and marsupialization methods. In general, marsupialization and Word catheter placement in the treatment of Bartholinitis seem to be equally effective.

Relationship between fine particulate matter (PM2.5) concentration and risk of hospitalization due to chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND: Short-term exposure to PM2.5 has been associated with human health risks. However, evidence on the association between short-term exposure to PM2.5 and the risk of chronic obstructive pulmonary disease (COPD) remains limited and controversial. This study aimed to specifically assess the relationship between exposure to PM2.5 and the risk of hospitalization due to COPD. METHODS: A systematic search was conducted in PubMed, Web of Science, and Google Scholar databases from January 1, 2010 to May 1, 2022. The odds ratio (OR) statistic was calculated as a common measure of effect size. Publication bias was also examined in all eligible studies on COPD hospitalization using funnel plots and Egger's test, as well as trim-and-fill method for missing studies on COPD hospitalization. RESULTS: A total of 19 studies were included in this meta-analysis. Random-effects models were plotted to calculate the pooled effect size by measuring OR (χ2 = 349.95; df = 18; I2 = 94.86%; P = 0.007; Z = 2.68; P < 0.001). A 10-mg/m3 daily increase in PM2.5 concentration was associated with a 1.6% (95% CI: 0.4-2.9%) increase in COPD hospitalization. There was no publication bias regarding the association between COPD hospitalization and PM2.5 (bias = 1.508; 95% CI: -1.475, 4.491; t = 1.066; P = 0.301). The subgroups of age ≥ 65 years and Asian countries were associated with an increased risk of COPD hospitalization. Besides, higher risks were estimated in the subgroups of studies performed in the warm season, case-crossover studies, studies with three lag days, and studies without adjustments for humidity and temperature confounders, with very small heterogeneity. CONCLUSION: Evidence suggests that short-term exposure to PM2.5 increases COPD hospitalization. Further studies are needed to understand the mechanism of the association between PM2.5 and COPD for reducing air pollution, which can be beneficial for COPD patients.

Strengthening E-learning strategies for active learning in crisis situations: a mixed-method study in the COVID-19 pandemic.

BACKGROUND: Medical universities are responsible for educating and training healthcare workers. One of the fields significantly impacted by the pandemic is medical education. The aim of this study is to identify strategies for enhancing e-learning for active learning and finding solutions for improving its quality. METHODS: This mixed-method (quantitative-qualitative) research was conducted in 2023 at three selected universities in Mazandaran Province. In the quantitative phase, 507 students participated via stratified random sampling using a standard questionnaire. In the qualitative phase, data were collected through semi-structured interviews with 16 experts until data saturation was achieved. SPSS 21 and MAXQDA 10 software were used for data analysis. RESULTS: In the multivariate regression analysis, an increase of one point in the dimensions of student-teacher interaction, active time, immediate feedback, and active learning corresponded to an average increase in learning scores of 0.11, 0.17, 0.16, and 1.42 respectively (p≤0.001). After the final analysis in the qualitative phase, four main domains (infrastructure, resources, quantity of education, and quality of education) and 16 sub-domains with 84 items were identified. CONCLUSIONS: The greatest challenge in e-learning is the interaction and cooperation between students and teachers. The implementation of the identified strategies in this research could provide useful evidence for policymakers and educational administrators to implement interventions aimed at addressing deficiencies and enhancing e-learning.

Analysis of policy responses to COVID-19: a case study in Babol University of Medical Sciences (BUMS), Iran.

BACKGROUND: Preparation and financing of treatments, control of disease by limited resources, are known as the most important challenges encountered by the policy-makers involved in an epidemic outbreak. Therefore, the present study was conducted to analyze the policy responses of Babol University of Medical Sciences (BUMS) to Coronavirus (COVID-19). METHODS: A qualitative study was performed to investigate the policy responses of BUMS to COVID-19 in Babol of January to March, 2021. The statistical population included the experts, pundits, policy-makers and planners involved in four areas of management, treatment, healthcare, and health donation. Data collection was done according to interviews and policy documents, and the obtained data were analyzed based on the Walt and Gilson's policy triangle. RESULTS: There are five main themes to names: policy context, policy analysis, policy-making process, actors and stakeholders and 16 sub-themes. After several rounds of revision, the text of the interviews and policy documents were tagged and finally, various issues related to sub-themes were extracted. Also, two sub-themes entitled (improving the policy framework, People's participation) were obtained from the strategies to reduce the incidence of Covid-19 theme. CONCLUSIONS: (BUMS) was able to use the capacities and skills of experienced physicians, specialists and nurses to respond to patients awaiting treatment. Therefore, most of the policies were aimed at patient care and treatment. The lack of financial resources was compensated by health donors. But the (BUMS) could not use the power of the city government to control traffic and comply with health protocols and prevent infections. It was mainly the formulation and implementation of irregular and unstable policies.

A knowledge implementation model in health system management based on the PARIHS model.

BACKGROUND: The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran. METHODS: The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software. RESULTS:  The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model. CONCLUSION:  The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran.

BACKGROUND: Inappropriate ways of health services purchasing for cancer patients can be challengeable and costly and seriously affect the access to health services and outcomes. This study aimed at Factors affecting health services strategic purchasing for breast cancer patients. METHODS: As a mixed study, this research was conducted in Iran in 2020. In the qualitative phase, 21 specialists and professionals in the field of health services purchasing were purposefully selected and interviewed. After data saturation, interviews were analyzed with the framework analysis and a structured questionnaire was made based on these analyses. 400 breast cancer patients were selected by randomized sampling and completed the questionnaire. Data were analyzed with SPSS23 in p < .05. RESULTS: The highest mean rate of the three main categories belonged to "insurance trusteeship" (4.71 ± .35), followed by "supply management" (4.48 ± .27) and "financial performance" (4.48 ± .37). There were significantly differences between the mean rates of the main categories and the cut-off point (p < .001). In addition, "insurance trusteeship" ranked first (2.58), followed by financial performance (1.77) and supply management (1.65). CONCLUSION: Of main components in health services strategic purchasing for breast cancer patients, insurance trusteeship, supply management, and financial performance ranked first to third, respectively. Therefore, healthcare policy-makers should consider the placement of insurance trusteeship and coordinate between purchasers and providers for making reform in the health system.

Cost-effectiveness of allopurinol versus febuxostat in the treatment of gout patients: A systematic review.

Background: In recent years, increased longevity, poor dietary habits, and the rising prevalence of metabolic syndrome and hypertension have increased the prevalence of gout. Gout significantly increases direct and indirect costs and reduces the quality of life. Allopurinol and febuxostat are the most commonly used drugs for reducing uric acid levels and controlling this disease with different cost-effectiveness. The present systematic review compares the cost-effectiveness of these drugs. Methods: This was a systematic review of economic evaluations. Cochrane CENTRAL, Web of Science, PubMed, Embase, and the Cost-Effectiveness Analysis (CEA) Registry were searched up to April 30, 2018, based on the specific search strategy of each database. Keywords used in the search include gout, cost-effectiveness, allopurinol, and febuxostat in MeSH and free-text forms. Screening of identified studies, data extraction, and quality assessment were done independently by 2 reviewers. The quality of studies was assessed based on Drummond Checklist. Finally, a qualitative analysis was done to analyze the results. Results: A total of 94 studies were identified through database search and the review of references. After screening the titles, abstracts, and full-texts, 6 economic evaluations were included in the review. The majority of the studies had been conducted in the US using the Markov model, within a 5-year horizon, and from the payer's perspective, with the quality of life as a measure of effectiveness. In most studies, the incremental cost-effectiveness ratios (ICERs) of febuxostat per quality-adjusted life year (QALY) were below the threshold (10 000$/QALY and 30 000€/QALY). Conclusion: Febuxostat has been shown to be more cost-effective than allopurinol in all treatment sequences in studies that have used uric acid levels as the measure of effectiveness. Furthermore, in studies with the quality of life as the measure of effectiveness, febuxostat has been shown to be very cost-effective as the second-line treatment.

Prevalence rate of laboratory defined aspirin resistance in cardiovascular disease patients: A systematic review and meta-analysis.

BACKGROUND: Cardiovascular disease (CVD) is the first cause of mortality worldwide, with all the healthcare systems facing this very challenging issue. Aspirin continues to be the major gold-standard treatment worldwide in the prevention of thrombotic disease in patients with CVD, even though not all individuals respond to antiplatelet therapy in a similar way, being resistant to aspirin. The aim of this study was to determine the prevalence of laboratory defined aspirin resistance in CVD patients worldwide. METHODS: Relevant articles were identified through searching EMBASE, PubMed/ MEDLINE, ISI /Web of Science, Scopus, and the Cochrane Library, from January 2000 to February 2018. The methodological quality of the included studies was critically appraised using the Newcastle-Ottawa scale. The pooled prevalence of laboratory defined aspirin resistance was computed using the Der Simonian-Laird random-effect model. RESULTS: We included 65 studies, with a total of 10,729 patients. The overall prevalence of laboratory defined aspirin resistance in CVD patients was 24.7% ([95%CI 21.4-28.4]. Women were found to be at increased risk of laboratory defined aspirin resistance compared to men, with an odds ratio of 1.16 [95%CI 0.87-1.54]. CONCLUSION: Doctors and healthcare providers should pay special attention to aspirin resistance since lack of awareness could cause problems and increase mortality in these patients, if not properly treated with higher aspirin doses.

Association between PM2.5 and risk of hospitalization for myocardial infarction: a systematic review and a meta-analysis.

BACKGROUND: It is generally assumed that there have been mixed results in the literature regarding the association between ambient particulate matter (PM) and myocardial infarction (MI). The aim of this meta-analysis was to explore the rate of short-term exposure PM with aerodynamic diameters ≤2.5 µm (PM2.5) and examine its potential effect(s) on the risk of MI. METHODS: A systematic search was conducted on databases like PubMed, Scopus, Web of Science, and Embase with components: "air pollution" and "myocardial infarction". The summary relative risk (RR) and 95% confidence intervals (95%CI) were also calculated to assess the association between the PM2.5 and MI. RESULTS: Twenty-six published studies were ultimately identified as eligible candidates for the meta-analysis of MI until Jun 1, 2018. The results illustrated that a 10-µg/m 3 increase in PM2.5 was associated with the risk of MI (RR = 1.02; 95% CI 1.01-1.03; P ≤ 0.0001). The heterogeneity of the studies was assessed through a random-effects model with p < 0.0001 and the I2 was 69.52%, indicating a moderate degree of heterogeneity. We also conducted subgroup analyses including study quality, study design, and study period. Accordingly, it was found that subgroups time series study design and high study period could substantially decrease heterogeneity (I2 = 41.61, 41.78). CONCLUSIONS: This meta-analysis indicated that exposure - response between PM2.5 and MI. It is vital decision makers implement effective strategies to help improve air pollution, especially in developing countries or prevent exposure to PM2.5 to protect human health.

Interventions on reducing burnout in physicians and nurses: A systematic review.

Background: Burnout is one of the main factors in reducing the performance quality among hospital staff. Appropriate interventions can reduce burnout among physicians and nurses and result in promotion of the quality of services provided at hospitals. The present study aimed to provide a more comprehensive understanding of the interventions on burnout reduction among hospital physicians and nurses. Methods: Studies were searched from January 2000 to June 2017 in PubMed, Embase, Scopus, Cochrane, and Web of Science. Randomized clinical trials (RCTs) and pretest-posttest studies that had interventions to reduce the burnout of physicians and nurses were included. However, studies conducted on medical and nursing students and nonmedical providers or beyond hospitals were excluded. Results: Based on the study inclusion criteria, 12 RCTs and 6 pretest-posttest studies were included in the review. Most of the included studies were from Netherlands, the United States, and England. The interventions included team-based program, EMH-approach, and coping and communication skills training. Most of the interventions had a positive effect on burnout reduction. Nevertheless, some studies had no significant impact. Conclusion: The results showed that the most interventions used to improve burnout were improving communication skills, teamwork, participatory programs, and psychological interventions (Yoga, meditation, and mindfulness). The impact of these interventions can increase mental health in the long term. Burnout is a complicated problem and should be treated by combining interventions.

Prevalence of nosocomial infections in Iran: A systematic review and meta-analysis.

Background: Nosocomial infections represent a serious public health concern worldwide, and, especially, in developing countries where, due to financial constraints, it is difficult to control infections. This study aimed to review and assess the prevalence of nosocomial infections in Iran. Methods: Different databases were searched between January 2000 and December 2017. To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95% confidence interval. To examine the heterogeneity among studies, the I2 test were conducted. The reporting of observational studies in epidemiology (STROBE) checklist was used to assess the methodological quality of observational studies. To further investigate the source of heterogeneity, meta-regression analyses stratified by publication year, sample size and duration of hospitalization in the hospital were carried out. Results: 52 studies were included. Based on the random-effects model, the overall prevalence of nosocomial infection in Iran was 4.5% [95% CI: 3.5 to 5.7] with a high, statistically significant heterogeneity (I2=99.82%). A sensitivity analysis was performed to ensure the stability results. After removing each study, results did not change. A cumulative meta-analysis of the included studies was performed based on year of publication and the results did not change. In the present study, a high rate of infections caused by Klebsiella pneumoniae (urinary tract, respiratory tract, and bloodstream infections) was found. Conclusion: Preventing and reducing hospital infections can significantly impact on reducing mortality and health-related costs. Implementing ad hoc programs, such as training healthcare staff on admission to the hospital, may play an important role in reducing infections spreading.

The Prevalence of Migraine in Iran: A Systematic Review and Meta-Analysis.

CONTEXT: Migraine is a major dilemma and problem which affects public health and results to reduced quality of life. This study aimed to determine the prevalence of migraine in Iran. EVIDENCE ACQUISITION: A systematic search was conducted using Pub Med, Web of Science, Embase, Scopus, Ovid, Google Scholar, as well as Iranian databases including: MagIran, IranMedex and Scientific Information Databank, from 2000 to November, 2015. The Der-Simonian/Laird's random-effects model, with a 95% confidence interval was employed to estimate the overall pooled prevalence. Heterogeneity was investigated using subgroup analysis based on sample size and time of study. RESULTS: Thirty studies comprising 33,873 participants met the inclusion criteria for the analysis. The overall prevalence of migraine in Iran was 14% (95% CI, 12% to 17%), respectively. The overall prevalence was (8%; 95% CI 6% to 11%) according to the international classification of headache disorders (ICHD-1), (17%; 95% CI 13% to 21%) according to ICHD-2, and (18%; 95% CI 7% to 30%) according to the other questionnaire for migraine screener (ID Migraine), respectively. Meta-regression demonstrated that the prevalence of migraine increased by year of publication and decreased by sample size. CONCLUSIONS: The prevalence of migraine in Iran, which was estimated as 14%, was similar or even higher than that reported world-wide. Migraine can have impact on the economic productivity of any country; therefore it is necessary to educate people on the early detection and the discovery of an effective treatment of migraine. More thorough review of further studies in this field is recommended.