The process of hip fracture management before and during the COVID-19 pandemic in Iran.

BACKGROUND: The COVID-19 pandemic affected the control of many chronic conditions, including hip fractures, worldwide. This study was to examine the impact of the COVID-19 pandemic on the management of hip fractures in a referral orthopedic hospital in Iran. By understanding how the pandemic has influenced the care of hip fracture patients, we can gain valuable insights into the challenges, adaptations, and potential improvements in orthopedic healthcare during such public health crises. METHODS: Data was collected on hip fracture patients aged 50 and above who were admitted to the hospital before and during the pandemic. The number of admissions and operations, length of hospital stay, and time from admission to surgery were recorded from the hospital information system (HIS) and compared between the two periods. RESULTS: The median number of admitted hip fracture patients per month increased slightly during the pandemic (11%), although this increase was not statistically significant (p = 0.124). After adjusting for potential confounders, the mean length of hospital stay was significantly lower during the pandemic period, indicating that patients were discharged sooner (p = 0.019) and the time from admission to surgery was shorter during the pandemic (p = 0.004). Although the increase in the number of hip fracture surgeries per month during the pandemic was not statistically significant (P = 0.132), a higher percentage of patients underwent surgery during the pandemic compared to before (84.8% VS. 79.4%). CONCLUSION: The study suggests that the COVID-19 pandemic did not have a negative impact on hip fracture management in the investigated orthopedic hospital in Iran. further research is needed to explore the effects of the pandemic on other aspects of healthcare services, particularly in general hospitals.

Mortality and re-fracture rates in low trauma hip fracture.

OBJECTIVES: This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event. MATERIALS AND METHODS: This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013-2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture. RESULTS: A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06-20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50-7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively. CONCLUSION: Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population.

The association between quality of life and diabetes: the Bushehr Elderly Health Program.

BACKGROUND AND OBJECTIVE: Considering the importance of diabetes and its increased prevalence with aging, this study aimed to evaluate the association between diabetes status and quality of life (QOL) and the determining factors in individuals over 60. METHODS: Two thousand three hundred seventy-five individuals including 819 (34.5%) with diabetes, aged 69.4 ± 6.4, from Bushehr Elderly Health Program (BEHP) were enrolled. We categorized the participants as non-diabetic, controlled diabetic, and poorly controlled diabetic. The QOL was assessed using the SF-12 questionnaire. The physical (PCS) and mental (MCS) component summaries of QOL were estimated. We compared the SF-12 domains and components between the categories using ANOVA. Further, the association of diabetes status with PCS and MCS was assessed after adjustment for possible confounders including age, sex, depression, cognitive impairment, physical activity, and other relevant factors using linear regression analysis. RESULTS: Individuals with diabetes had lower PCS (40.9 ± 8.8 vs. 42.7 ± 8.6, p-value < 0.001), and MCS scores (45.0 ± 10.2 vs. 46.4 ± 9.4, p-value < 0.001) compared to participants without diabetes. No significant differences were observed in PCS or MCS scores between controlled or poorly controlled individuals with diabetes. Diabetes status was associated with PCS and MCS scores in univariable analysis. Regarding physical component of QOL, after adjusting for other confounders, poorly controlled diabetes was significantly associated with PCS [beta: -1.27 (-2.02, -0.52)]; some other determinants include depression [-7.66 (-8.51, -6.80)], male sex [3.90 (3.24,4.57)], and good physical activity [1.87 (1.17,2.57)]. As for the mental component, controlled diabetes was significantly associated with MCS [-1.17 (-2.13, -0.22)]; other contributing factors include depression [-14.35 (-15.34, -13.37)], male sex [1.97 (1.20,2.73)], good physical activity [-1.55 (-2.35, -0.75)], and smoking [-1.42 (-2.24, -0.59)]. BMI had an inverse association with PCS [-0.19 (-0.26, -0.13)] and a direct association with MCS [0.14 (0.07,0.21)]. CONCLUSION: Individuals with diabetes exhibited reduced QOL scores. Upon adjusting for other variables, it was found that uncontrolled diabetes correlated with decreased PCS scores, whereas controlled diabetes was linked to lower MCS scores. Factors such as depression and being female were identified as contributors to diminished QOL in both physical and mental aspects. These results have the potential to guide healthcare decision-making, facilitating the creation of tailored interventions aimed at improving the QOL for individuals with diabetes, with a specific focus on women and depression.

Epidemiological Insights into Diabetic Foot Amputation and its Correlates: A Provincial Study.

Background: Diabetic foot ulcer and potential subsequent lower extremity amputation are major complications of diabetes mellitus and are also prominent morbidity factors that could affect patients' quality of life. Objectives: This study aimed to assess the prevalence of diabetic foot amputation and explore correlates of amputation cause and type among subjects with diabetes mellitus in Tehran, Iran. Methods: A descriptive cross-sectional study was conducted to assess the demographic, sociological, and clinical characteristics of subjects who had undergone lower extremity amputation due to diabetic foot ulcers, from 2011 to 2020, in two educational medical centers in Tehran, Iran. We examined the medical records of 4676 individuals who were admitted to Shariati and Sina hospitals due to diabetic foot issues. Information related to patient demographics (age, gender, marital status), social factors (education level, insurance), and clinical data (medical history, laboratory results, and characteristics of diabetic foot ulcers) was collected for subjects who had undergone lower extremity amputation due to diabetic foot ulcer. The collected data was reported using average values, standard deviations and proportions and analyzed using statistical tests. Results: During one decade, 882 out of 4676 (18.8%) patients with diabetic foot ulcers underwent lower extremity amputations of various types in Sina and Shariati hospitals in Tehran, Iran. Of these, 692 (14.5%) were included for further analysis in the study and the rest were excluded due to lack of sufficient recorded data. About 75.9% of the study population was male, and the average age including both sexes was 60 years. About 92.7% were married, and on average, subjects had been afflicted with diabetes mellitus for 15.1 years. Statistical analysis using Pearson's chi-square test showed there was a significant association between the treatment regimen for diabetes mellitus and the type of amputation (P = .01), as well as between the duration of the disease and the cause of amputation (P = .01) and its type (P = .04). Conclusion: diabetes mellitus related treatment regimen and duration of disease are significantly associated with amputation cause and type.

Understanding Why and How Diabetic Patients Lose Their Feet: A Study from Tehran, Iran This study explored patients with diabetes in Tehran, Iran, experience foot problems leading to amputation. We looked at the records of 4676 patients over a decade, finding that 18.8% had lower limb amputations. Key factors included treatment methods for diabetes and the duration of the disease, significantly impacting the cause and type of amputation. These insights can guide better care to prevent such serious complications in patients with diabetes.

The association between anti-diabetic agents and osteoporosis, sarcopenia, and osteosarcopenia among Iranian older adults; Bushehr Elderly Health (BEH) program.

PURPOSE: Various risk factors are mentioned for osteoporosis, sarcopenia, and osteosarcopenia. Our aim is to assess the impacts of anti-diabetic drugs on these disorders. METHODS: To perform this study, the participants' data was extracted from the Bushehr Elderly Health (BEH) program in Iran. Afterward, the data were categorized into three subgroups: osteoporosis, sarcopenia, and osteosarcopenia, based on WHO and European Working Group on Sarcopenia in Older People (EWGSOP-2) working group definitions. Demographic characteristics, anthropometric measures, past medical history, and current medications were recorded. Pearson chi-squared and simple/multiple logistic regression using Python (3.11.4) and R (4.3.1) programming software assessed the association between anti-diabetic agents and these bone disorders. RESULTS: Out of 1995 participants, 820, 848, and 404 had osteoporosis, sarcopenia, or osteosarcopenia, respectively. Among all types of anti-diabetic drugs, a significant protective association between osteoporosis and consumption of second-generation sulfonylureas was found; Adjusted Odd Ratio (AOR) = 0.65 ([95% CI: 0.45-0.94], p-value = 0.023). No associations were found between sarcopenia and consumption of anti-diabetic agents. A significant association was observed between using Meglitinides and the risk of osteosarcopenia; AOR = 4.98 ([95% CI: 1.5-16.55], p-value = 0.009). CONCLUSION: In conclusion, a protective association between consumption of second-generation sulfonylureas and osteoporosis was found. Moreover, a positive association was found between the consumption of meglitinides and osteosarcopenia. However, to support these findings, further studies are recommended.

Mind the osteoporosis care gap with timely diagnosis: an executive summary of nationwide osteoporosis Campaigns 2019-2021.

Background: The World Osteoporosis Day inaugurate on October 20 every year by the International Osteoporosis Foundation to initiate bone health and osteoporosis as a global health agenda for policymakers, health care providers, and the public. The reported the campaigns activities in three years 2019, 2020, and 2021. The aim of this campaigns was to promote the osteoporosis awareness to close osteoporosis care and data gaps. Methods: World Osteoporosis Day campaigns were held during three consecutive years 2019-2021 through "structuring" and "implantation" phases. The slogan of "early detection and timely diagnosis of osteoporosis" was followed in different public awareness and healthcare professional educational events. Also, a short survey regarding the knowledge of women aged ≥ 50 years of osteoporosis was used in campaigns to gather data for future planning. These nationwide campaigns was supported by the Osteoporosis Research Center in collaboration with the non-communicable diseases management office of Iran's Ministry of Health. Results: All activities stablished to close the "data" and "awareness" gap in osteoporosis care. 1972, 1881, and 2538 women aged ≥ 50 were participated in the world osteoporosis campaigns and educated in 2019, 2020, and 2021, respectively. More than thousands of online and published educational materials were provided and disseminated in group and face-to-face and virtual education via celebration meetings in primary healthcare facilities, parks and shopping malls. The wide-ranging health slogans and massages was distributed by way of SMS, press conferences on television, radio, and other social media platforms. In addition, the in-person and virtual events such as up-date osteoporosis symposiums, national osteoporosis research network meetings, osteoporosis essential courses, and subspecialty one-day seminars provided knowledge for health care teams and policy makers. Conclusion: Closing the osteoporosis treatment gap was approached by nationwide campaigns to make an appropriate intervention to emphasize early diagnosis and awareness of osteoporosis to close the care gap. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01257-7.

Association between perceived stress and cardio-metabolic risk factors: preliminary results of NURSE (Nursing Unacquainted Related Stress Etiologies) study.

Objective: Stress is known as a conventional risk factor of cardiovascular disease. Nurses work in stressful environment and could be one of the target populations to be assessed for cardio metabolic risk factor. This study aimed to identify the association between perceived stress and cardio-metabolic risk factors in nurses who are prone for various metabolic diseases. Method: In this cross-sectional study, nurses from five different educational hospitals of Tehran University of Medical Science attended the study. A self-administered questionnaire as well as Perceived Stress scale were completed. All anthropometric indices and blood pressure were measured. After 10-12 hours of fasting, venous blood samples were taken and level of total cholesterol, triglyceride, high-density and low-density lipoprotein cholesterol, fasting blood sugar and insulin level were determined. Data were analyzed using SPSS version 16 and a p value less than 0.05 was considered statistically significant. Results: In total 273 nurses were recruited in this study. The mean age of participants was 35.01 ± 0.399 years old. The mean of perceived stress was 15.55 ± 5.04 with the minimum of 3 and maximum of 30. There was no significant association between perceived stress and cardio-metabolic risk factors. Results showed that there was a negative association between perceived stress and insulin level only in nurses who worked rotationally (ß = - 0.195, p = 0.048). This association remained significant after adjustment for age and sex (ß = - 0.181, P = 0.041). Conclusion: Finding of the current study showed that negative association between perceived stress and insulin level and there is no significant association between stress and cardio-metabolic risk factors in nurses.

Prevalence of osteosarcopenic obesity and related factors among Iranian older people: Bushehr Elderly Health (BEH) program.

Osteosarcopenic obesity is a new syndrome that has been recently discussed in the scientific community. It is a condition that affects the elderly and involves the loss of bone, muscle, and fat tissue. The few studies that have been done on this disease showed that it has a high prevalence among the elderly and can cause various complications. This study was the first one to investigate this syndrome in Iran, and found that its prevalence was 19.83%. BACKGROUND: Osteosarcopenic obesity syndrome (OSO) is a condition that involves osteopenia/osteoporosis, sarcopenia, and obesity. It leads to a reduction in the quality of life of the elderly and an increase in hospitalization which has attracted the attention of physicians. This study aimed to determine the prevalence and risk factors of osteosarcopenic obesity in people over 60 years of age in Bushehr. MATERIALS AND METHODS: We used data from the Bushehr study, which included 2426 participants aged ≥ 60 years. We assessed osteoporosis/osteopenia based on T-score; sarcopenia based on hand grip strength, skeletal muscle mass index (SMI), and walking speed; and obesity based on fat mass and BMI for diagnosing OSO. We first examined the factors related to OSO in the univariable analysis and then fitted the multiple logistic regression model, separately for women and men. The result was summarized as adjusted odds ratios with a 95% confidence interval. RESULTS: In total, 2339 elderly were examined in our study, of which 464 elderly were suffering from osteosarcopenic obesity. The standardized prevalence of OSO was 23.66% (95% CI: 21.15-26.16) in women and 18.53% (95% CI 16.35-20.87) in men. Age was positively linked to osteosarcopenic obesity in both genders and so was diabetes in men. However, education, physical activity, and protein intake were negatively linked to osteosarcopenic obesity in both genders, as well as hypertriglyceridemia and hypertension in women. CONCLUSION: The prevalence of OSO among men and women of Bushehr city is high and is related to increasing age, low levels of education, physical activity, and protein intake among women and men.

The burden of rheumatoid arthritis and low back pain in North Africa and Middle East from 1990 to 2019: Results from the Global Burden of Disease Study 2019.

BACKGROUND: Rheumatoid arthritis (RA) and low back pain (LBP) are among the most prevalent musculoskeletal disorders (MSDs). The need for investigation of regional and local patterns of these two MSDs seems inevitable for better policy-making. The current study presents updated results of the Global Burden of Disease (GBD) Study 2019 and reports the burden of RA and LBP in North Africa and Middle East (NAME) countries from 1990 to 2019. METHODS: Incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors, including high body mass index, occupational ergonomic factors, and smoking, were extracted based on the GBD 2019 data. RESULTS: The age-standardized prevalence and mortality of RA were 120.6 (95% uncertainty interval [95% UI] 107.0-135.7) and 0.1 (95% UI 0.1-0.2) per 100 000 population in 2019 with 28.3% (95% UI 25.5%-30.9%) increase and 7.5% (95% UI -37.5% to 32.5%) decrease since 1990, respectively. Turkey had the highest age-standardized incidence, prevalence, and DALYs of RA in 2019. All RA burden measures were higher for women; however, the incidence was almost the same at ages greater than 65 years. The age-standardized prevalence and DALYs of LBP were 7668.2 (95% UI 6798.0-8636.3) and 862 (95% UI 605.5-1153.3) in 2019, which had decreased by 5.8% (95% UI -7.4% to -4.3%) and 6.0% (95% UI -7.7% to -4.2%) since 1990, respectively. Moreover, although Turkey had the highest incidence and prevalence in 1990, Iran was at the top in 2019. The regional age-standardized DALY rates due to RA and LBP attributed to smoking were 1.7 (95% UI 0.5-3.2) and 139.4 (95% UI 87.3-198.8) in 2019, respectively, which had decreased 2.2% (95% UI -19.2% to 13.7%) and 15.4% (95% UI -19.4% to -10.5%) since 1990, respectively. CONCLUSION: RA still imposes a significant burden in the NAME region as the burden measures have increased from 1990 to 2019. On the other hand, regarding LBP, a decreasing pattern was observed. Differences among the countries and between ages and genders can have implications, and the results of this study may be helpful for policy-makers in the NAME countries.

Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care.

Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients' knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway's main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.

Evaluation of foot self-care status and foot screening problems in patients with diabetes in Iran: a national multicenter study.

BACKGROUND AND PURPOSE: The lack of timely foot care among individuals with diabetics often lead to ulceration followed by infection and amputation. This study aimed to evaluate the foot self-care status and foot screening practices among patients with type 2 diabetes in various cities across Iran. METHODS: The cross-sectional descriptive study was performed on patients with type 2 diabetes in 10 main cities of Iran. The information about demographic and lifestyle factors, diabetes history, and diabetic foot self-care (DFSQ) was assessed. Additionally, the neurological and vascular condition of the foot were screened by Inlow's 60-Second Screen. RESULTS: The study included 1094 diabetic patients with, with a majority being female (64.8%) and married (92.5%). The average age of the participants was 57.6 ± 10.21 (mean ± SD), and the mean duration of diabetes was 11.56 ± 7.41 years. Based on Inlow's 60-Second Screen criteria, 58% of the patients should undergo yearly foot ulcer screening, 47% exhibited peripheral neuropathy, and 37% were found to have inappropriate footwear. CONCLUSION: The high prevalence of peripheral neuropathy observed in approximately half of the participants across different regions of Iran underscores the importance of continuous patient education regarding foot care and appropriate footwear. Furthermore, regular foot ulcer screenings, following the recommended intervals outlined in Inlow's screening protocol, should be implemented to effectively manage diabetic foot complications.

Trend in global burden attributable to low bone mineral density in different WHO regions: 2000 and beyond, results from the Global Burden of Disease (GBD) study 2019.

Background: We aimed to document the current state of exposure to low bone mineral density (BMD) and trends in attributable burdens between 2000 and 2019 globally and in different World Health Organization (WHO) regions using the Global Burden of Disease (GBD) study 2019. Methods: We reviewed the sex-region-specific summary exposure value (SEV) of low BMD and the all-ages numbers and age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributed to low BMD. We compared different WHO regions (Africa, the Eastern Mediterranean Region, Europe, Region of the Americas, Southeast Asia, and Western Pacific), age categories, and sexes according to the estimates of the GBD 2019 report. Results: The global age-standardized SEV of low BMD is estimated to be 20.7% in women and 11.3% in men in 2019. Among the WHO regions, Africa had the highest age-standardized SEV of low BMD in women (28.8% (95% uncertainty interval 22.0-36.3)) and men (16.8% (11.5-23.8)). The lowest SEV was observed in Europe in both women (14.7% (9.9-21.0)) and men (8.0% (4.3-13.4)). An improving trend in the global rate of DALY, death, and YLL was observed during 2000-2019 (-5.7%, -4.7%, and -11.9% change, respectively); however, the absolute numbers increased with the highest increase observed in global YLD (70.9%) and death numbers (67.6%). Southeast Asia Region had the highest age-standardized rates of DALY (303.4 (249.2-357.2)), death (10.6 (8.5-12.3)), YLD (133.5 (96.9-177.3)), and YLL (170.0 (139-197.7)). Conclusions: Overall, the highest-burden attributed to low BMD was observed in the Southeast Asia Region. Knowledge of the SEV of low BMD and the attributed burden can increase the awareness of healthcare decision-makers to adopt appropriate strategies for early screening, and also strategies to prevent falls and fragility fractures and their consequent morbidity and mortality.

Osteoporosis medication adherence tools: a systematic review.

Poor adherence reduces the effectiveness of osteoporosis treatment, resulting in lower bone mineral density and subsequently higher fracture rates. Reliable and practical tools are needed to measure medication adherence. The aim of this systematic review was to find osteoporosis medication adherence measurement tools and assess their applicability. Osteoporosis adherence measurement tools and all their related keywords in PubMed, Embase, Web of Science, and Scopus databases were searched on 4 December, 2022. After excluding duplicates in the Endnote software, two researchers independently investigated the remaining articles and included all those that used a method for measuring adherence to osteoporosis pharmacotherapy. Articles that did not specify the medications evaluated or if the primary focus was not adherence excluded. Two common measures of adherence, i.e., compliance and persistence were included. Four separate tables were designed, one for direct methods, one for formulas, one for questionnaires, and one for electronic methods of measuring adherence to treatment. Quality assessment was performed for selected articles by the Newcastle-Ottawa Quality Assessment Scale (NOS). A total of 3821 articles were found, of which 178 articles met the inclusion and exclusion criteria. In general, five types of methods were observed to measure medication adherence of osteoporosis, including direct methods (n = 4), pharmacy records (n = 17), questionnaires (n = 13), electronic methods (n = 1), and tablet counting (n = 1). The most commonly used adherence measurement tool, based on pharmacy records, was medication possession ratio (MPR). Among questionnaires, Morisky Medication Adherence Scale was mostly used. Our findings show what tools have been used to measure medication adherence in osteoporosis patients. Among these tools, direct methods and electronic methods are the most accurate methods. However, due to their high cost, they are practically not used in measuring osteoporosis medication adherence. Questionnaires are the most popular among them and are mostly used in osteoporosis.

Adoption of IWGDF guidance on prevention and management of foot problems in diabetes for local use in Iran by ADAPTE methodology: a step toward best practice.

Purpose: Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim. Methods: The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated. Results: The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version. Conclusion: The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01121-0.

Extracting virtual modules of diabetes courses for training primary health care professionals: a scoping review.

Purpose: There is plenty of evidence on the interventions that can improve outcomes of diabetes. Thus, there is an urgent need to innovate and provide cost-effective ways to optimize the best care for diabetes. The aim was to examine the components of diabetes courses to extract training virtual modules for training primary health care professionals (PHCPs) (i.e. general practitioners, nurses and nutritionists). Methods: In this scoping review, a systematic approach based on the Arksey and O'Malley method was used. In order to develop the modules for diabetes courses, search strategy was developed using main keywords. Also, databases including PubMed, Web of Science, Scopus, CINAHL, ERIC and Embase, and Google search engine were searched up to April 10th 2021. Two researchers independently screened the retrieved courses. After removing duplicates, and according to the eligibility criteria, the components of each retrieved course were extracted. Results: Diabetes training courses have been selected to examine their components to extract training modules. Initially, we found 120 courses related to the training of PHCPs. All information about 44 courses were available online. The researchers reviewed the courses according to tool approved by panel of experts, inclusion criteria, and purpose of the study. Thus, we first extracted 23 eligible programs and 15 final programs were considered for extracting the modules. According to the tool developed by the panel of experts, we extracted 9 virtual modules for diabetes courses including principles, prevention or delay, management, complications, education, special conditions, information technology, referral system of diabetes for training PHCPs. Conclusion: Education is an important part of diabetes and needs of PHCPs should be addressed in educational programs in the future. The design of the diabetes training course based on extracted modules in this research for the training of PHCPs can help in this field.

Molecular Characteristics of Staphylococcus aureus Strains Isolated from Nasal Cavity and Wound Infections Among Diabetic Patients.

Staphylococcus aureus is the most common pathogen contributing to diabetic foot infections (DFI). Nasal transmission of S. aureus potentially increases the risk of endogenous infection. The aim of this study was to determine the genetic diversity and antibiotic resistance profile of S. aureus isolates in nasal and wound samples from diabetic patients. A cross-sectional study was conducted from July 2018 to September 2019. S. aureus was isolated from the anterior nares and wounds of diabetic patients. All S. aureus isolates were characterized by detection of resistance and virulence genes (mecA, ermA, ermC, hla, hlb, hlg, sea, lukDE, pvl), staphylococcal cassette chromosome mec (SCCmec)-typing and staphylococcal protein A (spa)-typing. A total of 34 S. aureus were isolated from the wounds of 115 diabetic patients with DFI. Twenty-four S. aureus isolates were collected from the anterior nares of patients, and thirteen patients had concurrent S. aureus in nasal and wound specimens. The prevalence of methicillin-resistant S. aureus (MRSA) in nasal specimens was noticeable (41.7%), and the most common spa-type in nasal and wound specimens was t14870. Nearly half of the patients with concurrent S. aureus in wound and nasal specimens had similar isolates from both sites. Our data suggest that detection and screening of S. aureus colonization in the nasal cavity may prevent subsequent endogenous infections, particularly with MRSA strains.

The Association of Cardiovascular Diseases Risk Scores and Osteosarcopenia Among Older Adult Populations: The Results of Bushehr Elderly Health (BEH) Program.

Considering the association of cardiovascular disease (CVD) with both osteoporosis and sarcopenia, this study aimed to explore the association between a newly developed CVD risk score and osteosarcopenia in the elderly population. Participants in the second phase of the Bushehr Elderly Health (BEH) program were included. Osteosarcopenia was defined as having both osteopenia/osteoporosis and sarcopenia. The 10-year CVD risk score was estimated using the WHO lab-based model. The participants were considered as high-risk if the CVD risk was ≥ 20%. The estimated risks were compared in individuals with and without osteosarcopenia. The association of CVD risk and osteosarcopenia was investigated using a logistic regression model, adjusted by potential confounders. In all, 2392 participants (1161 men) with a mean age of 69.3 (± 6.3) years were studied and 532 [242 (45.5%) men] individuals were diagnosed with osteosarcopenia. The median (IQR) CVD risks were 0.340 (0.214) and 0.229 (0.128) in men with and without osteosarcopenia, respectively (P < 0.001); In women, the corresponding values were 0.260 (0.147) and 0.207 (0.128), respectively (P < 0.001). Adjusted by confounders, CVD risk ≥ 20% in women, increased the odds of osteosarcopenia by 72%. Body mass index showed an inverse association with osteosarcopenia in both men (0.81, 95%CI: 0.78-0.85) and women (0.66, 95%CI: 0.62-0.70). Considering the area under the ROC curve, the models showed a discriminative ability of 82% in men and 89% in women. This study displayed a significant association between WHO CVD risk score and osteosarcopenia. Due to the difficult diagnosis of osteosarcopenia, the high association of cardiovascular risk score with this disease can help identify high-risk individuals and refer them for further diagnostic procedures. Considering the high prevalence of osteosarcopenia and its complications in the older population, comprehensive strategies are needed to find high-risk populations.

Assessment of quality of life and its affecting factors in osteosarcopenic individuals in the Iranian older adult population: Bushehr Elderly Health (BEH) program.

Objectives: This cross-sectional study, conducted as part of the Bushehr Elderly Health program stage II in Bushehr, Iran, aimed to evaluate health-related quality of life (HR-QoL) in individuals aged ≥ 60 with osteosarcopenia, a condition characterized by the co-occurrence of osteopenia/osteoporosis and sarcopenia. Given the increasing elderly population worldwide, understanding the HR-QoL of this demographic is crucial, with osteosarcopenia being a significant factor. Methods: The study enrolled 2369 participants aged ≥ 60 and collected demographic and anthropometric data. Various questionnaires, including the Short Form 12, Patient Health Questionnaire-9, Activities of Daily Living, and Instrumental Activities of Daily Living, were administered. Comparisons were made between individuals with and without osteosarcopenia. Regression models were employed to identify variables associated with HR-QoL in those with osteosarcopenia. Results: Key findings revealed that 22.5% of participants had osteosarcopenia. Significantly different HR-QoL measures were observed between the 2 groups, especially in physical functioning and physical component summary scores. Male gender, advanced age, and chronic illnesses were linked to lower physical and mental HR-QoL scores among those with osteosarcopenia. In female participants, a history of fractures and physical disability were associated with reduced quality of life. Conclusions: This study underscores the negative impact of osteosarcopenia on HR-QoL, particularly in male participants, with a focus on physical aspects. It also highlights age and chronic disease as contributing factors to diminished HR-QoL in individuals with osteosarcopenia. These findings emphasize the importance of addressing osteosarcopenia in the elderly population to improve their overall well-being.

The association of opioid consumption and osteoporosis in old men: Bushehr Elderly Health (BEH) program.

In a population of 1156 men aged ≥ 60 years, opioid drug use was reported by 4.1% (n = 47) of participants. Among opioids, opium was the most prevalent consuming drug (83%). Adjusting for potential confounders, opioid consumption showed a positive association with osteoporosis. PURPOSE: Limited evidence suggest a relationship between opioid consumption and osteoporosis. This study aims to investigate the possible association of osteoporosis and drug use among older adult men of Bushehr, Iran. METHODS: In this study, 1156 men aged ≥ 60 years of Bushehr Elderly Health (BEH) were included. Bone density and trabecular bone score (TBS) were measured using dual-energy X-ray absorptiometry. Total osteoporosis was noted based on osteoporosis at either site of the lumbar spine, femoral neck, and total hip densitometry. Drug use was defined as a self-reported current use of opioid drugs, either regular (daily) use or irregular consumption. Multivariable modified Poisson regression analysis was used for investigating the association of opioids and osteoporosis, reporting the adjusted prevalence ratio (APR) with 95% confidence interval (CI). The association between drug use and TBS was evaluated using a linear regression model. RESULTS: Opioid drug use was reported by 4.1% (n = 47) of participants. Among drug users, opium was the most prevalent consuming drug (83%). In all, 38.3% of drug users and 22.4% of non-users had osteoporosis (p-value = 0.011). Multivariable analysis showed that adjusting by age, education, smoking, alcohol consumption, body mass index, diabetes, and physical activity, a positive and significant association was detected between opioid drug use and the likelihood of osteoporosis (APR: 1.46, 95%CI: 1.02-2.10). Considering the potential confounders, the results also showed a negative association between drug consumption and TBS (ß: - 0.027, 95%CI: - 0.053, - 0.001). CONCLUSION: Opioid drug use has a positive association with osteoporosis in elderly men, independent of other conventional risk factors. Elderly drug users might be at a higher risk for osteoporotic fractures, given the effect of substance use on cognition. So, osteoporosis among drug users would be of importance, especially in countries where opium consumption is prevalent.

Mapping evidence of Iran diabetes research: protocol for a scoping review.

Background: A considerable amount of research funding goes to diabetes management strategies to improve therapeutic goals and reduce the burden of diabetes. A vast amount of the budget is wasted due to unnecessary studies. A scoping review is a pivotal study to overview the available evidence and avoid research waste. In this review, we will try to find out the scope of available studies on diabetes management interventions, identify associated research gaps, and prioritize future studies. Method: We will carry out a study using Arksey and O'Malley's scoping review framework. We will search the Scopus and PubMed databases from 01/01/2015 till 01/01/2020. Only original articles related to pharmacological and non-pharmacological management interventions will be included. These interventional studies should be conducted on the Iranian population. After data extraction, a descriptive data analysis will be used to present information in different charts or tables. We will evaluate related published articles based on their document type, level of evidence, type of diabetes, subject area, interventions types, main findings and outcomes. Discussion: This study represents the first attempt to sum up available studies related to diabetes management interventions performed in Iran. The results of this study will be useful for all the stakeholders and policy-makers involved in diabetes research. It can help clinicians to be informed about studies on management interventions and can guide scientists eager to diabetes research to choose their future research plans based on diabetes research requirements and gaps.