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1.
Int J Med Inform ; 140: 104161, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32480360

RESUMO

BACKGROUND: There is an increasing trend in using network science methods and algorithms, including community detection methods, in different areas of healthcare. These areas include protein networks, drug prescriptions, healthcare fraud detection, and drug abuse. Counterfeit drugs, off-label marketing issues, and finding the healthcare community structures in a network of hospitals, are examples of using community detection in healthcare. OBJECTIVE: This paper attempts to find physicians' real medical specialties based on their prescription history. As a novel application of community detection in the healthcare field, this knowledge can be used as an alternative for missing values of the healthcare databases. Therefore, it could help scientists and researchers to obtain more accurate and more reliable results. METHODS: This research is done through the community detection method and applying big data tools as well as interviews with the field experts. The big data, which is used in this paper, includes 32 million written medical prescriptions in the year 2014, provided by the Health Insurance Organization. The results are validated both qualitatively and quantitatively. RESULTS: The findings reveal nine major communities of physicians, and labeling these communities by experts presents almost every specialty in the drug prescriptions field. Some of these communities are labeled as a single well-known specialty, and some others are consist of two or more specialties that have overlap with each other. CONCLUSION: After receiving the prescription data and getting the experts' opinions, it was revealed that some physicians might persistently prescribe drugs that are not in their fields of expertise. Regarding the accuracy of community detection and the use of existing data values, we proved this hypothesis.

2.
Arch Iran Med ; 23(6): 369-377, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32536173

RESUMO

BACKGROUND: Tobacco smoking is one of the most important avoidable causes of mortality from non-communicable diseases (NCDs). This study aimed to report the crude and standardized prevalence of current, ever, and secondhand smoking at national and provincial levels. METHODS: This study was performed through an analysis of the results of the STEPs survey 2016, which was conducted as a cross-sectional national study. The samples were selected via multistage cluster sampling and they were representative of general population aged ≥18 years in all provinces of Iran. All the data were analyzed via survey analysis while considering population weights. Age-standardized prevalence was also calculated for the Iranian national population in 2016 and the World Health Organization (WHO) Population 2000-2025. RESULTS: A total of 29963 subjects aged ≥18 years from all provinces of Iran, except for Qom, participated in this study. The age standardized prevalence of current tobacco smoking among adult males and females were 24.4% (95% CI: 23.6%-25.1%) and 3.8% (95% CI: 3.5%-4.1%), respectively. Among the participants, the majority of the current smokers were among those aged 45-54 years (14.5%; 95% CI: 13.6%-15.5%). With increase in age, the prevalence of secondhand smoking decreased to 34.8% (95% CI: 33.3%-36.7%) among people aged 18-24 years and to 22·6% (95% CI: 21.0%-24.3%) among subjects over 70 years. CONCLUSION: The result of the study can be used to inform policy makers about the status of smoking and help them to design policies for setting rules on and limiting the import of cigarettes and their components to the country.

3.
Arch Iran Med ; 23(5): 338-352, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32383619

RESUMO

OBJECTIVE: To explore historically primary healthcare (PHC) development in Iran in the light of development plans before and after the Islamic Revolution. The results of this study can be used to outline the future of PHC in the Iranian health system. METHODS: We conducted a retrospective analysis of the PHC development in the Iranian health system using data from relevant published and unpublished policy documents. The literature was retrieved and reviewed on the basis of predetermined inclusion criteria with no language or date restriction. The data were integrated and analyzed using content analysis. RESULTS: During various upstream development plans, the attitude of the policy makers to PHC has been very different, resulting in fundamental differences in addressing such an important issue and the consequent outcomes. In the aftermath of Iran's revolution, due to more understanding of PHC services importance and the principal slogans of the revolution to pay attention to villagers and vulnerable people, health policymakers paid more attention to PHC, which was not evident in previous periods. CONCLUSION: Despite considerable achievements in PHC, the history of PHC in Iran indicates frequent changes in planning and health provision structure. This suggests that the challenges facing the health sector today, the evolving needs and demands of the people, and population changes necessitate reinforcement and reform in the structure of the current PHC network as the main mission of Iran's Ministry of Health.

4.
Arch Iran Med ; 23(5): 353-355, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32383620
5.
Circulation ; 141(21): 1670-1680, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32223336

RESUMO

BACKGROUND: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017. METHODS: Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017. RESULTS: Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries. CONCLUSIONS: These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.

6.
BMC Public Health ; 20(1): 347, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183754

RESUMO

BACKGROUND: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. METHODS: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. RESULTS: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively. CONCLUSIONS: Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32174887

RESUMO

Background: Obesity has become a common health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the prevalence of overweight/obesity and the distribution of Body Mass Index (BMI) levels in the Iranian adult population, by sex, age, and geographical distribution. Methods: This was a large-scale national cross-sectional study of Non-communicable Diseases risk factor surveillance in Iran. Through a systematic random sampling cluster, 31,050 Iranian adult participants aged 18 years and over were enrolled in the study. The main research tools were used to assess three different levels of data, namely: (1) demographic, epidemiologic, and risk-related behavioral data, (2) physical measurements, and (3) lab measurements. Anthropometric measurements were taken using standard protocols and calibrated instruments. Results: In 2016, the national prevalence rates of normal weight, obesity, and overweight/obesity among Iranian adults were, 36.7% (95% CI: 36.1-37.3), 22.7% (22.2-23.2), and 59.3% (58.7-59.9), respectively. There was a significant difference between the prevalence of obesity among males [15.3% (14.7-15.9)] and females [29.8% (29.0-30.5)] (p < 0.001). The 55-64 [31.5% (30.1-33.0)] and the 18-24 [8.3% (7.3-9.4)] year-old age groups had the highest and lowest prevalence of obesity, respectively. The results show a geographical pattern at provincial level, where the level of BMI increases among populations ranging from the southeastern to the northwestern regions of the country. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: We found a significant difference between the prevalence of obesity in males and females. Moreover, there was a considerable difference in the geographical pattern of the prevalence of obesity and overweight. Further evidence is warranted to promote strategies and interventions related to prevention and control of factors that are associated with weight gain.

8.
Arch Iran Med ; 23(2): 61-68, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32061067

RESUMO

BACKGROUND: In this study, we seek to evaluate the population health improvements during the previous four decades in Iran. We have estimated the levels and trends of child and adult mortality in addition to life expectancy from 1979 to 2019 at national and sub-national levels using all the available data. METHODS: In this study, we used data from National and Sub-National Burden of Diseases study and employed Bayesian Averaging Model (BAM) to predict mortality rates and life expectancy from 1979 to 2019. By including all available data sources of death information of Iran, including national level data from the Institute for Health Metrics and Evaluation (IHME), national censuses, Demographic and Health Survey (DHS), and Death Registration System (DRS) and using Spatio-Temporal and Gaussian Process Regression (ST-GPR) models, we estimated mortality rates and life expectancy from 1990 to 2015. We also used a BAM to project our desired indices until 2019. RESULTS: Both child and adult mortality rates decreased dramatically over the period. At the national level in Iran, in 2019, child mortality rate (deaths per 1000 livebirths), was 16.0 (95%UI: 13.0-19.6), adult mortality rates [probability of death (%)] for females and males were 6.1 (5.4-6.8) and 11.5 (10.3-12.8), respectively. Also, life expectancy values for females and males were 81.6 (80.7-82.2) and 76.1 (75.3-76.6), respectively. The results were consistent for both sexes. Despite the total narrowing gaps among provinces, a difference can still be observed particularly for the border provinces regarding child mortality rates. However, the difference in the other measures are inconsiderable. From 1979 to 2019, the overall change percent in child mortality rate, adult mortality rate for females and males and life expectancy for females and males were -86.3% (-89.0%--83.1%), -52.5% (-60.9%--42.9%), -48.7% (-56.9%- -39.6%), 25.3% (20.8%-31.5%), and 31.3% (25.5%-41.3%), respectively. CONCLUSION: This study provides an overview of the previous 40 years of mortality rates (child and adult) and life expectancy. The provided framework of national and sub-national evaluation can be used by researchers to continue the path of providing information for prioritization and evaluation of programs and also performing cost-effectiveness analysis for proposing efficient strategies to policy makers.

9.
Asia Pac J Clin Oncol ; 16(3): 129-136, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32030897

RESUMO

AIM: Lung cancer is the most common cancer in incidence and mortality worldwide. The aim of the current study was to present population-based estimates of lung cancer epidemiology by gender and age group at national and subnational levels during the 27-year period of 1990-2016. METHODS: This study was part of the NASBOD project (National and Subnational Burden of Disease, Injuries, and Risk Factors). Cancer incidence and mortality statistics were obtained from the Iran Cancer Registry database and the national Death Registration System. The two-stage mixed effects and spatiotemporal model were fitted to all-cancer incidence and mortality data. Thereafter, the cancer-specific incidence and mortality fraction for each age group, gender, province, and year were applied to the data to estimate the lung cancer incidence and mortality. RESULTS: The age-standardized incidence rate showed a sevenfold increase during 27 years of the study. Lung cancer deaths showed an upward trend from 1990 to 2001 and subsequently decreased during the latter half of the study period. At provincial level, there was a wide range between the lowest and highest, from 3.2 to 13.2 in incidence rate and from 5.2 to 10.7 in mortality rate. CONCLUSION: The study showed an increasing trend in lung cancer incidence at national and subnational levels from 1990 to 2016, while the mortality rate peaked and then declined in the 2000s. The increasing trend of lung cancer in the overall population and the provincial disparities necessitate urgent implementation of preventive strategies and cancer control policies.

10.
Int J Stroke ; 15(2): 132-148, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30226449

RESUMO

BACKGROUND: Iran lacks a population level comprehensive assessment of stroke epidemiology. Using data from the NASBOD Study, we estimated the mortality of stroke among the Iranian population from 1990 to 2015. METHODS: Data were collected from all the available sources including the national death registration system and two major cemeteries. After addressing incompleteness of child and adult death data and by using mixed effect model, spatio-temporal model and Gaussian Process Regression, levels and trends of child and adult mortality were estimated. By considering cause fraction to these estimates; cause specific mortality was estimated. In these process wealth index, urbanization, and years of schooling were used as covariates. RESULTS: In 2015, the age-standardized stroke mortality rate due was 47.76 (95% UI: 34.68-65.03) for males and 40.16 (30.38-5 2.72) for females, per 100,000 population. Stroke occurrence for both ischemic and non-ischemic strokes showed decreasing trends in both sexes after 2001-2002, at national and sub-national levels. The highest and lowest mortality rates between provinces ranged from 52.11 (40.3-66.66) to 24.47 (18.71-31.79) in men and from 65.51 (47.13-89.41) to 30.43 (21.95-41.82) in women per 100,000 population. CONCLUSION: Although age-standardized rates of stroke mortality are falling, in the past three decades, the absolute number of people who have had a stroke has increased. Stroke mortality remains high in Iran.

11.
Eur J Nutr ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31802196

RESUMO

PURPOSE: There is a direct association between salt intake and blood pressure (BP), one of the main risk factors for CVDs. However, yet there has been a debate that how strong is this association in people with and without hypertension. This study was conducted to evaluate the magnitude of the association between salt intake and BP in hypertensive and normotensive population among a nationally representative population. METHODS: The study was conducted on a nationally representative sample of 18,635 Iranian adults aged 25 years and older who participated in the STEPS survey 2016 and provided urine sample. Salt intake was estimated through spot urine sample and Tanaka equation. Multiple linear regression model in survey data analysis was used to assess the independent effect of salt intake on BP. RESULTS: After adjusting for covariates, there was a significant association between salt intake and SBP in hypertensive (p < 0.001) and normotensive people (p < 0.001). In hypertensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.37 mmHg and 0.07 mmHg, respectively. Whereas in normotensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.26 mmHg and 0.05 mmHg, respectively. Moreover, there was a significant trend toward an increase of SBP across salt intake quartiles in both hypertensive (p < 0.001) and normotensive people (p = 0.002), though the slope was steeper in hypertensive than in normotensive people. CONCLUSIONS: The present study demonstrated that salt intake significantly increased SBP in both hypertensive and normotensive people, though the magnitude of this increase was greater in hypertensive people as compared with normotensive people.

13.
BMC Public Health ; 19(1): 1266, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519165

RESUMO

BACKGROUND: Insufficient physical activity (IPA) is one of the leading causes of premature mortality through the increased burden of non-communicable diseases. From 1990 to 2017, the percentage of low physical activity attributable disability-adjusted life years (DALY) increased globally by 1.5 times and 2-fold in Iran, causing more than 1.2 million deaths worldwide and 18,000 deaths in Iran in 2017. Reports suggest that Iran, a developing middle-income country, suffers from a high level of IPA. Socioeconomic and cultural alterations along with the country's developments expose the population to IPA risk. We aimed to describe IPA prevalence in Iran's adult population, categorized by demographics, geographical region, and activity domains to assess the present pattern of physical inactivity and its domains in the country. METHODS: In 2016, in order to represent Iran's adult population, adult participants (n: 30541) from 30 provinces were selected using systematic proportional to size cluster sampling. Physical activity (PA) was assessed via the Global Physical Activity Questionnaire, calculating the Metabolic Equivalent of Task (MET) value in minutes per week for work, recreation, and transport domains. Insufficient physical activity (IPA) was defined according to WHO's recommendation (less than 600 METs per week). Adjusted odds ratios of IPA associates for sociodemographic, lifestyle related variables, and metabolic risk factors were reported. RESULTS: A high prevalence of IPA was seen in the total population (54.7%, 95%CI: 54.0-55.3) with a considerable difference between the two genders (males: 45.3% (95%CI: 44.3-46.3); females: 61.9% (95%CI: 61.0-62.7)). Work-related activity was the domain with the greatest percentage of total PA, whereas, both genders lacked recreational activities. In our findings, being female, a housekeeper, younger and living in urban areas were significantly associated with higher levels of IPA. Moreover, insufficient fruit and vegetable consumption, lack of alcohol consumption, having a personal vehicle, and finally, having a medical history of diabetes were significantly associated with the presence of IPA in our population. Among the study population, 33.6% (95%CI: 33.0-34.2) had at least 4 h of sedentary behavior in a typical day. CONCLUSIONS: Widespread IPA among the Iranian adult population is of major concern. In our findings, we observed a considerable gap in the prevalence and pattern of IPA between the two genders. Additionally, IPA was associated with living in urban areas, unhealthy lifestyle habits and a history of other metabolic risk factors. Thus, a prompt initiative for population-specific actions should be taken.


Assuntos
Exercício Físico , Vigilância da População , Adolescente , Adulto , Idoso , Feminino , Humanos , Irã (Geográfico) , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Sedentário , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
14.
Environ Pollut ; 255(Pt 1): 113173, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521993

RESUMO

Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 µm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 µm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 µg/m3 (UI: 19.03-24.9) and 35.4 µg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Material Particulado/toxicidade , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China , Exposição Ambiental/estatística & dados numéricos , Humanos , Irã (Geográfico) , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/mortalidade , Isquemia Miocárdica/induzido quimicamente , Isquemia Miocárdica/mortalidade , Material Particulado/análise , Saúde Pública , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/mortalidade , Infecções Respiratórias/induzido quimicamente , Infecções Respiratórias/mortalidade , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/mortalidade
16.
Environ Pollut ; 254(Pt B): 113121, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31493628

RESUMO

There is limited evidence for short-term association between mortality and ambient air pollution in the Middle East and no study has evaluated exposure windows of about a month prior to death. We investigated all-cause non-accidental daily mortality and its association with fine particulate matter (PM2.5), nitrogen dioxide (NO2), and the Air Quality Index (AQI) from March 2011 through March 2014 in the megacity of Tehran, Iran. Generalized additive quasi-Poisson models were used within a distributed lag linear modeling framework to estimate the cumulative effects of PM2.5, NO2, and the AQI up to a lag of 45 days. We further conducted multi-pollutant models and also stratified the analyses by sex, age group, and season. The relative risk (95% confidence interval (CI)) for all seasons, both sexes and all ages at lag 0 for PM2.5, NO2, and AQI were 1.004 (1.001, 1.007), 1.003 (0.999, 1.007), and 1.004 (1.001, 1.007), respectively, per inter-quartile range (IQR) increment (18.8 µg/m3 for PM2.5, 12.6 ppb for NO2, and 31.5 for AQI). In multi-pollutant models, the PM2.5 associations were almost independent from NO2. However, the RRs for NO2 were slightly attenuated after adjustment for PM2.5 but they were still largely independent from PM2.5. The cumulative relative risks (95% CI) per IQR increment reached maximum during the cooler months, including: 1.13 (1.06, 1.20) for PM2.5 at lag 0-31 (for females, all ages); 1.17 (1.10, 1.25) for NO2 at lag 0-45 (for males, all ages); and 1.13 (1.07, 1.20) for the AQI at lag 0-30 (for females, all ages). Generally, the RRs were slightly larger for NO2 than PM2.5 and AQI. We found somewhat larger RRs in females, age group >65 years of age, and in cooler months. In summary, positive associations were found in most models. This is the first study to report short-term associations between all-cause non-accidental mortality and ambient PM2.5 and NO2 in Iran.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar , Mortalidade , Dióxido de Nitrogênio/toxicidade , Material Particulado/toxicidade , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/análise , Exposição Ambiental , Feminino , Humanos , Irã (Geográfico) , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/análise , Material Particulado/análise , Medição de Risco , Adulto Jovem
17.
PLoS One ; 14(8): e0221462, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31461470

RESUMO

BACKGROUND: Frequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology. METHODS: In this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling. RESULTS: There were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels. CONCLUSION: Results showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Objetivos , Sistemas de Infusão de Insulina , Insulina/uso terapêutico , Comorbidade , Feminino , Humanos , Insulina/administração & dosagem , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento
18.
Arch Iran Med ; 22(6): 293-300, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31356095

RESUMO

BACKGROUND: Cancer, a common disease in adulthood, is a rare albeit slowly increasing condition among children. Currently, limited data are available on the incidence, prevalence, and mortality of these diseases in many regions, including developing countries. Herein, we are reporting national and sub-national estimates on deaths due to childhood cancers between 2000 and 2015 in Iran. METHODS: Cancer mortality rates were estimated using the national death registration system's data after addressing its incompleteness and misclassification, using demographic (complete birth history and summary birth history) and statistical analysis (spatiotemporal, Gaussian process regression, and generalized linear mixed models). We included data from cemeteries of two cities (Tehran and Isfahan) that were not included in the death registration system. We used census data and household expenditure and income surveys for data on population and other covariates used in the modeling. RESULTS: The overall age-standardized death rate (ASDR) of childhood cancers have decreased by 69.52% (80.67-49.71) in Iran (equal to an annual percent change of -3.63 [-4.53- -2.24]), declining from 12.24 (95% UI: 10.52-14.49) in 2000 to 3.73 (2.8-5.29) deaths per 100000 in 2015. This decrement was equal to an annual percent change of 4.35% over these years. Leukemia, brain, and nervous system malignancies accounted for about 66% of all cancer-related mortalities among children and adolescents in 2015, which had a 10% increase compared to 2000. Moreover, trends at the sub-national level showed that the highest and lowest ASDR of childhood cancers ranged from 2.12 to 4.99 across provinces of Iran in 2015. CONCLUSION: Although the overall mortalities have decreased, there is still inequality in the distribution of the recorded deaths. This inequality should be addressed with the improvement of the quality of care and better access to pediatric hospitals and oncologists in these areas.

19.
20.
Talanta ; 201: 350-357, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31122434

RESUMO

In this work, a novel electrochemical biosensor has been fabricated based on step-by-step modification of a glassy carbon electrode (GCE) with methylene blue (MB)-DNA/multiwalled carbon nanotubes (MWCNTs)-chitosan (CS)/palladium nanoparticles (Pd NPs)/fullerene C60 (C60) for voltammetric and impedimetric detection of DNA damage induced by bisphenol A (BPA). Modifications applied to the GCE were characterized by cyclic voltammetry (CV), differential pulse voltammetry (DPV), electrochemical impedance spectroscopy (EIS) and scanning electron microscopy. The EIS and DPV responses of the biosensor were increased and decreased, respectively, by the DNA damage induced by BPA which led us to develop novel systems for detection of DNA damage. Our records confirmed that the biosensor was able to rapid and sensitive detection of DNA damage induced by BPA. Finally, according to the developed systems for detection of DNA damage, we have developed voltammetric and impedimetric methods for determination of BPA.


Assuntos
Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/análise , Dano ao DNA/efeitos dos fármacos , DNA/química , Fenóis/efeitos adversos , Fenóis/análise , Técnicas Biossensoriais/instrumentação , Técnicas Biossensoriais/métodos , Quitosana/química , Espectroscopia Dielétrica/métodos , Técnicas Eletroquímicas/instrumentação , Técnicas Eletroquímicas/métodos , Eletrodos , Limite de Detecção , Nanopartículas Metálicas/química , Azul de Metileno/química , Nanotubos de Carbono/química , Paládio/química , Reprodutibilidade dos Testes
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