Epidemiological status of type 2 diabetes mellitus in the Middle East and North Africa, 1990-2019.

Background: Type 2 diabetes mellitus (T2D) is associated with various complications and imposes significant economic pressures. Aims: The aim of this study was to determine the epidemiological status and the burden of T2D in the Middle East and North Africa (MENA) countries during 1990-2019; to inform targeting of prevention strategies. Methods: The study population included 21 countries, covering a population of about 400 million. The global burden of disease 2019 database was used. Disability-adjusted life years (DALYs) were computed by summing up the years of life lost and the years lived with disability. Prevalence, incidence, death rates and DALY rates per 100 000 people for all locations by age-standardized rates were calculated. Results: In 2019, Qatar had the highest prevalence [16312.4; 95% unit interval (UI): 15050.0-17723.2] and incidence rates (818.0; 95% UI: 773.9-868.7) of T2D Bahrain had the highest death (127.0; 95% UI: 102.5-154.6) and DALYs (3232.5; 95% UI: 2622.4-3929.3) rates In the MENA area, average DALY rates increased by nearly 31% (808.3 to 1060.8) and average death rates increased by 0.2% (24.8 to 25.2) during 1990-2019. The highest increase for T2D-related DALYs (516.5 to 958.1; 85%) and the highest increase for T2D-related deaths (12.5 to 22.0; 76%) was in the Islamic Republic of Iran. Conclusion: Prevalence, incidence, deaths and DALYs rates for T2D have continued to increase in most of the MENA countries. Health care systems must make efforts to control modifiable risk factors.

Causes and Predictors of Hospital-Death among Elderly Patients in Western Iran; a Hospital-Based Cross-Sectional Study.

INTRODUCTION: Identifying the death reasons amongst elderly, may help prioritizing the research projects and interventions. OBJECTIVE: This study purpose was to determine the death pattern and causes, and also its likely associated factors, in a mega hospital in western Iran. METHOD: This retrospective cross-sectional study, conducted on elderly died from April 2011 to March 2016, in Imam Reza hospital in Kermanshah, Iran. The data were collected about the demographic characteristics, medical information, and the main death causes. The causes-of-death was classified adopting the International Classification of Diseases, Tenth Revision (ICD-10). The relationships between outcome and predicting variables were assessed by using Chi-square and Tukey's test in SPSS. RESULTS: Totally, 2415 died elderly were registered during the study period. The participants mean age at the time of their death was 75.35±9.15 years old. The diseases of circulatory system (dominancy of stroke), infectious diseases (leading by septicaemia and septic shock, respectively), and respiratory system diseases were the most common death causes, respectively. Age was the most important associated factor for the all-cause mortality related to the cardiovascular diseases (p=0.001). CONCLUSION: The majority of deaths were the premature, which requires paying more attention. Although, cardiovascular diseases were the leading death causes and that is predictable, but the fatality of infectious diseases is still causing concerns.

Circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction in western Iran.

BACKGROUND: Circadian variation is known as an important factor in acute myocardial infarction (AMI). Moreover, the circadian pattern may help in disease prevention and better medication prescription. Therefore, the aim of our study was to investigate the circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: This cross-sectional study was conducted on 777 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of STEMI from March 2018 to February 2019. Data were collected using a checklist developed based on the study's objectives. Differences between subgroups were assessed using one-way analysis of variance (ANOVA) with post-hoc testing and chi-square test (or Fisher's exact test). RESULTS: Out of the 777 patients, 616 (79.3%) were men. The mean and standard deviation (SD) of age of the patients was 60.93 ± 12.86 years. 380 patients (48.9%) were current smoker, 40.3% were hypertensive, 21.1% had hypercholesterolemia, 18.3% had diabetes mellitus (DM), 25.2% had history of angina, and about 15.0% had history of myocardial infarction (MI). The occurrence of STEMI was most common during hours between 06:01-12:00 (27.7%), followed by 12:01-18:00 (27.3%), 00:00-06:00 (24.3%), and 18:01-24:00 (20.7%), respectively. Gender was significantly associated with circadian pattern of STEMI. Women showed a double peak of symptom onset in 06:01-12:00 and 12:01-18:00. CONCLUSION: The present study of Iranian patients displayed circadian pattern of STEMI with 2 peaks in the morning and afternoon, and the both peaks were dominated by women.

Gender-based difference in early mortality among patients with ST-segment elevation myocardial infarction: insights from Kermanshah STEMI Registry.

Introduction: This study aimed to evaluate the in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI), according to gender and other likely risk factors. Methods: This study reports on data relating to 1,484 consecutive patients with STEMI registered from June 2016 to May 2018 in the Western Iran STEMI Registry. Data were collected using a standardized case report developed by the European Observational Registry Program (EORP). The relationship between in-hospital mortality and potential predicting variables was assessed multivariable logistic regression. Differences between groups in mortality rates were compared using chi-square tests and independent t-tests. Results: Out of the 1484 patients, 311(21%) were female. Women were different from men in terms of age (65.8 vs. 59), prevalence of hypertension (HTN) (63.7% vs. 35.4%), diabetes mellitus (DM) (37.7% vs. 16.2%), hypercholesterolemia (36.7% vs. 18.5%) and the history of previous congestive heart failure (CHF) (6.6% vs. 3.0%). Smoking was more prevalent among men (55.9% vs. 13.2%). Although the in-hospital mortality rate was higher in women (11.6% vs. 5.5%), after adjusting for other risk factors, female sex was not an independent predictor for in-hospital mortality. Multivariable analysis identified that age and higher Killip class (≥II) were significantly associated with in-hospital mortality rate. Conclusion: In-hospital mortality after STEMI in women was higher than men. However, the role of sex as an independent predictor of mortality disappeared in regression analysis. The gender based difference in in-hospital mortality after STEMI may be related to the poorer cardiovascular disease (CVD) risk factor profile of the women.

Socio-cognitive determinants of safe road-crossing behaviors: an application of the prototype willingness model.

BACKGROUND: Pedestrians are one of the most vulnerable groups of road users that potentially are at risk for road traffic injuries and deaths. The present paper reports an application of the Prototype Willingness Model (PWM) to the prediction of road-crossing behaviors among students from Kermanshah University of Medical Sciences (KUMS) in the west of Iran. METHODS: This cross-sectional study was carried out among a sample of 315 medical students who were randomly selected from seven faculties of KUMS in 2017 according to their size, and who filled out a self-administered questionnaire containing a scenario depicting a potentially hazardous road-crossing behavior, followed by items measuring the PWM constructs. Data were analyzed by SPSS version 16 at 95% significant level. RESULTS: The mean score of safe road-crossing behaviors was 9.57 [95% CI: 9.10, 10.05], ranging from 0 to 16. Attitude, subjective norms, and prototype accounted for 15% and 9% of the variation of willingness and intention, respectively. Willingness was a stronger predictor of the safe road-crossing behaviors (P less than 0.001). The road crossing behavior of female student pedestrian was safer than that of their male counterparts (P less than 0.035). CONCLUSIONS: The results have a number of implications. In particular, PWM-based interventions should focus on willingness in order to encourage safer road-crossing behavior among pedestrians.

The effect of team-based learning on public health students' educational outcomes.

BACKGROUND: The educational environment has been confirmed as crucial factor for active learning. Team-based learning (TBL) is an interactive teaching method which improves students' perceptions and performance. OBJECTIVES: The comparison of the team-based learning method through lecture-based approach on health education curriculum in public health students. METHODS: A quasi-experimental study was conducted among 23 public health students of bachelor degree and 14 public health students of associate degree to teach communication and Health Education in Qom University of Medical Sciences from January 2015 to Jun 2016. Students of bachelor degree selected TBL and students of associate degree preferred the traditional lecture-based method. In the current study, educational outcomes were defined as educational environment and academic performance. At the last session of the semester, the educational environment and academic performance of both groups were evaluated. Data were analyzed by SPSS version 20.0 using Chi-square and Mann-Whitney test. RESULTS: The mean and standard deviation of individual test score between the two groups showed significant difference based on Mann-Whitney results (P = 0.036). The mean of final examination score in TBL group was significantly higher than the traditional lecture group (P < 0.021, Mann-Whitney). Our findings showed that in TBL group, 78.3% of students' perceptions were in very favorable condition while it was only 28.6% for students of the traditional method. CONCLUSIONS: TBL method improves students' perceptions about each area of educational atmosphere and also provides opportunities to innovate which lead to active teamwork among learners, and it can effectively enhance students' academic performance.

Determinants of Compliance With Iron and Folate Supplementation Among Pregnant Women in West Iran: A Population Based Cross-Sectional Study.

Objective: To assess the compliance with iron and folate supplementation, and the possibly causally associated factors, among pregnant women in western Iran. Materials and methods: A cross-sectional study of 433 pregnant women, selected randomly amongst those (n = 8,500) attending 40 primary health care centers (PHCCs) in west Iran in 2017. A validated questionnaire was used to gather data, including demographic characteristics, the compliance with iron/folate supplementation and reasons for non-compliance. Results: The participants' mean age and the duration of their pregnancies when commencing supplementation were (27.86 ± 5.54y [µ ± SD]) and (23.29 ± 9.86w), respectively. The compliance was 71.6% / 28% for iron, and 81.5% / 40% for folate. The commonest causes of poor compliance were forgetfulness and side-effects. Educational status, age, and history of anemia were significantly positively associated with folate compliance. The compliance with iron was associated only with the level of education. Conclusion: Although the compliance with iron and folate was relatively high, most women had not started taking the supplements regularly or at the correct time, usually due to forgetting and/or experiencing adverse side-effects.