Testing Psychometrics of Healthcare Empowerment Questionnaires (HCEQ) among Iranian Reproductive Age Women: Persian Version

BACKGROUND: Producing high quality data needs an accurate measurement in any fields of study. This study aimed to test psychometrics of the Persian version Healthcare Empowerment Questionnaire (HCEQ) in relation to personal care among Iranian reproductive age women and to validate the instrument for future use.METHODS: A cross-sectional study was conducted on 549 reproductive age women in a health centers affiliated to Tehran University of Medical Sciences producing a response rate of 100%. Content validity was established using translation and backtranslation procedures, pilot testing, and getting views of expert panel. Construct validity was measured using explanatory factor analysis. Cronbach’s alpha was used to measure internal consistency, and intra-class correlation coefficients were used to confirm stability.RESULTS: The results indicated that explanatory factor analysis of 10 items in three dimensions explained 63.2% of the total variance. Validity and reliability of the 10-items of HCEQ with two response scales (perception of control and motivation of being empowered) assessed for internal quality showed the reliability of internal consistency (α=0.70; range=0.62-0.76). The correlation between convert (10 items) and apparent (3 factors) variables was 0.5 times higher than the revealed convergent validity.CONCLUSION: The findings of this study supported the reliability and validity of the Persian version of HCEQ to assess the degree of individual empowerment in relation to personal healthcare and services among reproductive age women. Therefore, the HCEQPersian version could be a useful, comprehensive, and culturally sensitive scale for assessing healthcare empowerment among reproductive age women.KEYWORDS: Healthcare Empowerment Questionnaire (HCEQ), Reproductive Age, Women, Reliability, Validit

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

نقش میانجی حساسیت به عدالت در رابطه بین سبک‌های دلبستگی و بی‌صداقتی تحصیلی دانشجویان

Background and Aim: Justice sensitivity is a stable personality trait that relates to prosocial behavioral tendencies and altruistic orientation. Secure attachment and deep emotional bond with others will increase justice sensitivity in students and prepare the ground for academic honesty and efficiency of education system. Considering the role of this personality trait in healthy educational behaviors; the purpose of this study is to investigate the antecedents and outcomes of justice sensitivity in a frame of a causal model. Methods: The present study is descriptive and in the form of structural equation modeling in which, the attachment styles were considered as independent variables, justice sensitivity as a mediating variable and academic dishonesty as a dependent variable. Participants were 240 (boys and girls) M.S. Shiraz University students. They completed Justice Sensitivity Scale, Revised Adult Attachment Scale and Academic Dishonesty Scale. Factor analysis method was used to verify validity and the Cronbach Alpha was applied to determine the reliability of the scales؛ Also, bootstrapping method in AMOS 24 was conducted to examine the mediational effects of the intervening variables. Ethical Considerations: Participants completed the scales online after they were informed of the study aims and were ensured on paper that the responses would remain confidential. Results: Results showed that attachment styles were significant predictor of academic dishonesty through which secure attachment style was negative significant predictor of academic dishonesty (β=-0/44, p=0/0001) and insecure attachment styles (avoidant and anxious) were respectively positive significant predictors of academic dishonesty (β=0/13, p=0/0001) and (β=0/36, p=0/0001). Results also revealed that secure attachment style predicted justice sensitivity positively (β=0/41, p=0/0001) and avoidant style predicted justice sensitivity negatively (β=-0/35, p=0/0001). Furthermore, results demonstrated that justice sensitivity mediated the relationship between attachment styles and academic dishonesty. In general; findings confirmed that secure attachment style decreases academic dishonesty through increasing the justice sensitivity. Conclusion: According to the hypothesis testing results, it can be concluded that Secure adults tended to hold positive self-image and positive image of others; meaning that they had both a sense of worthiness and an expectation that other people were generally responsive and trustworthy. This means that secure students will apply effective and ethical strategies to achieve their educational goals and never intend to violate the rights of others to gain academic legitimacy. Please cite this article as: Mohebbi L, Jowkar B. Mediating Role of Justice Sensitivity in Relationship between Attachment Styles and Academic Dishonesty. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2022; 16(47): e4.زمینه و هدف: حساسیت به عدالت یک ویژگی با ثبات شخصیتی است که با تمایلات رفتار جامعه‌پسند و گرایشات نوع دوستانه در ارتباط است. دلبستگی ایمن و ارتباط عاطفی عمیق با اطرافیان باعث افزایش حساسیت به عدالت در بین دانشجویان شده است و زمینه را برای صداقت تحصیلی و ارتقاء کارآمدی ساختار آموزشی فراهم می­آورد. با توجه به نقش این سازه­ی شخصیتی در تعیین رفتارهای سالم آموزشی، پژوهش حاضر بر آن است تا با ارائه­ی مدل علّی به بررسی پیشایندها و پیامدهای حساسیت به عدالت در فضای آموزشی بپردازد. مواد و روش­ ها: این پژوهش از نوع همبستگی در قالب مدل معادلات ساختاری است که در آن   روابط بین سبک­های دلبستگی (متغیر برونزاد)، حساسیت به عدالت (متغیر واسطه‌­ای) و بی‌صداقتی تحصیلی (متغیر ملاک)  مورد بررسی قرار خواهدگرفت. مشارکت­کنندگان 240 دختر و پسر از دانشجویان مقطع کارشناسی دانشگاه شیراز بودند. این افراد پرسشنامه حساسیت به عدالت، مقیاس سبک‌های دلبستگی بزرگسالان و مقیاس بی‌صداقتی تحصیلی را تکمیل نمودند. برای تعیین روایی ابزارها از روش­ تحلیل عامل تاییدی و جهت احراز پایایی مقیاس­ها از آلفای کرونباخ استفاده شد. شواهد نشان دهنده­ی روایی و پایایی مطلوب مقیاس­ها بود. به منظور بررسی مدل پژوهش از روش مدل یابی معادلات ساختاری و برای تعیین نقش واسطه­گری متغیر میانجی از روش بوت استرپ در نرم­افزار ایموس استفاده شد. ملاحضات اخلاقی: شرکت کنندگان پس از اطلاع از اهداف پژوهش و کسب اطمینان از محرمانه ماندن پاسخ­ها، پرسشنامه­ها را بصورت آنلاین تکمیل کردند. یافته ­ها: نتایج پژوهش نشان داد که سبک‌های دلبستگی پیش‌بین بی‌صداقتی تحصیلی بوده است؛ بدین شکل که سبک دلبستگی ایمن به طور منفی و معنادار و سبک‌های دلبستگی ناایمن بصورت مثبت و معنادار بی‌صداقتی تحصیلی را پیش بینی کردند. نتایج همچنین روشن ساخت که دلبستگی ایمن پیش‌بین مثبت و معنی‌دار و دلبستگی اجتنابی پیش‌بین منفی و معنی‌دار حساسیت به عدالت است. علاوه بر این نتایج حاکی از آن بود که حساسیت به عدالت در رابطه­ی سبک‌های دلبستگی و بی‌صداقتی تحصیلی نقش واسطه­ای معناداری دارد. در مجموع می­توان بیان داشت که سبک دلبستگی ایمن به واسطه­ی افزایش حساسیت به عدالت موجب کاهش بی‌صداقتی در تحصیل می­شود. نتیجه‌گیری: نتایج حاصل از آزمون فرضیه­ها بیان می­دارد که دلبستگی ایمن موجب ایجاد تصویر ارزشمندی از خود و تصویر پاسخگو و قابل اعتمادی از دیگران در فرد می­شود. این مسئله باعث می­شود تا دلبستگان ایمن از راهبردهای موثر و اخلاقی برای رسیدن به اهداف آموزشی خود استفاده کنند و هرگز در صدد کسب مشروعیت تحصیلی به قیمت تقلب و تضییع حقوق دیگران نباشند. &nbsp