تأثير آموزش مبتني بر الگوي اعتقاد بهداشتي و ارتقاي مصرف ميوه و سبزيجات به منظور پيشگيري از بيمار يهاي قلبي- عروقي: يك مطالعه مداخله اى

Background and Aims: Cardiovascular diseases are noncontiguous diseases which are caused by various factors. Considering the importance of nutrition education especially consumption of fruits and vegetables; This study was performed to determine the effect of health education based on health belief model on the improvement of consumption of fruits and vegetables aiming at preventing cardiovascular disease among high school girls in Shahr-e-kord city.Materials and Methods: This is a quasi-experimental intervention study. The research population was 120 students that were randomly divided into different groups, experimental (60 person) and controls (60 person). The tools for data collecting were questionnaire health belief model based and FFQ questionnaire. The HBM questionnaire was completed 3 times, (before, Immediately and 2 months after education) and FFQ questionnaire was completed 2 times, (before and 2 months after education) by students. After pre-test, 6 educational session classes in experimental group were performed. Finally data collected and analyzed by SPSS16 computer software (T- test, repeated measure ANOVA).Results: The two groups had no significant difference in terms of demographic variables. There was no significant differences observed in two groups before the intervention between the scores of different structures of this model (P>0/05). There was significant differences observed after the intervention between experimental and control groups in the levels of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy and performance (p<0.001).Conclusion: According to the results, intervention has positive impact on the improvement of consumption of fruits and vegetables among students.زمينه و هدف: بيماري هاي قلبي- عروقي، بيماري هاي غير واگير هستند كه توسط عوامل متعدد ايجاد مي شوند. نظر به اهميت آموزشبه منظور ارتقاي رفتارهاي تغذيه اي پيشگيري کننده از بيماري هاي قلبي- عروقي به ويژه مصرف ميوه و سبزيجات، اين پژوهش باهدف تعيين تأثير برنامه آموزشي مبتني بر الگوي اعتقاد بهداشتي بر ارتقاي مصرف ميوه و سبزيجات به منظور پيشگيري از بيماري هايقلبي – عروقي انجام شد. مواد و روش ها: پژوهش حاضر یک مطالعه نیمه تجربی اس. این مطالعه روی120 دانش آموز دختر دبیرستانی که به صورت تصادفی در2 گروه آزمون(60نفر) و شاهد(60نفر) قرار گرفتند انجام شد. ابزار جمع آوری اطلاعات پرسشنامه مبتنی بر الگوی اعتثقاد بهداشتی در سه زمان قبل تکمیل گردید. یافته ها: دو گروه ازنظر متغیرهای دموگرافیک تفاوت معنی داری با هم نداشتند. قبل از مداخله تفاوت معنی داری بین میانگین نمرات سازه های مختلف این الگو در دو گروه مشاهده نشد. بعد از مداخله تفاوت معنی داری در میانگین نمرات آگاهی، حساسیت درک شده، شدت درک شده، منافع درک شده و موانع درک شده و عملکرد بین دو گروه آزمون و شاهد مشاهده شد. نتيجه گيري: با توجه به يافته هاي پژوهش چنين استنباط مي شود كه مداخله حاضر تأثير مثبتي روي افزايش مصرف ميوه و سبزيجاتدانش آموزان داشته است

Strive for kidney health for everyone during COVID-19; the possible theme for the world kidney day 2021

Increasing awareness regarding CKD and self-care during COVID-19 pandemic has become the most important aspect for the nephrologists. Hence it is appropriate that the theme of the forthcoming World Kidney Day on 11 March 2021 should be “Strive for kidney health for everyone during COVID-19

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Depression: Detecting the historical roots of research on depression prevention with reference publication year spectroscopy

Background: Reference citation analysis and reference publication year can help to demonstrate the historical context of a research field. Therefore, this study aimed to determine the most important historical publications regarding depression prevention. Methods: This was a bibliometric study carried out using reference publication year spectroscopy(RPYS) method. Data gathering was carried out using Thomson Reuters Web of Science in the period of 2007–2016. A total of 17,043 records were retrieved which were uploaded as full record and cited references in plain text format. Then modified data were analyzed using RPYS.exe software. Results: Distribution of cited references in the area of depression prevention based on publication year revealed nine peaks in the twentieth century in years 1921, 1935, 1944, 1977, 1983, 1990, 1994, 1999, and 2000. Moreover, our analysis showed that some peaks occurred in the 21st century in years 2001–2005. Conclusions: Researchers have investigated depression prevention with physiological, epidemiological, biological as well as physical approaches. Furthermore, created criteria for measuring depression in different target societies have played an important and vital role in depression prevention

A review of current evidence from cardiovascular manifestations and outcomes in patients with COVID-19

Background: In 2019, acute respiratory syndrome related to COVID-19 occurred as a global epidemic problem. The COVID-19 pathogenesis method is by using enzyme 2-converting enzyme angiotensin ACE2, which infects host cells, which is resulted in some organs, involving the lungs, heart, kidneys and intestines According to reports from the first signs of involvement of the cardiovascular system in various forms, the involvement of Cardiovascular injuries. The aim of this study was to evaluate the cardiovascular manifestations in COVID-19 disease. Methods: In this study with help of medical science database (Scopus, PubMed and etc.) for gathering of basic information and recent reports of COVID-19 disease in all over the world. All the data collected from the databases were identified and evaluated so that the evidence could be fully reported and ultimately a general conclusion could be reached. Results: Cardiac complications in patients with COVID-19, could be caused by several mechanisms, some of which overlap, e.g., IL-6 and inflammation. Direct viral cardiomyocyte invasion, with unopposed angiotensin II effects, immune activation, microvascular dysfunction, or increased metabolic demand, could contribute to the to heart damage. Conclusion: COVID-19, in turn, can exacerbate cardiovascular damage Along with other symptoms of for COVID-19. If care services, medical and treatment facilities, as well as the care team provide the required care and treatment in a timely manner, it will lead to the reduction of mortality rate. Keywords: ACE2; COVID-19; Cardiac involvement; Cardiovascular Diseases; Clinical presentations; Complications; Mechanisms; SARS-CoV-2; Vascular inflammation

Analysis of Factors Affecting the Self-Efficacy of Natural Childbirth in Pregnant Women

Background: Self-efficacy of childbirth has an important role in increasing the ability of the mother to adapt to normal childbirth and decreasing the tendency for cesarean section. The aim of the present study was determining the self-efficacy status of normal vaginal delivery and related demographic variables in pregnant women in Lenjan City, Iran. Methods: The study population consisted of all pregnant women in Lenjan City at 20 to 37 weeks of gestation. Using simple random sampling method and considering the inclusion and exclusion criteria of the study as well as ethical considerations, 87 people were selected from Lenjan comprehensive health centers. All participants completed the Maternal Self-efficacy Questionnaire (MSQ) and demographic variables assessment questionnaire. Data were analyzed using descriptive statistics as well as correlation and regression tests in SPSS software. Findings: The mean self-efficacy of normal vaginal delivery in pregnant women in Lenjan City was 101.8 with a range of 17-170, that was in the desired range. In addition, results of correlation analysis and regression analysis showed that among demographic variables, only preparation classes for childbirth could significantly explain self-efficacy of normal delivery (P < 0.001). Conclusion: The results of this study play an important role in formulating the content of special education for pregnant women and increasing their empowerment and adjustment to childbirth

The effect of the nursing care based on the roy adaptation model on the level of the quality of life and fatigue in the patients undergoing coronary artery bypass graft surgery

This article reports the findings of a study designed to investigate the effectiveness of the Roy Adaptation Model, as it relates to improvements in nursing care outcomes for patients undergoing coronary bypass graft surgery. Results revealed that the implementation of a training program based on this model enhanced staff education and led to decreases in the level of fatigue and improved the quality of life for this group of patients

Opportunities and challenges of resident specialists' attendance plan guidelines (health-care transformation plan) in Isfahan university hospitals in 2015

Background: Given new reforms in Iran's health-care system and due to the need for gathering evidence regarding the implementation of this plan, this study aimed to investigate opportunities and challenges created by resident specialist attendance plan guidelines in university hospitals. Materials and Methods: This study used the qualitative method. Semi-structured interviews were used for data gathering. The study population included all experts of Isfahan University of Medical Science. Sampling was carried out using purposeful sampling method and continued until data saturation was reached. In total, 16 experts were interviewed. Criteria such as “reliability of information,” “trustworthiness,” and “verifiability of the information” were considered. Interviewees were assured that their names would keep hidden and that all information is confidential. Subject analysis method was used for data analysis. Results: The findings of this study based on subject analysis led to extracting three themes in regards of challenges in the implementation of resident (specialist or fellowship) plan in hospitals including structural, management, and resource challenges and one theme in the area of opportunities which were improved quality and timely provision of services. Conclusion: The findings showed that despite the strengths of this guideline, there are some fundamental challenges in various areas and need better attention by national level policymakers. These results help health-care policymakers to evaluate the problem with a better attitude and improve the necessary plans for implementation of these guidelines

Trends of geographic distribution of general practitioners in the public health sector of Iran

Background: Proper distribution of general practitioners (GPs) is one of the challenges in all health systems. This study aimed to investigate geographical distribution of GPs in public health sector in Iran between 2010 and 2016. Methods: The study is a descriptive–cross-sectional study. The population of provinces was extracted from Iran's National Statistic Center, while information on GPs was gathered from deputy of statistic and information technology in Ministry of Health and Medical Education. Data analysis was carried out using descriptive statistics, Gini coefficient (GC), and by drawing geographical distribution map of GPs. Data analysis was performed by excel 2013, Stata V.14, and Arc GIS software. Results: The results of calculating the number of GPs per 100,000 population in Iran showed that, in year 2010, Chaharmahal and Bakhtiari Province had the highest (10.39) and Alborz Province had the lowest (0.66) number of per capita GPs. The highest number of GPs per 100,000 population among Iran's provinces belonged to Chaharmahal and Bakhtiari (8.97), while the lowest belonged to Tehran (0.28) in year 2016. The GC was 0.31 in year 2010 and 0.283 for 2011. The lowest GC belonged to year 2012 (GC = 0.272), while the largest coefficient belonged to year 2016 (0.356). Conclusions: According to the results of this study, the distribution of GPs in public health sector of Iran in between 2010 and 2016 showed inequality. Therefore, along with increasing the number of GPs working in public health sector, it is necessary to pay attention to their distribution. Further studies are needed to investigate inequality of GPs within and between the provinces