Prevalence of depression among Iranian patients under hemodialysis: A systematic review and meta-analysis

Context: Depression is a highly prevalent and debilitating mental disorder, particularly among patients under hemodialysis, who are more susceptible to depression due to their complex treatment regimens, dietary limitations, side effects of medications and fear of disease outcomes. This systematic review and meta-analysis explored the prevalence of depression in Iranian hemodialysis patients. Evidence Acquisitions: In this systematic review and meta-analysis, search was done in national and international databases, including SID, MagIran, Google Scholar, Web of Science, Medline (via PubMed), and Scopus from inception to March 2018. Key search terms included hemodialysis, renal replacement therapy, dialysis, end-stage renal disease, renal failure, depression and Iran along with all their possible combinations. Data were combined for meta-analysis using random effects model. Heterogeneity between studies was analyzed by I2 test, and data were analyzed by STATA (version 12) software. Results: The included 24 articles had a sample size of 2941 participants; the overall prevalence of depression in hemodialysis patients in Iran was 56.8 (95 CI: 50.5-63). The results of the univariate meta-regression analysis showed no significant correlation between prevalence of depression and methodological quality of articles (P = 0.524), duration of hemodialysis (P = 0.885), publication year (P = 0.116), mean age of participants (P = 0.224) and sample size (P = 0.194). Conclusions: More than half of the hemodialysis patients in Iran suffer from depression. Given the overlap of depression symptoms with uremia in this group of patients, it is necessary to identify depression in these patients for early management and interventions. © 2018 The Author(s)

Psychometric features of the persian version of self-efficacy tool for patients with hypertension

Background: Hypertension is one of the causes of mortality that can be prevented. Self-efficacy with regard to patients� performance predicts their abilities to change high-risk behaviors. Positive self-efficacy in patients with hypertension predicts compliance, adherence to medications, diet and exercise regimens, and behavioral self-management. Objectives: This study aimed to examine the psychometric features of self-efficacy questionnaire in patients with hypertension. Patients and Methods: In this cross-sectional study, 260 patients with hypertension were selected by multistage cluster sampling in Tehran�s public places to complete the Persian version of hypertension self-efficacy questionnaire. Then, face validity, content, and structure of the questionnaire were evaluated. To determine the reliability of the questionnaire, test-retest method with a two-week interval and Cronbach�s alpha coefficient were used. All data analyses were performed using the SPSS statistical software, version 18.0. Results: According to the results of Content Validity Ratio (CVR), three items were eliminated. The results of exploratory and confirmatory analyses identified three factors, including diet regimen, disease management, and adherence to treatment. The goodness of fit of the three-factor self-efficacy model in patients with hypertension was confirmed based on standard indices (RMSEA = 0.082, NNFI = 0.90, CFI = 0.91, IFI = 0.91, and X2/df = 328.35). Besides, internal consistency of diet regimen, disease management, and adherence to treatment based on Cronbach�s alpha was 0.849, 0.471, and 0.572, respectively. Conclusions: The three-factor structure of the self-efficacy questionnaire showed appropriate validity and reliability in patients with hypertension. Thus, this tool can help caregivers and health service providers assess self-efficacy of hypertensive patients and plan and implement educational and clinical interventions. © 2018, Iranian Cardiovascular Research Journal. All rights reserved

Health literacy among Iranian patients with type 2 diabetes: A systematic review and meta-analysis

Health literacy is one of the most important determinants of health. Limited health literacy can leads to reduced adherence to treatment, repeated hospitalizations, and increased diseases complications. Several studies on health literacy among Iranian patients with type 2 diabetes have reported different prevalences of health literacy. The present study is aimed to determine through a systematic review and meta-analysis the prevalence of adequate health literacy in the Iranian population. A total of 8 articles that met the inclusion criteria, published from inception until December 2018, were collected. Articles were searched using the following keywords and their possible combinations: Health Literacy, Illiteracy, Functional Health Literacy, Diabetes, Diabetes Mellitus, and Iran. The data were analyzed using meta-analysis and the random-effects model was used to obtain a pooled prevalence estimate along with its 95 confidence interval. Heterogeneity among the studies was assessed using the I 2 statistic. Analyses were performed using STATA software, version 12. The overall prevalences of inadequate and borderline health literacy among Iranian patients with type 2 diabetes were 43.47 (95 CI: 31�55.95) and 26.34 (95 CI: 19.49�33.19), respectively. In addition, the prevalence of adequate health literacy among patients with type 2 diabetes was 29.72 (95 CI: 22.79�36.64). There was no significant relationship between health literacy with year of publication, sample size, and patients� age. Inadequate health literacy is high (43.5) among Iranian patients with type 2 diabetes. This makes it necessary to provide interventions aimed at improving their heath literacy which will reduce hospitalizations and diseases complications. © 2019 Diabetes Indi

Quality of life in iranian war veterans: A systematic review and meta-Analysis

Background and Aim: Soldiers encounter various physical and mental outcomes after military wars which adversely affect different aspects of their quality of life. The aim of the present review was to determine the total score of quality of life in Iranian war veterans. Methods: In current systematic review and meta-Analysis, searches were conducted in national and international databases using keywords "war veteran" and "quality of life" and their combinations. Data were analyzed using meta-Analysis and random effects model methods. Heterogeneity between the studies was evaluated using the I2 test. Data were analyzed using STATA software version 12. Results: Analyzing 19 selected studies with a total sample size of 2575 participants showed that the mean scores of the physical and mental aspects of quality of life in Iranian war veterans were 41.6 (confidence interval of 95: 37.69-47.02) and 42.22 (confidence interval of 95: 37.04-47.40), respectively. The lowest scores of physical (28.79 with a confidence interval of 95: 21.92-35.66) and mental (33.86 with a confidence interval of 95: 25.08-42.64) dimensions of quality of life belonged to chemical war veterans. Conclusion: Iranian war veterans have a low physical and mental quality of life and providing strategies for improving their quality of life seems necessary. © 2018 Baqiyatallah University of Medical Sciences. All rights reserved

Quality of life in iranian war veterans: A systematic review and meta-Analysis

Background and Aim: Soldiers encounter various physical and mental outcomes after military wars which adversely affect different aspects of their quality of life. The aim of the present review was to determine the total score of quality of life in Iranian war veterans. Methods: In current systematic review and meta-Analysis, searches were conducted in national and international databases using keywords "war veteran" and "quality of life" and their combinations. Data were analyzed using meta-Analysis and random effects model methods. Heterogeneity between the studies was evaluated using the I2 test. Data were analyzed using STATA software version 12. Results: Analyzing 19 selected studies with a total sample size of 2575 participants showed that the mean scores of the physical and mental aspects of quality of life in Iranian war veterans were 41.6 (confidence interval of 95: 37.69-47.02) and 42.22 (confidence interval of 95: 37.04-47.40), respectively. The lowest scores of physical (28.79 with a confidence interval of 95: 21.92-35.66) and mental (33.86 with a confidence interval of 95: 25.08-42.64) dimensions of quality of life belonged to chemical war veterans. Conclusion: Iranian war veterans have a low physical and mental quality of life and providing strategies for improving their quality of life seems necessary. © 2018 Baqiyatallah University of Medical Sciences. All rights reserved

Psychometric features of the persian version of self-efficacy tool for patients with hypertension

Background: Hypertension is one of the causes of mortality that can be prevented. Self-efficacy with regard to patients� performance predicts their abilities to change high-risk behaviors. Positive self-efficacy in patients with hypertension predicts compliance, adherence to medications, diet and exercise regimens, and behavioral self-management. Objectives: This study aimed to examine the psychometric features of self-efficacy questionnaire in patients with hypertension. Patients and Methods: In this cross-sectional study, 260 patients with hypertension were selected by multistage cluster sampling in Tehran�s public places to complete the Persian version of hypertension self-efficacy questionnaire. Then, face validity, content, and structure of the questionnaire were evaluated. To determine the reliability of the questionnaire, test-retest method with a two-week interval and Cronbach�s alpha coefficient were used. All data analyses were performed using the SPSS statistical software, version 18.0. Results: According to the results of Content Validity Ratio (CVR), three items were eliminated. The results of exploratory and confirmatory analyses identified three factors, including diet regimen, disease management, and adherence to treatment. The goodness of fit of the three-factor self-efficacy model in patients with hypertension was confirmed based on standard indices (RMSEA = 0.082, NNFI = 0.90, CFI = 0.91, IFI = 0.91, and X2/df = 328.35). Besides, internal consistency of diet regimen, disease management, and adherence to treatment based on Cronbach�s alpha was 0.849, 0.471, and 0.572, respectively. Conclusions: The three-factor structure of the self-efficacy questionnaire showed appropriate validity and reliability in patients with hypertension. Thus, this tool can help caregivers and health service providers assess self-efficacy of hypertensive patients and plan and implement educational and clinical interventions. © 2018, Iranian Cardiovascular Research Journal. All rights reserved

Burden of musculoskeletal disorders in Iran during 1990�2017: estimates from the Global Burden of Disease Study 2017

Summary: Musculoskeletal diseases (MSDs) are the leading cause of disability and facing them demands updated reports on their burden for efficient policymaking. We showed Iran had the highest female-to-male ratio and highest increase in the burden of musculoskeletal diseases, in the past three decades, worldwide. We further confirmed the role of population aging as the main cause. Purpose: MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017. Methods: We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990�2017, for population aged � 5 years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes. Results: In Iran, MSDs were responsible for 1.82 million (95uncertainty interval UI 1.3�2.4) DALYs, in 2017. During the past 28 years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors. Conclusion: Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females. © 2020, International Osteoporosis Foundation and National Osteoporosis Foundation

Mapping routine measles vaccination in low- and middle-income countries

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)(1-4). Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)(5-8). Here we generated annual estimates of routine childhood MCV1 coverage at 5 x 5-km(2) pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019

Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15–19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: –1·21% [–1·26 to –1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (−0·94% [–1·72 to –0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990�2019: a systematic analysis from the Global Burden of Disease Study 2019

Background: Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods: We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings: In 2019, 273·9 million (95 uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72 (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29 82·15 to 84·42) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15�19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: �1·21% �1·26 to �1·16), similar progress was not observed for chewing tobacco (0·46% 0·13 to 0·79). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (�0·94% �1·72 to �0·14), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation: Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens