A fundamental, national, medical disaster management plan : an education-based model

During disasters, especially earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME). The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5–7 experts from each member university. Working in medical disaster management field for ≥2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007–April 2008). Pretest and post-tests were used to examine the participants’ knowledge regarding disaster management; the mean score on the pre-test was 67.1 ±11.6 and 88.1 ±6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan in the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing countryNonePublishe

In vivo antioksidativni potencijal biljke Teucrium polium u usporedbi s α-tokoferolom

The present study was undertaken to explore antioxidant potential of Teucrium polium (Lamiaceae) in vivo. Antioxidant activity was measured by three tests including inhibition of 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical, total antioxidant power (TAP), and thiobarbituric acid reactive substances (TBARS) in serum. Rats received dry extract of T. polium in 80% ethanol by intragastric intubation at doses of 50, 100 and 200 mg kg-1 daily for 14 days. Treatment of rats with T. polium extract showed significant antioxidant activity in the DPPH test as compared to the control. T. polium extract at doses of 50 and 100 mg kg-1 significantly increased rats\u27 TAP and decreased TBARS compared to the control. Administration of T. polium at a dose of 200 mg kg-1 per day did not significantly alter serum TAP and TBARS. Antioxidant activities of T. polium at doses of 50 and 100 mg kg-1 were comparable to that of -tocopherol (10 mg kg-1) in all experiments.U okviru ovih istraživanja ispitan je antioksidativni potencijal biljke Teucrium polium L. Lamiaceae in vivo. Antioksidativni učinak je mjeren pomoću tri testa koji uključuju inhibiciju 1,1-difenil-2-pikrilhidrazil (DPPH) radikala, ukupnu antioksidativnu snagu (TAP) i reaktivne supstancije tiobarbiturne kiseline (TBARS) u serumu. Štakorima je davan suhi ekstrakt T. polium u 80%-tnom etanolu intragastričnom intubacijom u dozama od 50, 100 i 200 mg kg-1 dnevno tijekom 14 dana. Pokusi su pokazali značajno antioksidativno djelovanje T. polium DPPH testom u usporedbi s kontrolom. T. polium je u dozama 50 i 100 mg kg-1 značajno povisio TAP i snizio TBARS u usporedbi s kontrolom. Primjena ekstrakta T. polium u dozi od 200 mg kg-1 dnevno nije značajno mijenjala serumske TAP i TBARS vrijednosti. Antioksidativni učinak T. polium u dozama 50 i 100 mg kg-1 u svim eksperimentima bio je sličan učincima α-tokoferola (10 mg kg-1). Preliminarna ispitivanja ukazuje na antistresni učinak T. polium koji je usporediv antioksidativnom učinku. Međutim, potrebna su daljnja ispitivanja da se rasvijetli bi li T. polium mogla biti korisna u uklanjanju posljedica oksidativnog stresa

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories:A systematic analysis for the Global Burden of Disease Study 2019

Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

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

رابطه هوش اخلاقی و اهمال‌کاری سازمانی با امنیت شغلی کارکنان بهزیستی شهر سنندج

Background and Aim: Moral intelligence and organizational procrastination are considered as important factors affecting the job security of welfare personnel. Therefore, the present study aimed to investigate the role of components of Moral intelligence and organizational procrastination in the job security of welfare personnel. Methods: The research method was descriptive and correlational. The statistical sample of the research was 230 welfare workers of Sanandaj city, who were selected by a simple random sampling method. For data collection from a moral intelligence questionnaire, organizational procrastination questionnaire and job security questionnaire were used. Data were analyzed using software SPSS 22 and statistical tests Pearson correlation and multiple regressions (stepwise). Ethical Considerations: Participants verbal consent in order to participate in the research was obtained and about the anonymous questionnaires and the privacy of information were assured to them. Results: Findings showed that all components of moral intelligence and organizational procrastination had a significant relationship with job security (P<0.01). Also, the inefficiency component and the honesty component were able to significantly predict the job security of personnel (P<0.01). Conclusion: The results of this study showed that moral intelligence and organizational procrastination have an important role in the job security of personnel; Therefore, senior managers of organizations can help improve job security and reduce job procrastination by strengthening personnel' moral intelligence. Please cite this article as: Hadi A, Hasani O, Alipour F, Shahbaziyan Khonig A. The Relationship between Moral Intelligence and Organizational Procrastination with Job Security of Welfare Personnel in Sanandaj City. Akhlaq-i zisti, i.e., Bioethics Journal. 2022; 12(37): e36.زمینه و هدف: هوش اخلاقی و اهمال‌کاری سازمانی از عوامل مهم تأثیرگذار بر امنیت شغلی کارکنان به شمار می‌روند، لذا پژوهش حاضر با هدف بررسی نقش مؤلفه‌های هوش اخلاقی و اهمال‌کاری سازمانی در امنیت شغلی کارکنان بهزیستی انجام شد. روش: روش پژوهش، توصیفی و از نوع همبستگی بود. نمونه آماری پژوهش به تعداد 230 نفر از کارکنان بهزیستی شهر سنندج بود که با روش نمونه‌گیری تصادفی ساده انتخاب شدند. برای جمع‌آوری داده‌ها از پرسشنامه هوش اخلاقی، پرسشنامه اهمال‌کاری سازمانی و پرسشنامه امنیت شغلی استفاده شد. برای تجزیه ‌و تحلیل داده‌ها از نرم‌افزار SPSS 22 و روش‌های آماری ضریب همبستگی پیرسون و رگرسیون چندگانه به شیوه گام‌ به گام استفاده شد. ملاحظات اخلاقی: رضایت شفاهی شرکت‌کنندگان برای شرکت در پژوهش کسب‌ شده و درباره بی‌نامی پرسشنامه‌ها و محرمانگی اطلاعات به آنان اطمینان خاطر داده شد. یافته‌ها: نتایج نشان دادند که تمامی مؤلفه‌های هوش اخلاقی و اهمال‌کاری سازمانی با امنیت شغلی رابطه معنادار داشت (01/0P<). همچنین مؤلفه ناکارآمدی و مؤلفه درستکاری توانستند به طور معناداری امنیت شغلی کارکنان را پیش‌بینی کنند (01/0P<). نتیجه‌گیری: نتایج این پژوهش نشان داد که هوش اخلاقی و اهمال‌کاری سازمانی نقش مهمی در امنیت شغلی کارکنان دارند. بنابراین مدیران ارشد سازمان‌ها می‌توانند با تقویت هوش اخلاقی کارکنان به بهبود امنیت شغلی و کاهش اهمال‌کاری شغلی آنان کمک کنند

Vulvar cancer in Iran: Retrospective study over 20 years (1998-2018)

Background: We did not have any data about vulvar cancer — as a fourth cause of gynecological cancer in the worldwide — in our country. Study Design: Our study is designed to evaluate the frequency, stage and outcome of patients with vulvar cancer. Materials and Methods: In this retrospective observational study, we studied patients' records with diagnosis of vulvar cancer who referred to department of gynecology oncology, Emam-Khomeini Hospital (EKH), Tehran, Iran, between January 1998 and December 2018. A total of 106 cases of vulvar cancers were found in the records of outpatient oncology clinic of medical university of Tehran university. Survival was estimated using the Kaplan-Meier analysis with SPSS version of 24. Results: Mean age of the 106 patients in the study was 59.2 years. The most site of tumor involvement was major labial (39.1%). Vulvar cancer significantly was more in multiparous (P < 0.001) and menopause patients (P < 0.001). Squamous Cell Carcinoma was the most pathology of vulvar cancer (72.2%). Ninety patients (84.9%) had surgery as a primary treatment and 48 (53.3%) of these patients received adjuvant radiotherapy or chemoradiation after surgery. Mean duration of patient's follow up was 82.4 ± 68.3 month. Five-year survival of our patients in all stages was 71%. Conclusions: Our findings are located between developed and underdeveloped countries. Our patients are diagnosed nearly in earlier stages of disease and 84.9%t of them had surgery as a primary treatment, so earlier surgery resulted in good survival of patients

Venoplasty and Venous Stenting in Patients with Chronic Venous Insufficiency in the Lower Extremities

Background: Venoplasty and stenting is a minimally invasive therapy that can be used for patients with deep venous insufficiency in the lower extremities. This study aimed at investigating the effect of venoplasty and venous stenting in patients with chronic venous insufficiency in the lower limbs. Methods: This prospective case-series study recruited patients with chronic deep venous insufficiency in the lower limbs candidated for venoplasty in the Vascular Clinic of Sina Hospital in Tehran, Iran. Venoplasty and stenting was done if the deep venous system in the lower extremities had stenosis or obstruction on venography. The patients were visited 1, 3, and 6 months after venoplasty to assess their symptoms, venous clinical severity, and venous disability. Primary and secondary patency was evaluated with Doppler ultrasound. Results: Seventy-three patients were included in the study. The follow-up of the patients’ clinical symptoms showed significant improvement rates of about 90%, 88.7%, 92.5%, and 100% in claudication, edema, pain, and ulcers-respectively- only 1 month after the procedure. The stent patency rates were 93.2, 91.5, and 92.4 in the 1st, 2nd, 3rd, and 6th postprocedural months, correspondingly. The venous clinical severity score and the venous disability score before the procedure were 14.2 and 2.73, respectively, which were decreased to 5 and 1.1, correspondingly, at 6 months’ follow-up (p value < 0.001). Conclusion: Venoplasty and stenting in our patients with chronic deep venous insufficiency in the lower extremities conferred a significant improvement in clinical symptoms and a high percentage of patency