Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations.publishedVersio

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Evaluation of Human Resources in the Hospitals Affiliated to Babol University of Medical Sciences and Social Security of Qaemshahr City based on the Standards of the Iranian Ministry of Health

BACKGROUND AND OBJECTIVE: Human resources is one of the most important factors in the process of production, as well as the greatest asset of every healthcare institution. Resolution of hospital issues regarding the provision and management of human resources has been a major concern in the field of health care. This study aimed to evaluate human resources in the hospitals affiliated to Babol University of Medical Sciences and Social Security of Qaemshahr city in Iran based on the standards of the Ministry of Health and Medical Education. METHODS: This cross-sectional study was conducted using an analytical-descriptive approach in 2015 in the hospitals affiliated to Babol University of Medical Sciences and Social Security of Qaemshahr city, Iran. Sample size consisted of all the hospital personnel, with the exception of physicians and maintenance staff. Data were collected using checklists via interviews with head nurses and supervisors. Data analysis was performed in SPSS V.19 . FINDINGS: In total, 3,130 personnel employed at seven hospitals were enrolled in this study. Lowest mean age of human resources was reported in Ayatollah Rohani Hospital (33.74±5.907 years). In addition, the highest number of health care providers in proportion to the total of human resources was reported in Ayatollah Rohani Hospital of Babol and Valiasr Hospital affiliated to the Social Security of Qaemshahr city (65.7% and 64.7%, respectively). Between the studied hospitals, no significant difference was observed regarding the mean of human resources (p=0.921). However, a significant difference was observed in the distribution of nursing human resources compared to the standards of the Ministry of Health (p<0.001). So that the manpower shortage in medical sections and paraclinic centers in most centers was observed. CONCLUSION: According to the results of this study, the selected hospitals had surplus of human resources in financial and administrative departments, while shortage of human resources was observed in medical and paraclinical units. Therefore, it is recommended that planning and organization of human resources be performed based on the standards of the Ministry of Health for the recruitment, development and transfer of healthcare personne

Patient’s Satisfaction of Emergency Department Affiliated Hospital of Babol University of Medical Sciences in 2013 -14

BACKGROUND AND OBJECTIVE: Patient satisfaction in emergency departments is an indicator of healthcare quality, evaluation of which can promote awareness of the relevant authorities regarding its status. This study aimed to evaluate patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences. METHODS: This cross-sectional study was performed in patients admitted to emergency departments in hospitals affiliated to Babol University of Medical Sciences, Babol, Iran, during a period of eight months (2013-2014). The participants were chosen through convenience sampling. Information regarding hospital environment, facilities, and nursing team was collected using a standard questionnaire. Standard questionnaire responses were classified to” don’t happen, dissatisfied, low, medium and high satisfaction”. Then medium and high responses classified to favorable satisfaction (above average) and low or dissatisfied responses were classified to unfavorable satisfaction. In case the patients were unable to fill-out the questionnaire, their companion completed it for them. FINDINGS: Overall, 444 (87.9%) patients expressed optimum satisfaction. The highest rate of dissatisfaction (14.8%, n=74) was related to environment and services, while the highest rate of satisfaction (49.3%, n=246) was pertinent to nursing staff. The results indicated that the rate of satisfaction in residents of rural areas was 0.55 times higher than in urban residents (OR: 1.55, 95% CI: 1.12-2.70, p=0.02), 50% lower in patients compared to companions (OR: 0.55, 95% CI: 0.36-0.83, p=0.05),and  in the evening shift was 0.65 times higher than in those admitted in the morning (OR: 1.65, 95% CI: 1.06-2.58, p=0.03). Moreover, this rate in patients admitted at night shift was 0.74 times higher than in those admitted in the morning (OR: 1.74, 95% CI: 1.12-2.70, p=0.01). CONCLUSION: This study demonstrated optimum patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences