Evaluation of life expectancy in Kurdistan Province, Iran, during the years 2006 and 2016

BACKGROUND: Life expectancy index is used in assessing changes in the health status of Kurdistan Province community, Iran, especially among the elderly, the difference in the health levels of women and men, and also the economic levels and the desired changes. This study aimed to evaluate the life expectancy in the age groups in Kurdistan Province using demographic information and mortality based on age and sex during the years 2006 and 2016.METHODS: In this study, life expectancy was used for calculating life table according to the World Health Organization (WHO). Death information was extracted based on age groups and using demographic data of the statistical centers; in addition, the raw mortality rate was extracted according to age groups and calculated using Chiang method in the stage of life expectancy by sex and location. To analyze the data, Stata 12 and Excel software packages were used for calculations.RESULTS: Life expectancy at birth in Kurdistan Province in the whole population was equal to 74.56 and 78.31 years in 2006 and 2016, respectively, and this rate was higher among women compared to men.CONCLUSION: Extensive factors including medical and health status, well-being, nutrition status and quality, etc., affect the life expectancy index in different societies, and promotion of each criterion increases the life expectancy. It is necessary to establish required fields for establishing these indicators at the provincial level by creating a complete and accurate record of mortality and illness

Evaluation of life expectancy in Kurdistan Province, Iran, during the years 2006 and 2016

BACKGROUND: Life expectancy index is used in assessing changes in the health status of Kurdistan Province community, Iran, especially among the elderly, the difference in the health levels of women and men, and also the economic levels and the desired changes. This study aimed to evaluate the life expectancy in the age groups in Kurdistan Province using demographic information and mortality based on age and sex during the years 2006 and 2016. METHODS: In this study, life expectancy was used for calculating life table according to the World Health Organization (WHO). Death information was extracted based on age groups and using demographic data of the statistical centers; in addition, the raw mortality rate was extracted according to age groups and calculated using Chiang method in the stage of life expectancy by sex and location. To analyze the data, Stata 12 and Excel software packages were used for calculations. RESULTS: Life expectancy at birth in Kurdistan Province in the whole population was equal to 74.56 and 78.31 years in 2006 and 2016, respectively, and this rate was higher among women compared to men. CONCLUSION: Extensive factors including medical and health status, well-being, nutrition status and quality, etc., affect the life expectancy index in different societies, and promotion of each criterion increases the life expectancy. It is necessary to establish required fields for establishing these indicators at the provincial level by creating a complete and accurate record of mortality and illness

Seroprevalence of West Nile Virus in Regular Blood Donors Referred to the Blood Bank of Kurdistan Province, Iran

Background: West Nile virus is an infection that is most commonly caused by infected mosquito bites, however, blood transfusions, organ transplants, breast feeding, pregnant mother-to-the-fetus transmission, and occupational transmission among laboratory and medical staff are also the less common routes of infection. Given the endemic nature of this virus in the Middle East, the aim of this study was to investigate the presence of this virus in regular blood donors, as the reliable source of blood supply needed for patients in hospitals. Methods: In this descriptive-analytical study, venous blood samples were collected from 259 regular blood donors referred to the Blood Transfusion Organization of Kurdistan. After separating blood serum, the amount of IgM and IgG antibodies against West Nile virus was measured via ELISA test. Results: Concerning antibodies, IgG and IgM against West Nile virus were positive in 14 patients (5.4%) and 3 patients (1.2%), respectively. Seropositive IgG levels were observed in 11 patients over the age of 40 (12.5%) but only in 3 patients under 40 years of age (1.8%). The difference was statistically significant (OR = 7.95; 95% CI: 2.16–29.32; p < 0.01). Conclusion: Given the value of blood and blood products obtained from regular blood donors for therapeutic purposes and the significant prevalence of the virus and considering the presence of cases with positive IgM, it seems necessary to screen blood donors in blood transfusion centers in the western parts of Iran

Hypercalciuria and febrile convulsion in children under 5 years old

PurposeThe association between hypercalciuria and febrile convulsion is controversial. The present study aimed to investigate the statistical association between hypercalciuria and childhood febrile convulsions.MethodsOverall, 160 children aged 6 months to 5 years, including 80 children with febrile convulsion and 80 febrile children without convulsion (comparison group), were recruited. All laboratory tests, including 24-hour urine calcium, were undertaken in an academic clinical laboratory.ResultsForty-five children of the febrile convulsion group (60%) and 30 of the comparison group (40%) had hypercalciuria. There was a significant difference between the 2 groups (P=0.02).ConclusionOur results indicated that there is a statistical association between convulsion and hypercalciuria in children. Since we found this association with a cross-sectional assessment, further studies, especially prospective and controlled designs, are needed

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

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 age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Quality of education in community medicine externship and internship: Perspective of medical students of Kurdistan University of Medical Sciences

Introduction: Community medicine externship and internship programs in the health field prepare medical students for entry into the family medicine program and implementation of community-based medical services, especially in rural areas. The aim of this study was to assess the quality of education in community medicine externship and internship from the viewpoints of medical students of Kurdistan University of Medical Sciences. Methods: In this descriptive, cross-sectional study, the views of all community medicine students at Kurdistan University of Medical Sciences (55 externs and 53 interns) in 2014 were investigated. Data were collected using a valid and reliable questionnaire. A three-point Likert scale of good (score 3), average (score 2) and weak (1) was used to scale the items. The final mean scores of good, average and weak levels were calculated as above 2.4 (67%), from 1.7 to 2.4 (33%-67%) and below 1.7 (33%) respectively. Descriptive statistics was used to analyze the data. Results: From the viewpoint of externs, the mean scores of briefing classes (2.8, 83.6%), vaccination and cold chain training (2.9, 96.4%) and trainers’ ability to respond to educational needs (2.7, 81.8%) were at a good level. From the interns’ viewpoint, the mean scores of briefing classes (2.7, 64%) and problem solving and prioritization training (2.4, 58.5%) were at good level. Interns’ satisfaction rate with the two items of enhancing treatment management skills (2.05, 32.3%) and health education (2.2, 28.3%) was at a low (weak) level. Conclusion: Maintaining and promoting the quality of education in the field of externship, and promoting the quality of education in the field of internship seem to be necessary

Gender-based violence against women during the COVID-19 pandemic: recommendations for future

Abstract Background Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics. Methods This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis. Results A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods. Conclusions Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics

The Immunomodulatory Effect of Recombinant Exotoxin A of Pseudomonas Aeruginosa on Dendritic Cells Extracted from Mice Spleen

Background & Objective: Dendritic cell (DC) is as a key cell in activation of immune response against microbes and disease. Therefore, the effect of recombinant exotoxin A of Pseudomonas aeruginosa on the maturity and the activation of DCs was evaluated in this study. Materials & Methods: Recombinant exotoxin A was produced from Pseudomonas aeruginosa DNA. MTT assay was used to evaluate the cytotoxicity of this protein on DCs. The expression of co-stimulatory molecules CD40, CD86, and MHCΠ was evaluated by flow cytometry. Moreover, the effect of this antigen (Ag) on T-cell proliferation was evaluated using Mixed Lymphocyte Reaction (MLR) assay and the secretion of IL-4 and IFN- γ. Secretion of IL-12 by DCs was measured with Enzyme-Linked Immunosorbent Assay (ELISA) method. The data were collected and analyzed with one way ANOVA test. Results: Recombinant exotoxin A had no effect on DCs viability. In addition, expression of CD40, CD86, and MHCΠ did not change significantly compared to the negative control cells. Moreover, T-cells proliferation was decreased significantly at the concentration of 0.1µg/ml of this Ag. The secretion of IL-12 was increased by DCs, in contrast the secretion of IL-4 and IFN-γ in MLR supernatant did not decrease significantly. Conclusion: Exotoxin A decreases the proliferation of T-cells and also leads to a change in the pattern of cytokine secretion of immune cells