Comparison of patient’s prognostic based on Madras Head Injury Prognostic Scale and Glasgow Outcome Scale in head trauma patients admitted in emergency ward of 5th Azar educative and therapeutic center in Gorgan, 2011

زمینه و هدف: آسیب‌ های تروماتیک سر بزرگترین علت مرگ و ناتوانی در میان بیماران ترومایی است. تخمین پیش‌ آگهی بیمار بلافاصله پس از بروز ضربه سر، می ‌تواند اساس تصمیمات بالینی صحیح در آینده، صرفه‌ جویی در هزینه‌ ها، توان بخشی به موقع و افزایش رضایت بیماران باشد؛ بنابراین این مطالعه با هدف تعیین پیش ‌آگهی بیماران ضربه سر مراجعه ‌کننده به بخش فوریت مرکز آموزشی درمانی پنجم آذر گرگان با مقیاس پیش‌ گویی کننده مدراس انجام گردید. روش بررسی: در این مطالعه توصیفی- همبستگی 117 نفر از بیماران ضربه سر مراجعه‌ کننده به بخش فوریت مرکز آموزشی درمانی پنجم آذر گرگان با روش نمونه‌ گیری در دسترس انتخاب و بررسی شدند. جمع ‌آوری داده ‌ها با استفاده از برگه اطلاعات دموگرافیک، مقیاس پیش ‌گویی جراحات سر مدراس و مقیاس برآیند گلاسکو (GOS) انجام شد. داده‌ ها در محیط نرم ‌افزار آماری SPSS با استفاده از آمار توصیفی و آزمون ‌های آنالیز واریانس، کای مجذور، ضریب همبستگی پیرسون و تی مستقل تحلیل شد. یافته‌ ها: میانگین و انحراف معیار سن بیماران 54/1±51/32 بود. بر حسب مقیاس پیش‌ گویی ضربه سر مدراس، پیش‌ آگهی اغلب بیماران (7/54) خوب بود. بیماران با ضایعات داخل جمجمه و شکستگی ‌های جمجمه از پیش ‌آگهی ضعیف ‌تری برخوردار بودند و این تفاوت از نظر آماری معنی ‌دار بود (001/0P<). بین نمرات حاصل از مقیاس پیش‌ گویی ضربه سر مدراس در بدو پذیرش با نتایج نهایی ضربه سر بر اساس مقیاس برآیند گلاسکو، ارتباط مستقیم و معنی‌ دار آماری وجود داشت (001/0P<، 688/0r=). نتیجه ‌گیری: با توجه به یافته ‌های این مطالعه، مقیاس پیش ‌گویی ضربه سر مدراس، در مقایسه با سایر مقیاس‌ های مورد استفاده در این زمینه مقیاسی دقیق، سریع و در عین حال ساده‌ تر و کاربردی ‌تر است؛ لذا انجام پژوهش‌ های بیشتر با هدف کاربرد جهت تریاژ بیماران در اورژانس توصیه می ‌شود

Psychometric evaluation of the shorter version of expectation regarding aging instrument (ERA-12-Persian) among older adults in Iran

Background: Aging perceptions and expectations influence health behaviors and outcomes in older adults. The Expectations Regarding Aging (ERA-12) instrument has been validated in Western populations, but limited studies have examined its psychometric properties in Asian contexts. As Iran faces rapid demographic aging, there is a need for culturally appropriate tools to assess aging expectations. This study aims to evaluate the psychometric properties of the Persian version of the ERA-12 among older adults in Iran. Methods: Convenience sampling method was used to collect data of 302 older adults in Iran. Psychometric properties of the ERA-12 were evaluated. Validity and reliability tests using exploratory and confirmatory factor analysis were conducted. Cronbach’s alpha (α), and McDonald’s Omega (Ω) Coefficient as measures of internal consistency was used to evaluate the reliability of the Persian version of ERA-12. Results: Confirmatory factor analysis (CFA) confirmed the three-factor structure of the ERA-12-Persian scale, explaining 71.99% of the total variance. Model fit indices indicated a good fit (CFI = 0.930, RMSEA = 0.096, SRMR = 0.032). Internal consistency was strong, with Cronbach’s alpha values ranging from 0.728 to 0.865. Additionally, convergent and discriminant validity were established, supporting the scale’s construct validity. Conclusions: The validated ERA-12-Persian scale provides healthcare providers in Iran with a reliable tool to assess aging expectations across physical, mental, and cognitive domains. This instrument enables both the development of culturally-appropriate interventions and comparative studies of aging perceptions between Iranian older adults and other populations.</p

The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries

Context: Psychological problems are very common in traumatic patients' caregivers necessitating usage of appropriate coping strategies to promote their mental health. Aim: The aim of this study was to assess anxiety, stress, and depression as well as coping strategies in caregivers of patients with head injuries. Settings and Design: In this cross-sectional study, 127 caregivers of traumatic patients referred to educational hospitals of Zabol city were selected by convenience sampling method. Subjects and Methods: The data were collected using a demographic questionnaire, as well as Depression, Anxiety and Stress Scale-21 and the Jalowiec coping strategies tools. The data were analyzed using descriptive statistics, one-way ANOVA, independent samples Student's t-test, and multivariate regression model. Results: Our findings showed that more than 70 of the caregivers of patients with head injuries suffered from severe and very severe stress and anxiety. The multivariate regression model demonstrated a negative and significant relationship between either stress (B = -0.81 P = 0.001) or depression (B = -1.23 P = 0.000) and problem-based coping strategies. Furthermore, stress (B = 0.64 P = 0.006) and anxiety (B = 0.74 P = 0.002) were negatively associated with emotional-based coping strategies. Conclusion: Considering the high rates of anxiety, stress, and depression in caregivers of patients with head injuries and significant associations observed between these variables and problem-based strategies, it is necessary to identify and obviate factors leading to anxiety and to educate coping strategies to these individuals

Sumatriptan ameliorates renal injury induced by cisplatin in mice

Objective(s): Cisplatin (Cis) is an anticancer compound, which is used for the treatment of various cancers. Sumatriptan (Suma) is a selective agonist of 5-hydroxytryptamine 1B/1D (5HT1B/1D) receptor, which is prescribed for the management of migraine. It is well-established that Suma has anti-inflammatory and antioxidant properties. We have explored the protective effects of Suma in the mitigation of Cis-induced nephrotoxicity. Materials and Methods: The mice received a single IP injection of Cis (20 mg/kg) on the first day of the experiment. Suma treatment (0.1 and 0.3 mg/kg/day, IP) was started on day 1 and continued for 3 consecutive days. Results: Creatinine (Cr), blood urea nitrogen (BUN) and malondialdehyde (MDA) levels were elevated and glutathione peroxidase (GPx) as well as superoxide dismutase (SOD) activities were decreased in Cis-treated mice. Suma (more potently 0.3 mg/kg) reduced Cr, BUN and MDA levels and increased SOD and GPx levels. Suma also reduced the acute renal injury (tubular degeneration, tubular cells vacuolation, tubular necrosis and cast), which corresponded to kidney damage in Cis-treated mice. Conclusion: These findings demonstrate that Suma mitigates Cis-induced renal injury by inhibition of oxidative stress and enhancing the antioxidant enzymes activities

Randomized Controlled Trial of a Peer Based Intervention on Cardiac Self-efficacy in Patients Undergoing Coronary Artery Bypass Graft Surgery: a 3-year Follow-up Results

Background: Self-efficacy is one's belief in ability to succeed in specific situations and considerable factor to maintaining healthy behaviors. It has an important role in person-centred care and significantly improves after effects of heart attacks. This study aimed to investigate the effects of a peer based intervention on cardiac self-efficacy of the patients after bypass surgery.Methods: In this clinical trial study, 60 patients undergoing bypass surgery were chosen and assigned equally into the control and intervention groups. The patients were assigned into two groups by block randomization. While routine education was presented to the patients in the control group, intervention group were taught using the peer education in two sessions. Cardiac self-efficacy of all the selected patients was assessed orderly in 36-month (3 years) follow-up after surgery. Inclusion criteria used to choose the suitable patients were as the following: no record of CABG surgery, understanding and talking Persian language, willingness to participate in the research, age between 40 and 70 years, no dementia, confusion, mental and psychological problems which might hinder their participation. In addition, exclusion criteria in this study were patient’s death, serious physical problems after CABG surgery, emergency and unexpected surgeries, or cancellation the CABG surgery due to patient’s situation. Data was collected using cardiac self-efficacy scale and analyzed using chi-square, independent t-test and Kolmogorov-Smirnov tests. Results: The patients in both groups were homogenous in terms of demographic data. The mean score of cardiac self-efficacy in the intervention group was significantly different from control group in 3- year follow-up after surgery (P&lt;0.038).Conclusions: Based on this study, accomplishment of peer based intervention can be a beneficial educative-supportive approach in cardiac surgery fields.

Randomized Controlled Trial of a Peer Based Intervention on Cardiac Self-efficacy in Patients Undergoing Coronary Artery Bypass Graft Surgery: a 3-year Follow-up Results

Background: Self-efficacy is one's belief in ability to succeed in specific situations and considerable factor to maintaining healthy behaviors. It has an important role in person-centred care and significantly improves after effects of heart attacks. This study aimed to investigate the effects of a peer based intervention on cardiac self-efficacy of the patients after bypass surgery.Methods: In this clinical trial study, 60 patients undergoing bypass surgery were chosen and assigned equally into the control and intervention groups. The patients were assigned into two groups by block randomization. While routine education was presented to the patients in the control group, intervention group were taught using the peer education in two sessions. Cardiac self-efficacy of all the selected patients was assessed orderly in 36-month (3 years) follow-up after surgery. Inclusion criteria used to choose the suitable patients were as the following: no record of CABG surgery, understanding and talking Persian language, willingness to participate in the research, age between 40 and 70 years, no dementia, confusion, mental and psychological problems which might hinder their participation. In addition, exclusion criteria in this study were patient’s death, serious physical problems after CABG surgery, emergency and unexpected surgeries, or cancellation the CABG surgery due to patient’s situation. Data was collected using cardiac self-efficacy scale and analyzed using chi-square, independent t-test and Kolmogorov-Smirnov tests. Results: The patients in both groups were homogenous in terms of demographic data. The mean score of cardiac self-efficacy in the intervention group was significantly different from control group in 3- year follow-up after surgery (P&lt;0.038).Conclusions: Based on this study, accomplishment of peer based intervention can be a beneficial educative-supportive approach in cardiac surgery fields.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017

BackgroundThe global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.MethodsWe used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.ResultsGlobally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.ConclusionsWhile road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented