Barriers to Medication Adherence among Hypertensive Patients in Deprived Rural Areas

BACKGROUND: Poor adherence to medication regimen leads to poor health outcomes, increased medical costs and increased death rate due to hypertension. The aim of this study was to evaluate baseline barriers to medication adherence among hypertensive patients in deprived rural areas.METHODS: A cross-sectional study was conducted on 238 hypertensive patients living in deprived rural areas of Iran. Data were collected using a questionnaire consisting of demographic information, Morisky medication adherence scale and the barriers to medication adherence that were reliable and valid.RESULTS: The results of the study showed that medication adherence was significantly decreased and had a significant positive correlation with gender and economic status, while it had a negative correlation with age. Medication Adherence had a positive correlation with the duration of hypertension, while it had a negative correlation with the number of medications used and concurrently with other diseases.CONCLUSIONS: Based on the present study it can be concluded that enhanced knowledge about illness and treatment in rural communities is improves the medical adherence. Financial supports along with the reduced number of prescribed drugs are also found to be the determining factors in the medical adherence.&nbsp

Assessing quality of life in nurses with chronic low back pain working in educational hospitals in Tabriz, 2013

Background and aims: Low back pain is a common problem throughout the world and Iran. Nurses also due to their working conditions are considered among high-risk groups. If this situation be chronic, it can have a serious impact on their quality of life, result in low quality of work, reduce the time to do useful work and increase the number of days missed. The aim of this study was to assess quality of life of patients with low back pain. Methods: In this descriptive- analytic study, 250 nurses working in educational hospitals in Tabriz admited to participate in this research in 2013. Data were collected by a two-part cheklist containing demographic characters and Modified Oswestry Low Back Pain questionnaire. The quality of life of nurses suffering from chronic low back pain was determined. Results: Of the total nurses participating in research, 65.8% (n = 250) obtained inclusion criteria. There was impaired quality of life in patients with chronic low back pain in moderate level in most nurses (38/04%). 6/88% of nurses'impairments was very severe. There was the most disruption in patients with chronic low back pain in the social relations and the least was related to self-care. It was reported experienced pain severity in nurses moderate to severe. Conclusions: The high prevalence of low back pain in nurses affects their quality of life. So, holding training classes and providing an environment with minimal risk factors for low back pain in nurses' work environments to reduce the individual, social and economic damage seems necessary

Seroprevalence and risk factors of Toxoplasma gondii infection among healthy blood donors in south‐east of Iran

This prospective cross-sectional study was aimed to evaluate the prevalence of IgM and IgG anti-T. gondii antibodies and the associated risk factors among healthy blood donors in Kerman province, south-eastern Iran. Structured questionnaires (before the donors gave blood) were used to obtain information on risk factors for infection. Totally, 500 serum samples from healthy blood donors of Kerman Blood Transfusion Organization (KBTO) at Kerman, Iran, were screened for IgG and IgM anti-T. gondii antibodies by enzyme-linked immunosorbent assay (ELISA) and Roche Elecsys Toxo IgM assay. Real-time PCR was used to detect DNA of T. gondii in the IgM-positive samples. Seroprevalence of IgG and IgM anti-T. gondii antibodies was 28�8% and 3�2%, respectively. In the multiple logistic regression, it could be observed that living in rural regions, having B blood type, being in contact with cats, consuming raw vegetables and raw milk/egg and doing agricultural activities were independent risk factors for Toxoplasma seropositivity. T. gondii DNA was also found in one (9�0%) of IgM-positive samples. In this study, it was found that T. gondii infection was present among healthy blood donors in south-east of Iran. Therefore, it is suggested to design screening programmes for preventing transfusion-transmitted toxoplasmosi

A survey of life style and its influential Factors Among the University Students in Gorgan

Introduction: Most of the complex health issues results from chronic diseases in which the individual has areole. The role of individual healthy behaviors like Physical activity, nutrition and stress management on reduction of the rate of diseases mortality and morbidity is well known. The aim of this study is to the conditiondetermination of physical activity, nutrition, and stress in Gorgan,s university students. Material & Methods: The Participants of this cross-sectional study were 800 students of Gorgan,s Universities , selected via random sampling method. The data collections was performed using by a questionnaire including demographic and lifestyle questions. Analysis of the data was performed by Chi square test in SPSS software. A p-value less than 0.05 was considered as significant. Results: The mean age of the subjects was 22.43 and , BMI mean was 24.1. 22.1 % of them were married and 53.9% single. 24.1% of the students had a weak life style, 29.6% moderate, 22.9% good, and 23.4 % excellent. Although the relationship between life style and sex, degree of education, income, father's educational level, mother's job, type of university and cigarette smoking was significant (p-value 0.05). Conclusion: The results reveal that the life style of more than half of the student's is weak and moderate. This needs designing some program for improving university student lifestyle

Enzymatic and structural characterization of HAD5, an essential phosphomannomutase of malaria-causing parasites

The malaria-causing parasite Plasmodium falciparum is responsible for over 200 million infections and 400,000 deaths per year. At multiple stages during its complex life cycle, P. falciparum expresses several essential proteins tethered to its surface by glycosylphosphatidylinositol (GPI) anchors, which are critical for biological processes such as parasite egress and reinvasion of host red blood cells. Targeting this pathway therapeutically has the potential to broadly impact parasite development across several life stages. Here, we characterize an upstream component of parasite GPI anchor biosynthesis, the putative phosphomannomutase (PMM) (EC 5.4.2.8), HAD5 (PF3D7_1017400). We confirmed the PMM and phosphoglucomutase activities of purified recombinant HAD5 by developing novel linked enzyme biochemical assays. By regulating the expression of HAD5 in transgenic parasites with a TetR-DOZI-inducible knockdown system, we demonstrated that HAD5 is required for malaria parasite egress and erythrocyte reinvasion, and we assessed the role of HAD5 in GPI anchor synthesis by autoradiography of radiolabeled glucosamine and thin layer chromatography. Finally, we determined the three-dimensional X-ray crystal structure of HAD5 and identified a substrate analog that specifically inhibits HAD5 compared to orthologous human PMMs in a time-dependent manner. These findings demonstrate that the GPI anchor biosynthesis pathway is exceptionally sensitive to inhibition in parasites and that HAD5 has potential as a specific, multistage antimalarial target

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

Meta-discourse markers in the book reviews published in ISI and non-ISI journals of applied linguistics

Meta-discourse markers constitute a significant part of a reader friendly text. This study focused on the types and frequency of meta-discourse markers in applied linguistics book reviews (BR) published in ISI and non-ISI journals. To this end, meta-discourse markers were analyzed in 86 BRs selected from six journals (three ISI and three non-ISI journals). According to this model, meta-discourse markers include two main groups: interactive and interactional elements. Using AntConc text concordance software program, the meta-discourse markers were checked in the corpora. To check the type and number of meta-discourse markers, frequency analyses were carried out. Chi-square test results and frequency analyses showed that significant differences existed between meta-discourse markers used in BRs published in ISI and non-ISI journals and BR authors used more meta-discourse markers in ISI BRs. Additionally, comparing to non-ISI BRs, ISI BR authors used more evaluative patterns and interactional elements to develop their academic writing. Implications, limitations, and suggestions for further studies were discussed in detail