Systematic Review of Studies in the Field of Competencies of New or Soon To-Be-Graduate General Physicians in Iran

Background & Objective: One method to evaluate and monitor the effectiveness of the general medicine curriculum is the collection of results of research in this field. In this study, research results on the extent of predefined general competency in the formal document of the minimum competencies of Iranian general physicians have been systematically integrated. Methods: The search strategy in this study included the searching of words doctor, student, interns, or graduate, and ability, competency, knowledge, skill, attitude, or performance, in the title, abstract, or keywords of articles. All papers published from 2002 to 2014 in Persian language journals were retrieved from the Irandoc, Iranmedex, Magiran, Medlib, and SID databases. Results: After the removal of irrelevant or duplicate papers, from 270 recorded papers, 24 articles were selected and analyzed. All studies were descriptive studies and most used self-reporting methods to assess the competency of physicians. Reviewed articles focused on only 48% of subdomains of the formal document of the minimum competencies of physicians. In 70% of assessed skills, physicians’ competencies were estimated as low to moderate. Conclusion: Although these studies did not assess all skills mentioned in the formal document of the minimum competencies of physicians, estimates show that the competencies of general physicians in assessed skills were not desirable. It is recommended that future studies in this field to be managed. Key Words: General practitioners, Clinical competence, Program evaluation, Educational achievemen

Effects of Pomegranate Juice with and without Aerobic Training on Glycemic Control and Lipid Profile in Women with Type 2 Diabetes

Background and Aim: Type 2 diabetes is a common metabolic disease, which is associated with obesity and inactivity. Plant-based dietary patterns are recommended for the treatment of type 2 diabetes. On the other hand, the effect of aerobic training on the improvement of type 2 diabetes is also highly emphasized. The purpose of this study was to investigate the effects of 2-months of pomegranate juice consumption with and without aerobic training on the levels of HbA1c, fasting blood glucose (FBG), lipid profile in women with type 2 diabetes. Methods: In this study, 58 women with type 2 diabetes who were referred to Tehran Lorzadeh clinic were randomly divided into four groups: control, pomegranate juice, aerobic training, combined pomegranate juice with aerobic training. The aerobic training plan consisted of 2-months and three times per week (training time from 20 minutes to 45 minutes). Three days before and after this interventional study, serum levels of FBG, total cholesterol (TC), triacylglyceride (TG), and low-density lipoprotein (LDL) were measured by colorimetric methods. Results: Results showed that combined pomegranate extract consumption with aerobic exercise training significantly decreased the levels of FBG, HbA1c, and TG in women with type 2 diabetes compared to the control group after the intervention (P<0.01), while TC, LDL-c, and BMI remained unchanged. There was no statistically significant difference in the levels of TC, TG, HbA1c, and FBG in pomegranate extract or aerobic training groups compared to the control group after intervention. Conclusion: The results of this study indicate that combined pomegranate juice with aerobic training has beneficial effects on type 2 diabetes and could be recommended in their therapeutic program. *Corresponding Author: Fariba Mohammadi Tahroodi; Email: [email protected] Please cite this article as: Vaziri Javid R, Safizadeh F, Rastegary M, Nabi Afjadi M, Khonakdar-Tarsi A, Zare Z, Zarpou S, Mohammadi Tahroodi F. Effects of Pomegranate Juice with and without Aerobic Training on Glycemic Control and Lipid Profile in Women with Type 2 Diabetes. Arch Med Lab Sci. 2020;6.1-6 (e17). https://doi.org/10.22037/amls.v6.3038

Healthcare Workers Coronavirus (COVID-19) Infection during an Early Phase of the Pandemic: A Systematic Review and Meta-Analysis

Background: Infection and death of health care workers (HCWs) with COVID-19 is an important health problem and will lead to inadequate care of patients, causes more damage and more spread of this pandemic. This study aimed to combine data on COVID-19 infection among HCWs through a systematic review and meta-analysis study. Methods: We searched PubMed via MEDLINE, the SCOPUS, and Web of Science (ISI) to identify the studies on the prevalence of HCWs infection among COVID-19 patients. We used an eight-item checklist critically appraised to assess the quality of publications on the COVID-19 infection among HCWs. Random-effect models and meta-regression were used for the meta-analysis of the results. Results: Overall, 98 articles were retrieved from the databases, of which, seven met the eligibility criteria published between December 2019 to March 2020. The total sample size of the included studies contained 72677 COVID-19 confirmed cases, of which 3131 were HCWs. The pooled COVID-19 infection prevalence among HCWs was 4% (95% CI: 3% to 5%). Conclusions: According to the results, COVID-19 infection in HCWs was 4% of all cases in the early phase of the pandemic. So HCWs need special care including regular screening and appropriate, adequate, and standard personal protective equipment (PPE). Keywords: Novel Coronavirus, COVID-19, Health Care Workers, Medical Staff

Healthcare Workers Coronavirus (COVID-19) Infection during an Early Phase of the Pandemic: A Systematic Review and Meta-Analysis

Background: Infection and death of health care workers (HCWs) with COVID-19 is an important health problem and will lead to inadequate care of patients, causes more damage and more spread of this pandemic. This study aimed to combine data on COVID-19 infection among HCWs through a systematic review and meta-analysis study. Methods: We searched PubMed via MEDLINE, the SCOPUS, and Web of Science (ISI) to identify the studies on the prevalence of HCWs infection among COVID-19 patients. We used an eight-item checklist critically appraised to assess the quality of publications on the COVID-19 infection among HCWs. Random-effect models and meta-regression were used for the meta-analysis of the results. Results: Overall, 98 articles were retrieved from the databases, of which, seven met the eligibility criteria published between December 2019 to March 2020. The total sample size of the included studies contained 72677 COVID-19 confirmed cases, of which 3131 were HCWs. The pooled COVID-19 infection prevalence among HCWs was 4% (95% CI: 3% to 5%). Conclusions: According to the results, COVID-19 infection in HCWs was 4% of all cases in the early phase of the pandemic. So HCWs need special care including regular screening and appropriate, adequate, and standard personal protective equipment (PPE). Keywords: Novel Coronavirus, COVID-19, Health Care Workers, Medical Staff

Serial Interval Distribution of COVID-19 among Iranian Reported Confirmed Cases

Type of manuscript: short report Introduction:  Serial interval refers to the average time between of the onset of the symptoms of two successive cases. Serial interval distribution can be used for the calculation of the basic reproduction number (R0), transmission rate, and study of an epidemic trend. This study aims to investigate the mean, standard deviation, and distribution of serial interval among the confirmed cases of COVID-19 using a Gamma distribution.      Methods: To determine the serial interval, 60 confirmed infected cases of COVID-19 (based on PCR test results) in February 20th-May 20th, 2020 were selected as the cases. For these cases, 37 transmissions occurred. The data of the dates of the occurrence of primary and secondary symptoms were collected by referring to the COVID-19 surveillance system and interviewing the patients Results: The findings showed that the median and mean of the serial interval were 3.0 and 4.5± 3.5 days. The findings showed that the median of the serial interval was 3.0 days (with the inter-quartile range of 2.0-6.0). The mean serial interval was 4.5± 3.5 days (95% confidence interval: 3.1-5.5). Conclusions: Our report showed a shorter period for a serial interval less than the previous reported interval in China. It seems that regarding the shorter serial interval reported in this study, the basic reproduction numbers reported by the first papers published in Iran have been overestimated regarding the serial interval of 7.5 days. Key words: COVID-19, Serial interval, Gamma distributio

Serial Interval Distribution of COVID-19 among Iranian Reported Confirmed Cases

Type of manuscript: short report Introduction:  Serial interval refers to the average time between of the onset of the symptoms of two successive cases. Serial interval distribution can be used for the calculation of the basic reproduction number (R0), transmission rate, and study of an epidemic trend. This study aims to investigate the mean, standard deviation, and distribution of serial interval among the confirmed cases of COVID-19 using a Gamma distribution.      Methods: To determine the serial interval, 60 confirmed infected cases of COVID-19 (based on PCR test results) in February 20th-May 20th, 2020 were selected as the cases. For these cases, 37 transmissions occurred. The data of the dates of the occurrence of primary and secondary symptoms were collected by referring to the COVID-19 surveillance system and interviewing the patients Results: The findings showed that the median and mean of the serial interval were 3.0 and 4.5± 3.5 days. The findings showed that the median of the serial interval was 3.0 days (with the inter-quartile range of 2.0-6.0). The mean serial interval was 4.5± 3.5 days (95% confidence interval: 3.1-5.5). Conclusions: Our report showed a shorter period for a serial interval less than the previous reported interval in China. It seems that regarding the shorter serial interval reported in this study, the basic reproduction numbers reported by the first papers published in Iran have been overestimated regarding the serial interval of 7.5 days. Key words: COVID-19, Serial interval, Gamma distributio

Integration of Research, Public Health, and Hospital Interventions as a Successful Model for Controlling COVID-19 Pandemic: A Perspective

The COVID-19 pandemic has been a serious health problem in most countries in the last few months, with every country adopting different preventive and therapeutic measures based on their specific circumstances. The epidemic began in Iran on February 19, 2020, and gradually spread across the country. The epidemic extent varies, and different preventive and therapeutic measures are taken in Iran. Shahroud and Miami Counties, covered by the Shahroud University of Medical Sciences, have experienced the highest incidence of COVID-19 in Iran. However, the epidemic is well controlled by integrating the activities of the health, treatment, and research sectors and using information technology and a proprietary software application. This model can be thus studied as a successful experience. Keywords: COVID-19, Control, Successful model, Ira

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe