Studying the Impact of Auditors' Anxiety on Auditor's Report Content

Backgound: Auditors face a wide range of expectations due to conflict of interest between managers and investors that causes stress in the audit work and may have a significant impact on the quality of the audit. Methods: This cross-sectional study was performed on 585 signatories of the audit reports of 139 companies listed on the Tehran Stock Exchange in 2016 and 2017. The statistical population of the study was the signatories of the audit report of the accepted companies in Tehran Stock Exchange. In present study, the information about anxiety of audit managers was collected using Beck Anxiety Questionnaire (1988) and multiple regression and logistic models were used to test the hypotheses. Results: In this study, 585 auditors were examined. The results shown auditors' anxiety leads to presenting an acceptable report and a smaller number of condition clauses, but it does not affect the type of clause and the number of opinion clauses. The results show that auditors who are not anxious or are slightly anxious 371(63.4%) cases do not find themselves under the pressure of negligence of the client, but auditors with moderate anxiety 228 (39%) cases are more probably tend to present acceptable reports and therefore fewer condition clauses due to fear of losing their job. Conclusion: As this study showed auditor's anxiety has no effect on the type of condition clause and also the number of clauses after the opinion; while auditors' anxiety affects the type of auditors' opinion and the number of condition clauses

Vitamin D Level and Vitamin D Receptor Gene Polymorphisms in Iranian Azeri Turkish Patients With Autoimmune Thyroid Diseases

The Autoimmune thyroid diseases (AITDs) are among the most common endocrine disorders. Vitamin D as an immunomodulator and Vitamin D receptor (VDR) gene polymorphisms may be effective in AITDs pathogenesis. The aim of this study was to evaluate the vitamin D level and VDR BsmI and TaqI polymorphisms in Iranian Azeri Turkish patients with AITDs. This case-control study included 121 adults with AITDs and 117 non-AITDs controls. Serum level of 25-hydroxyvitamin D was measured by electrochemiluminescence (ECL) immunoassay. BsmI and TaqI polymorphisms were assessed by polymerase chain reaction fragment length polymorphism technique. The serum level of 25-hydroxyvitamin D in AITDs patients were lower than controls (P=0.03). The frequencies of TT, TC, CC, T and C genotypes/alleles at TaqI (rs731236) marker were 52.1%, 34.7%, 13.2% , 69.4% and 30.6% in AITDs and 44.4%, 41.9%, 13.7%, 65.4% and 34.6% in controls, respectively. The frequencies of AA, AG, GG, A and G genotypes/alleles at BsmI (rs1544410) marker were 14%, 64.5%, 21.5% , 46.3% and 53.7% in AITDs and 26.5%, 58.1%, 15.4%, 55.6% and 44.4% in controls, respectively. BsmI (rs1544410) GG+AG genotypes and G allele were more frequent among patients with Hashimoto compared with control group (86.6% vs. 73.5% (OR: 2.34, 95% CI: 1.16-4.70, P = 0.014) and 54.29% vs. 44.44% (OR: 1.48, 95% CI: 1.02-2.15, P = 0.038), respectively). Vitamin D status can be related to AITDs pathogenesis. BsmI (rs1544410) GG+AG genotypes and G allele may play an important role in the predisposition to Hashimoto.

Measuring diet quality: development of a new index and comparative evaluation with other indices in Australia

Background and aims Developing a valid index of overall diet quality and using the measure to predict chronic disease risk has been a focus of nutritional epidemiology; however, there has been little research on the validation of such indices for use in Australia. This research aimed to critically investigate the literature on diet quality indices to develop a valid diet quality index based on dietary guidance for Australians and to examine its validity using data from Australian population based cross-sectional and longitudinal studies. Construct validity of the index was also assessed by comparing the Dietary Guideline Index (DGI) and Australian Healthy Eating Index (Aust-HEI). Methods A critical literature review was undertaken to guide design and validity assessment of the Aussie-DQI. A new categorisation method of diet quality indices based on their purpose and which explains differences in diet quality indices was introduced. Dietary guidance for Australians was used to guide the selection of components and development of age- and sex-specific cut-offs of the new index. For the purpose of assessing content validity, a checklist was used to ensure that components of the new index addressed the key aspects of the guidelines. To assess construct validity of the Aussie-DQI, the association of the Aussie-DQI with socio-economic, demographic and health behaviour characteristics and intakes of desirable/undesirable components adjusted for sex and age was examined. People with implausible energy intake, and breastfeeding and lactating women were excluded from the analyses. We used the 1995 National Nutrition Survey (NNS), a nationally representative data with 10,851 participants aged 19 years and over which used 24/h recall for dietary assessment. Physical measurements included anthropometric measurements and blood pressure, and interviewer administered questionnaires were used to collect information on the above mentioned characteristics. We used a general linear regression model to examine the association between dietary intakes and the above mentioned characteristics (exposure) across categories of the Aussie-DQI scores (outcome) using data from the 24/h recall. The analysis was repeated using dietary data obtained from a validated food frequency questionnaire (FFQ) also administered during the 1995 NNS. Criterion validity was assessed based on the capacity of the Aussie-DQI to predict mortality over 16 year follow-up. Longitudinal data were used from the Nambour Skin Cancer Study, with 1621 participants aged between 25 and 75 years at baseline. Information relating to age, sex, education, smoking, physical activity and history of selected medical conditions was collected using a self-administered health behaviour questionnaire at baseline. The Cox proportional hazard model was used to examine the association between the index (exposure) and all-cause and specific-cause mortality (outcome). Results Analysis of dietary information from the 24/h recall of the 1995 NNS shows that females (F:55.3±12.8 vs. M:52.5±13.6), higher age (F:57.2±12.5 vs. 49.2±12.7; M:56.8±13.2 vs. 45.3±12.9), non-smokers (F:56.5±12.6 vs. 51.3±12.5; M:53.3±13.4 vs. 47.3±12.8), lower BMI (F:54.8±12.7 vs. 53.4±12.8; M:52.8±13.8 vs. 49.2±13.0), higher physical activity (F:55.8±12.4 vs. 52.0±12.8 ; M:52.4±14.0 vs. 49.7±13.4), higher income (M:52.8±12.9 vs. 50.0±13.7) and higher schooling years (M:51.4±13.5 vs. 50.4±13.9), are more likely to have higher diet quality scores (P for trend < 0.05). The intake of meat and dairy products, calcium (men) and zinc generally decreased as diet quality scores increased, but no statistically significant decrease was found for calcium intake among women. Similar results were achieved when dietary information from the FFQ was used in the analysis. When compared with the two recent Australian diet quality indices, similar associations were found between the score of the three indices and intake of most food groups and nutrients. Only the Aussie-DQI showed a significant inverse association with BMI among males, while the DGI scores were significantly higher among females in the highest BMI group, adjusted for energy and other characteristics. A significant inverse association between diet quality score and the intake of total sugar was observed only with the Aussie-DQI in both genders (P for trend < 0.05). In the Cox proportional hazard analysis, after adjustment for potential confounding variables the Aussie-DQI was inversely associated with the risk of cancer mortality among men (HR= 0.30, 95% CI: 0.11, 0.83; P for trends = 0.06). No association was found for CVD mortality or cancer mortality for females. Conclusion A critical literature review on diet quality indices has been provided by modelling a systematic approach for developing and validating diet quality indices. The new approach explains differences in diet quality indices and provides guidance on several stages of their development. The Aussie-DQI, which has been developed and validated to measure diet quality in Australia, is different from other indices, particularly concerning components, approaches used for validation, flexibility of application to different studies and types of dietary information and consideration of overconsumption. The findings of the assessment of construct validity are comparable with other well-conducted studies. The assessment of criterion validity of the Aussie-DQI was associated with decreased risk of cancer mortality among men

Development and validity assessment of a diet quality index for Australians

Existing Australian diet quality indices have assumed links to health outcomes but their validity for this has not been reported. We extend the features of existing indices for Australian adults by constructing a new diet quality index (Aussie-DQI) using the national dietary guidelines linked to the Australia National Health Priority Areas. Construct validity was assessed using 24 hour dietary recalls from the 1995 National Nutrition Survey (n=10,851 adults aged 19 years and older). Construct and criterion validity were assessed using food frequency questionnaire data from the Nambour Skin Cancer study (n=1355), a community-based longitudinal study with 16 year follow-up and cause-specific mortality outcomes. Generalised linear regression was used to assess associations between Aussie-DQI scores and socio-economic, demographic, health-behaviour characteristics, and food and nutrient intakes, while Cox proportional-hazards modeling was used to assess associations with cancer and allcause mortality. A high Aussie-DQI score was associated with being female, being older, non-smoking status, and BMI in the normal range in both study populations; and Aussie-DQI scores were inversely associated with cancer mortality among men in multivariable-adjusted analyses (hazard ratio = 0.30, 95% CI: 0.11, 0.83; p for trends = 0.06). In conclusion, Aussie-DQI successfully discriminated diet quality and showed that men, younger adults, current smokers and those overweight/obese were less likely to consume foods that meet dietary recommendations; and that a high diet quality is associated with decreased risk of cancer mortality among men. This study adds further evidence to clarify the role of diet quality in decreasing mortality from chronic diseases

A randomized controlled trial comparing effects of a low-energy diet with n-3 polyunsaturated fatty acid supplementation in patients with non-alcoholic fatty liver disease

Background: Weight loss is the cornerstone of NAFLD management, but weight maintenance is difficult. Some studies have suggested that n-3 polyunsaturated fatty acid (n-3 PUFA) might have beneficial effects in NAFLD. We aim to compare the effects of a low-energy diet with n-3 PUFA supplementation on liver enzymes, body composition, and cardiometabolic risk factors in NAFLD. Materials and Methods: The study was a randomized controlled trial conducted in Urmia in Iran from October 2016 to May 2017. One hundred and fourteen eligible patients were randomly assigned to one of the three following groups: low-energy diet group, n-3 PUFA supplementation (fish oil) group (1500 mg/d), or control group for 12 weeks. Liver enzymes, lipid profile, insulin resistance, and body composition were assessed before and after the intervention. Results: One hundred and four patients completed the study. All groups lost weight, but the reductions were greater in the diet group (−2.97 ± 2.79 kg, P = 0.001). The diet group had significant decreases in fat mass compared to other groups. Insulin resistance, total cholesterol, and low-density lipoprotein cholesterol significantly decreased only in the diet group, and patients who lost weight ≥4% showed significantly larger decreases in serum liver enzymes. N-3 PUFA had no beneficial effects on the study outcomes. Conclusion: We found that 1500 mg/d n-3 PUFA supplied for 12 weeks, in contrast to 3.40 ± 2.98% weight loss, does not improve liver enzymes, body composition, and cardiometabolic risk factors in NAFLD patients

Randomized controlled trial on the effects of legumes on cardiovascular risk factors in women with abdominal obesity

BACKGROUND: The effect of legume-based hypocaloric diet on cardiovascular disease (CVD) risk factors in women is unclear. This study provides an opportunity to find effects of high-legume diet on CVD risk factors in women who consumed high legumes at baseline. METHODS: This randomized controlled trial was undertaken in 34 premenopausal women with central obesity. After 2 weeks of a run-in period on an isocaloric diet, subjects were randomly assigned into two groups: (1) hypocaloric diet enriched with legumes (HDEL) (n = 17) (two servings per day) and (2) hypocaloric diet without legumes (HDWL) (n = 17) for 6 weeks. The following variables were assessed before intervention, 3, and 6 weeks after it: Waist to hip ratio (WHR), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-sensitive-C-reactive protein (hs-CRP), total antioxidant capacity (TAC), nitric oxides (NOx), and Malondialdehyde (MDA). RESULTS: Both hypocaloric diets reduced hs-CRP in 3 weeks and returned it to basal values after 6 weeks (P = 0.004). HDWL significantly reduced WHR [P = 0.010 (3.2%)] and increased TC [P &lt; 0.001 (6.3%)]. Despite the significant effect of HDEL on increasing TAC in 3 weeks [P = 0.050 (4%)], the level of TAC remained the same in 6 weeks. None of the diets had any significant effects on NOx and MDA. CONCLUSION: The study indicated that beneficial effects of legumes on TC, LDL-C, and hs-CRP were achieved by three servings per week, and consuming more amounts of these products had no more advantages. &nbsp;&nbsp;</div

Mutation analysis of the phenylalanine hydroxylase gene in Azerbaijani population, a report from West Azerbaijan province of Iran

Objective(s):Phenylketonuria (PKU) is a genetic inborn error of phenylalanine (Phe) metabolism resulting from insufficiency in the hepatic enzyme, phenylalanine hydroxylase (PAH), which leads to elevated levels of Phe in the blood. The present study was carried out for mutation analysis of the PAH gene in West Azerbaijan province of Iran. Materials and Methods:A total of 218 alleles from 40 PKU families were studied using restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) method. Results:The frequencies of IVS10-11, S67P, R261Q, R252W, IVS11nt-1 g>c, R408Q, and Q232Q mutations were 28(35), 17(21.25), 15(18.75), 3(3.75), 3(3.75), 2(2.5), and 1(1.25), in cases group, and 51(23.4), 31(14.2), 27(12.4), 6(2.75), 6(2.75), 4(1.83), and 2(0.92) in total group, respectively. The mutations of R243Q, 364delG, L333F, 261X, I65T, and R408W were not detected in our samples. Conclusion: It can be concluded that the IVS10-11 mutation has the highest frequency in the tested population. To our knowledge, this report is the first in its own kind and provides better understanding of the genetic heterogeneity, the origin and distributions of PAH mutations in West Azerbaijan province of Iran

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

BackgroundEstimates 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.Methods22 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.FindingsGlobal 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.InterpretationGlobal 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