Social determinants of anesthesia choice for cesarean section in mothers attending selected primary health care centers of Tehran

  Background: There are different techniques for anesthesia in Cesarean Section (C/S), which can be affected by different factors including mothers and health care providers' preferences. The objective of the present study was to evaluate social determinants of anesthesia choice for Cesarean Section in mothers attending selected primary health care centers of Tehran.  Methods: The current descriptive cross-sectional study was conducted in mothers who had a history of C/S and settled in catchment area of selected Primary Health Care centers known as Defined Population (DP). The DP is linked to Social Determinants of Health Research center affiliated to Shahid Beheshti University of Medical Sciences, Tehran.    Results: Totally, 1408 mothers participated in the study. The mean±SD age of mothers was 27.6±4.42, more than 50% of the participants had university education, and about 25% of mothers were unemployed. The previous history of C/S was reported by 29.9% of mothers and 91.9% of these mothers had experienced general anesthesia. Anesthesia choice of the study participants was as follows: 562 (39.9%) general anesthesia, 566 (40.2%) local anesthesia, 231 (16.4) had no idea about the anesthesia method, and 46 (3.5%) did not want to have C/S. The most frequent person with whom mothers discussed the method of anesthesia prior to their admission was their gynecologist (44%). The final decisions for choosing anesthesia method were made by the patient in about 40% of the participants.  Conclusion: Informing mothers appropriately about anesthesia procedure and possible complications of each technique in the prenatal period can help mothers for choosing the best method of anesthesia and may increase mothers' tendency to have local anesthesia

Self-report demands of patients referred to social workers in Taleghani hospital, Tehran

  Background: Social workers have a responsibility to tackle the social determinants of health which cause health inequities. The hospitals’ social work units have the responsibility to improve patients' physical, mental, and social health. In this regard, understanding patients' demands is essential. The objective of the present study was to determine self-report demands of patients who were referred to social work unit in Taleghani hospital, Tehran.  Methods: The current cross-sectional study was conducted on the clients who were referred to social work unit of Talghani hospital, Tehran. Data was collected during autumn 2015 using convenience sampling method. Data collection form included demographic characteristics of the participants, the reason for referral to the social worker, self-report demands of the patients, and the response of the social worker to the patients. Data was analysed using IBM SPSS Statistics for Windows, Version 22.0.   Results: Of all clients who had attended social work unit, 772 accepted to participate in the study (response rate 87.1%). About 43% of the patients were female. Out of 990 requests, about 50% of the clients needed assistance to resolve financial problems. Help for resolving familial and insurance problems were the subsequent demands of the clients. Meanwhile, the most common response given by the social worker to the patients’ demands was financial assistance (n=276) (28.9%), and helping to resolve patient's familial problems (n=107) (11.2%) and offering health insurance services (n=106) (11.1%) were the second and the third most common responses, respectively.  Conclusion: The present study showed that still we have a long way to meet the aims of social work unit for empowering the patients and their families to withstand difficult conditions following the disease

Parallel Increases in Heterochromatin Variants and Chromosome Damages in Drugs Addicts

Polymorphisms of the size of heterochromatin regions and abnormalities of chromosomes have been well documented in human genome; they consist of DNA sequences that are not transcribed. The prime aim of the present study was to evaluate the heterochromatin polymorphism and numerical and structural abnormalities associated with chromosomes in drug addicts. No data exists in Iran regarding the cytogenetic characteristics of drug addiction lymphocytes. Therefore, cytogenetic investigations were performed in 93 drug addiction lymphocytes and 93 normal controls. This randomized collected study was conducted on 93 consecutive drug addiction individuals and 93 healthy individuals in Loghman and private hospitals, Tehran, Iran between the years 2007-2009. By applying Barium Hydroxide saline Giemsa (BSC) method, the variant heterochromatin polymorphism of chromosomes 1, 9 and 16 on lymphocyte cultures were evaluated. Cytogenetic analysis was performed in drug addicts’ lymphocytes cultures.Constitutive heterochromatin polymorphism of chromosomes 1 in drug addicts revealed statistical significant when compared with chromosome of healthy controls (P=0.004).  The differences were significant for chromosome 9 (P=0.029), it was 94.1%   in drug addiction and 5.9% in the control group (P=0.196). The differences were also significant for chromosome 16: it was 91.9% in addicts and 8.1% in the control group (P=0.052). Also the frequency of partial and complete inversion did not show any significant differences between the drugs addicts and the control group. The occurrence of chromosomal defects including, chromatid break (12 addicts), chromatid gap (8 addicts), dicentric (2 addicts), was higher in our observation. Our constitutive heterochromatin polymorphism blocks and chromosomal abnormalities in drugs addicts’ chromosome may provide an opportunity to serve as a marker for the detection and characterization of the damages chromosomes in drug addicts

Public Awareness, Attitudes, and First-Aid Measures on Epilepsy in Tehran

Background: People with epilepsy generally encounter misconceptions and negative attitudes about different aspects of the disease. They are also prone to physical injuries during seizures. Lack of awareness about first-aid measures results in taking inappropriate first-aid measures. The objective of this survey was to determine public awareness, attitudes, and first-aid measures about epilepsy in Tehran.Methods: This population-based cross-sectional survey was conducted during December 2016 to May 2017 throughout Tehran. Random stratified cluster sampling was used. Data were collected through interviews using a questionnaire. The awareness section included general awareness, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section which included 20 statements. The answers about first-aid measures were categorized as helpful, or harmful.Results: A total of 833 adults participated in the survey. The level of total awareness score of 41 (4.9%) participants was very good, 194 (23.3%) good, 255 (30.6%) fair, 210 (25.2%) low, and 133(16.0%) very low. The mean (SD) score about general awareness was 4.6 (3.0), range=0 to 11; causes 5.8 (3.4), range=0 to 13; symptoms of seizures 7.0 (4.0), range=0 to 13; first-aid measures 7.5 (3.4), range=0 to 14. Among all participants, 260 (31.2%),  named at least one superstitious cause for epilepsy. Attitudes were generally positive except for marriage and having kids. The level of first-aid measures score of 74(42.5) was very good, 79(45.4) good, and 21(12.1) low.Conclusion: The awareness of people of Tehran about epilepsy was insufficient, attitudes were generally positive but rather conservative, and first-aid measures at the last witnessed seizure were fairly helpful

Socio-demographic determinants of obesity indexes in Iran:findings from a nationwide STEPS survey

Background: Overweight and obesity are considered as non-communicable diseases (NCDs)risk factors with increasing prevalence worldwide. This nationwide study aimed to determine the socio-demographic determinants of obesity indexes in Iran. Methods: This cross-sectional study was conducted based on data from the sixth round of nationwide Stepwise approach to surveillance (STEPS) survey in the 31 provinces of Iran in 2011. A total of 9878 people aged ≥20 years were selected using a multi-stage cluster sampling method. Data were collected through three steps questionnaire including ecological, physical and biochemical measurements. We assessed body mass index (BMI), waist circumference(WC) and waist-hip ratio (WHR) as the main indicators of obesity. Results: In this study, the weighted prevalence of overweight and obesity were 34.5% (95% CI:33.6, 35.5) and 21.5% (95% CI: 20.7, 22.3), respectively. The mean ± standard deviation (SD)of BMI among men and women were 25.4±4.4 and 26.9±5.2 kg/m2 respectively. Older age,living alone, having lower education level, being housewife or retired were associated with overweight and obesity (P<0.05). Urbanization was positively associated with BMI and WC.Being obese or overweight was associated with having a history of type 2 diabetes mellitus (T2DM), hypertension (HTN) and cardiovascular diseases (CVDs). Conclusion: The prevalence of overweight in this study was less than global rate while it was vice versa for obesity prevalence. Some socio-demographic characteristics were identified as determinants of obesity which should be considered for planning preventive and control action plans

Research Network of Tehran Defined Population: Methodology and Establishment

Background: We need a defined population for determining prevalence and incidence of diseases, as well as conducting interventional, cohort and longitudinal studies, calculating correct and timely public health indicators, assessing actual health needs of community, performing educational programs and interventions to promote healthy lifestyle, and enhancing quality of primary health services.The objective of this project was to determine a defined population which is representative of Tehran, the Capital of Iran. This article reports the methodology and establishment of the research network of Tehran defined population.Methods: This project started by selecting two urban health centers from each of the five district health centers affiliated to Shahid Beheshti University of Medical Sciences in 2012. Inside each selected urban health center, one defined population research station was established. Two new centers have been added during 2013 and 2014. For the time being, the number of the covered population of the network has reached 40000 individuals. The most important criterion for the defined population has been to be representative of the population of Tehran. For this, we selected two urban health centers from 12 of 22 municipality districts and from each of the five different socioeconomic of Greater Tehran. Merely 80000 individuals in neighborhoods of each defined population research station were considered as control group of the project.Results: Totally we selected 12 defined population research stations and their under-covered population developed a defined population which is representative of Tehran population.Conclusion: a population lab is ready now in metropolitan of Tehran

Disparities in Obesity Prevalence in Iranian Adults: Cross-Sectional Study Using Data from the 2016 STEPS Survey

Introduction: This paper outlines the prevalence, disparities, and social determinants of preobesity and obesity in Iranian adults. Methods: Data on 28,321 adults who participated in the 2016 National Survey of the Risk Factors of Noncommunicable Diseases (STEPS) survey were analyzed. The body mass index (BMI) was calculated from physically measured height and weight. To assess the association between sociodemographic factors and the prevalence of preobesity and obesity, a χ2 test and a logistic regression model were used. Socioeconomic inequality was quantified by a concentration index. Disparities in provincial mean BMI and concentration indices were shown on the map of Iran using geographic information system analysis. Results: Overall, 60.3% of the participants were affected by preobesity or obesity. The preobesity prevalence was 39% in men and 35.2% in women. The obesity prevalence was 15.6% in men and 30.4% in women. The mean BMI for the country was 26.5. Higher ranges were observed across the northwestern and central territories. Female individuals in the age group 48–57 years who were married and lived in urban settings had an increased risk of being preobese or obese. The concentration index revealed a prorich inequality, with a greater magnitude among women. Conclusion: The findings suggest that policies aimed at reducing preobesity and obesity should remain a public health priority in Iran. However, a greater emphasis should be placed on the northwestern and central territories and on higher socioeconomic groups

Myocardial Infarction in Iran: Epidemiology, Management, and Prognosis

Background: Cardiovascular diseases, specifically acute myocardial infarction (AMI), are the leading cause of death worldwide. In this review, we explain the characteristics of AMI in Iran. Methods: We searched PubMed, Google, and Google Scholar for articles containing myocardial infarction, STEMI, and MI+ Iran in English and Persian words. Results: The age-standardized incidence rate of MI was 73.3 per 100 000. The mean±SD age of patients was 61.20±13.40 years. In-hospital mortality of patients with AMI in the IMIR was 12.1%. Concerning AMI complications reported in the IMIR, 5.8% of patients experienced ventricular tachycardia, and 2.5% experienced ventricular fibrillation. The 1-year mortality rate in the IPACE2 study was 4.3%. Conclusion: Only a few national studies are available in Iran regarding patients with AMI. A federal surveillance program continuously monitoring and tracking coronary events is essential to improve the general population’s health

Burden of diseases and injuries attributable to alcohol consumption in the Middle East and North Africa region, 1990–2019

Alcohol consumption is associated with a number of diseases and injuries, including cardiovascular diseases, cancers, mental and neurological disorders, as well as transport-related injuries. This article reports the alcohol-attributable burden of diseases and injuries at the regional and national levels in the Middle East and North Africa (MENA) region between 1990 and 2019, by sex, age, underlying cause, and Socio-demographic Index (SDI). The regional deaths and disability-adjusted life-years (DALYs) attributable to alcohol consumption were reported for the MENA region, between 1990 and 2019, using the methodological framework and analytical strategies adopted by the Global Burden of Disease (GBD) study 2019. The estimates were all reported as counts, population-attributable fractions, and age-standardised rates per 100,000 population, along with their corresponding 95% uncertainty intervals (UIs). Also, the average annual percentage changes were used to represent the trends of age-standardised rates. In 2019, there were an estimated 22.0 thousand deaths (95% UI: 16.1–29.4) and 1.1 million DALYs (0.8–1.3) attributable to alcohol consumption in the MENA region. The number of DALYs attributable to alcohol consumption were much higher in men (878.0 thousand, 691.4–1104.8) than among women (181.8, 138.6–232.0). The overall age-standardised death and DALY rates attributable to alcohol consumption decreased by 34.5% (13.2–48.3) and 31.9% (16.9–42.5), respectively, over the study period. Egypt (10.1 [5.7–16.6]) and Kuwait (1.1 [0.8–1.5]) had the highest and lowest age-standardised death rates attributable to alcohol consumption, respectively. In 2019, the number of deaths and DALYs in the MENA region were highest in those aged 60–64 and 50–54 years, respectively. A negative association was observed between a country’s SDI and their corresponding age-standardised DALY rates over the period 1990 to 2019. Digestive diseases were the main contributor to the alcohol-attributable burden. Over 1990–2019, the regional deaths and DALYs of diseases and injuries attributable to alcohol consumption decreased with AAPC of − 1.45 (− 1.78 to − 1.12) and − 1.31 (− 1.46 to − 1.15), respectively. The death and DALY rates attributable to alcohol consumption in the MENA region have decreased over the past three decades. Further decreases can be facilitated by implementing country-level policies and increasing public awareness

The burden of low back pain and its association with socio-demographic variables in the Middle East and North Africa region, 1990–2019

Background Low back pain (LBP) is the most common musculoskeletal disorder globally. Providing region- and national-specific information on the burden of low back pain is critical for local healthcare policy makers. The present study aimed to report, compare, and contextualize the prevalence, incidence and years lived with disability (YLDs) of low back pain in the Middle East and North Africa (MENA) region by age, sex and sociodemographic index (SDI), from 1990 to 2019. Methods Publicly available data were obtained from the Global Burden of Disease (GBD) study 2019. The burden of LBP was reported for the 21 countries located in the MENA region, from 1990 to 2019. All estimates were reported as counts and age-standardised rates per 100,000 population, together with their corresponding 95% uncertainty intervals (UIs). Results In 2019, the age-standardised point prevalence and incidence rate per 100,000 in MENA were 7668.2 (95% UI 6798.0 to 8363.3) and 3215.9 (95%CI 2838.8 to 3638.3), which were 5.8% (4.3 to 7.4) and 4.4% (3.4 to 5.5) lower than in 1990, respectively. Furthermore, the regional age-standardised YLD rate in 2019 was 862.0 (605.5 to 1153.3) per 100,000, which was 6.0% (4.2 to 7.7) lower than in 1990. In 2019, Turkey [953.6 (671.3 to 1283.5)] and Lebanon [727.2 (511.5 to 966.0)] had the highest and lowest age-standardised YLD rates, respectively. There was no country in the MENA region that showed increases in the age-standardised prevalence, incidence or YLD rates of LBP over the measurement period. Furthermore, in 2019 the number of prevalent cases were highest in the 35–39 age group, with males having a higher number of cases in all age groups. In addition, the age-standardised YLD rates for males in the MENA region were higher than the global estimates in almost all age groups, in both 1990 and 2019. Furthermore, the burden of LBP was not associated with the level of socio-economic development during the measurement period. Conclusion The burden attributable to LBP in the MENA region decreased slightly from 1990 to 2019. Furthermore, the burden among males was higher than the global average. Consequently, more integrated healthcare interventions are needed to more effectively alleviate the burden of low back pain in this region