Publications by authors named "Masoud Behzadifar"

86 Publications

A policy analysis of agenda-setting of Brucellosis in Iran using a multiple-stream framework: health policy and historical implications.

J Prev Med Hyg 2021 Jun 30;62(2):E544-E551. Epub 2021 Jul 30.

Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: Brucellosis, a major zoonotic disease, is highly present in Iran, especially in Lorestan province. The aim of this study was to understand the issues related to Brucellosis utilizing the multiple streams framework.

Methods: A two-step method was adopted: 1) assessment of brucellosis-related documents and 2) interviews with stakeholders. As a first step, all documents related to Brucellosis were reviewed at provincial and national levels. Policy documentation on health issues included the consultation of guidelines, rules and regulations, websites, reports, books, guides, and conferences. These documents were collected by referring to specialized centers, institutions, and organizations. In the second step, semi-structured interviews were conducted to determine the burden of disease with actors and stakeholders involved with the brucellosis program in the Lorestan province. More in detail, physicians, healthcare workers, managers, policy- and decision-makers were selected for interviews.

Results: The problem stream was characterized by: 1) high prevalence of the disease, 2) traditional livestock production, 3) unsafe animal slaughtering, 4) centers for the sale and distribution of non-authorized dairy products, 5) raw milk and 6) traditional unsafe dairy products consumption, 7) incomplete livestock vaccination, 8) lack of knowledge of Brucellosis, 9) neighboring countries with high prevalence of Brucellosis, 10) lack of livestock quarantine, and 10) nomadic immigration. The policy stream was characterized by 1) primary healthcare networks, 2) guidelines, 3) medicines, insurance, and 4) diagnostic services. Finally, the political stream was characterized by: 1) support of the University of Medical Sciences, 2) sponsorship by the Ministry of Health and Medical Education, 3) Health transformation plan, and 4) Working Group on Health and Food Security in Lorestan.

Conclusion: This study examined the brucellosis-related agenda setting: if different issues are taken into consideration, it can be perceived as a health priority.
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http://dx.doi.org/10.15167/2421-4248/jpmh2021.62.2.2041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451350PMC
June 2021

Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review.

Yale J Biol Med 2021 Sep 30;94(3):465-476. Epub 2021 Sep 30.

Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.

: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. : Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I statistics. : Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). : The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461582PMC
September 2021

Burden of Hypertensive Heart Disease in Iran during 1990-2017: Findings from the Global Burden of Disease study 2017.

PLoS One 2021 22;16(9):e0257617. Epub 2021 Sep 22.

Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Hypertension and its consequent end-organ damage including Hypertensive Heart Disease (HHD) are a major concern that impact health, resulting into impairment and reduced quality of life (QOL). The purpose of this study was to describe the burden of HHD in Iran and comparing it with the World Bank upper middle-income countries (UMICs) in terms of disability-adjusted life years (DALY), mortality and prevalence.

Methods: Using data from the Global Burden of Disease study 2017, we compared the number of DALYs, deaths and prevalence trends for HHD from 1990 to 2017 in all age groups for both sex in Iran, and compared the epidemiology and trends with UMICs and globally.

Results: The age-standardized DALY rate for HHD increased by 51.6% for men (95% uncertainty interval [UI] 305.8 to 436.7 per 100,000) and 4.4% for women (95% UI 429.4 to 448.7 per 100,000) in Iran. The age-standardized prevalence of HHD in Iran was almost twice times higher than globally and 1.5-times more than the World Bank UMICs. The age-standardized death rate for HDD increased by 60.1% (95% UI 17.3 to 27.7% per 100,000) for men and by 21.7% (95% UI 25.85 to 31.48 per 100,000) for women from 1990 to 2017. Age-standardized death rate in Iran was 2.4 and 1.9 times higher than globally and UMICs, respectively.

Conclusions: The higher prevalence and death rate in Iran in comparison with UMICs and globally should encourage health care provider to perform intensive screening activities in at risk population to prevent HHD and mitigate its mortality.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257617PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457465PMC
September 2021

Burden of Respiratory Infection and Tuberculosis Among US States from 1990 to 2019.

Clin Epidemiol 2021 29;13:503-514. Epub 2021 Jun 29.

Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.

Purpose: To estimate the incidence, death, disability-adjusted life years (DALYs) and attributable risk factors for respiratory infection and tuberculosis (RIT) in the US from 1990 to 2019.

Methods: Following the methodology framework and analytical strategies used in the Global Burden of Disease Study 2019, the incidence, death, DALYs and risk factors of RIT were examined by age, gender and states from 1990 to 2019 in the US. All estimates were calculated as counts, age-standardized rates per 100,000 people and percentage change, with 95% confidence intervals (CIs).

Results: In 2019, the age-standardized incidence, death and DALY rates per 100,000 people of RIT were 339,703 (95% CI 303,184 to 382,354), 13.6 (95% CI 12.2 to 14.4) and 384.9 (95% CI 330.6 to 458.6), respectively. Among RIT causes, upper respiratory infection accounted for the large majority of RIT age-standardized incidence rate, while lower respiratory infection constituted the highest proportion of RIT age-standardized death and DALY rates. The age-standardized incidence, death and DALY rates of RIT in 2019 and their temporal trends since 1990 varied widely across states and socio-demographic index. Among all attributable risk factors, smoking was the leading one for age-standardized RIT deaths in 2019, followed by low temperature and alcohol use (the attributable fractions were 17.7%, 15.3% and 6.9%, respectively).

Conclusion: Our results suggest that RIT remained a major cause of health burden in the US, with large disparities persisting between US states. Intervention efforts for RIT hotspots, high-risk populations and modifiable risk factors are necessary.
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http://dx.doi.org/10.2147/CLEP.S314802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254524PMC
June 2021

Physical rehabilitation financing in Iran: a policy analysis using Kingdon's multiple streams.

BMC Health Serv Res 2021 May 3;21(1):413. Epub 2021 May 3.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Adequate financing is a crucial function, securing that physical rehabilitation services (i.e., physiotherapy, occupational therapy, prosthetics and orthotics) are available with no financial hardship. Like many other countries, despite the adoption of various policies and strategies in recent decades, Iran enjoys no desirable physical rehabilitation financing (PRF). Accordingly, this qualitative study aimed to explore the PRF-related strategies and issues as well as their impacts on relevant policies in Iran.

Methods: An analysis of PRF-related policies was conducted in Iran using semi-structured interviews and policy documents review. Purposive and snowball sampling techniques were employed to select key informants, including health-policy makers, civil society, rehabilitation-policy makers, university professors, and practitioners. Thematic analysis was used to analyze the collected data. The analysis was framed within Kingdon's multiple streams.

Results: The hindering factors for desirable financing were weak insurance coverage, lack of sustainable financial resources, fragmented financing, lack of split between provider and financer, high-cost of physical rehabilitation services, low engagement of relevant experts in policy-making processes, and corrupt activities. In the policy stream, the following factors were highlighted: involvement of sustainable financial resources, the use of external revenue sources, allocated resources' earmarking, the integration of the current funds to have better pooling, the use of incentive and timely payment mechanisms, the implementation of strategic purchasing principals, and the employment of effective rationing strategies. Moreover, parliament support, changes in administrations, international effects, pressures from interest campaigns and NGOs, and international sanctions were found as factors affecting the politics stream.

Conclusion: The study findings revealed that a variety of national and international factors affect PRF-related issues in Iran. The recently enacted laws indicate that the PRF policies have already been on the national health political agenda. The study reflected the multifaceted nature of barriers to optimal PRF in Iran.
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http://dx.doi.org/10.1186/s12913-021-06447-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094566PMC
May 2021

The Impact of the Social Distancing Policy on COVID-19 Incidence Cases and Deaths in Iran from February 2020 to January 2021: Insights from an Interrupted Time Series Analysis.

Yale J Biol Med 2021 03 31;94(1):13-21. Epub 2021 Mar 31.

Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada.

: In December 2019, a viral outbreak occurred in China, and rapidly spread out worldwide. Due to the lack of immediately available vaccines and effective drugs, many policy- and decision-makers have focused on non-pharmacological methods, including social distancing. This study was aimed at assessing the effects of the implementation of this policy in Iran, one of the countries most affected by COVID-19. We conducted a quasi-experimental study, utilizing the interrupted time series analysis (ITSA) approach. : We collected daily data between February 20, 2020 and January 29, 2021, through governmental websites from 954 public hospitals and healthcare settings. The Iranian government launched the social distancing policy on March 27, 2020. Statistical analyses, including ITSA, were carried out with R software Version 3.6.1 (London, UK). : During the study period, 1,398,835 confirmed incidence cases and 57,734 deaths occurred. We found a decrease of -179.93 (95% CI: -380.11 to -20.25, P-value=0.078) confirmed incidence cases following the implementation of the social distancing policy, corresponding to a daily decrease in the trend of -31.17 (95% CI: -46.95 to -15.40, P-value=0.08). Moreover, we found a decrease of -28.28 (95% CI: -43.55 to -13.01, P-value=0.05) deaths, corresponding to a daily decrease in the trend of -4.52 (95% CI: -5.25 to -3.78, P-value=0.003). : The growth rate of confirmed incidence cases and deaths from COVID-19 in Iran has decreased from March 27, 2020 to January 29, 2021, after the implementation of social distancing. By implementing this policy in all countries, the burden of COVID-19 may be mitigated.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995950PMC
March 2021

Universal Health Coverage to counteract the economic impact of the COVID-19 infection: current practices and ethical challenges.

J Prev Med Hyg 2020 Dec 14;61(4):E520-E524. Epub 2021 Jan 14.

Department of Mathematics and Statistics, York University, Toronto, ON, Canada.

In late December 2019, the first case of an emerging coronavirus was identified in the city of Wuhan, Hubei province, in mainland China. The novel virus appears to be highly contagious and is rapidly spreading worldwide, becoming a pandemic. The disease is causing a high toll of deaths. Effective public health responses to a new infectious disease are expected to mitigate and counteract its negative impact on the population. However, time and economic-financial constraints, as well as uncertainty, can jeopardize the answer. The aim of the present paper was to discuss the role of Universal Health Coverage to counteract the economic impact of the COVID-19 infection. Appropriate financing of the health system and ensuring equitable access to health services for all can, indeed, protect individuals against high medical costs, which is one of the most important goals of any health system. Financing profoundly affects the performance of the health system, and any policy that the health system decides to implement or not directly depends on the amount of available funding. Developed countries are injecting new funding to cope with the disease and prevent its further transmission. In addition to psychological support and increased societal engagement for the prevention, control, and treatment of COVID-19, extensive financial support to governments by the community should be considered. Developed and rich countries should support countries that do not have enough financial resources. This disease cannot be controlled and contained without international cooperation. The experience of the COVID-19 should be a lesson for further establishing and achieving universal health coverage in all countries. In addition to promoting equity in health, appropriate infrastructure should be strengthened to address these crises. Governments should make a stronger political commitment to fully implement this crucial set of policies and plans.
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http://dx.doi.org/10.15167/2421-4248/jpmh2020.61.4.1581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888394PMC
December 2020

Assessing Iran's health system according to the COVID-19 strategic preparedness and response plan of the World Health Organization: health policy and historical implications.

J Prev Med Hyg 2020 Dec 14;61(4):E508-E519. Epub 2021 Jan 14.

Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Italy.

Background: The role of health systems in the management of disasters, including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the World Health Organization (WHO) to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran's health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak.

Methods: The present investigation was designed as a qualitative study. We utilized the "COVID-19 Strategic Preparedness and Response Plan" devised by WHO as a conceptual framework.

Results: The dimension/pillar which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillars/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry.

Discussion: The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face possible future crises.
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http://dx.doi.org/10.15167/2421-4248/jpmh2020.61.4.1613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888405PMC
December 2020

The impacts of health transformation plan on physiotherapy sector in Iran: a qualitative study using five control knobs.

Disabil Rehabil 2021 Feb 4:1-7. Epub 2021 Feb 4.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: To investigate physiotherapists', academics', and relevant decision- and policy-makers' experiences regarding the impacts of the Health Transformation Plan (HTP) on the physiotherapy sector in Iran.

Materials And Methods: This qualitative study was conducted using in-depth semi-structured interviews. The participants were selected using both purposive and snowball sampling strategies with maximum diversity. The sampling procedure continued until data saturation was achieved. The collected data were analyzed using thematic content analysis in accordance with Braun and Clarke's methodology.

Results: The findings showed that the physiotherapy sector has faced several challenges after the implementation of HTP in five control knobs: (1) financing (a decline in the government budget and insufficient health insurance coverage), (2) payment (delayed payments and setting a tight ceiling for reimbursements), (3) behaviors (a decrease in the motivation of physiotherapists, the tendency toward misbehaviors such as absenteeism and providers' unwillingness to cooperate with insurance companies), (4) organization (difficulty in clinical education and ignoring the preventive effects of physiotherapy interventions), and (5) regulation (absence of stakeholders in political processes and inconsistency of upstream documents).

Conclusion: HTP has posed various challenges on the physiotherapy sector in Iran. Promoting the policymakers' awareness and aligning the health reforms such as HTP with the current upstream documents would diminish the existing challenges.IMPLICATIONS FOR REHABILITATIONMore government budgets and better insurance coverage are needed to strengthen the physiotherapy sector.Timely payment and modification of limitations for reimbursements of physiotherapy services are recommended.It is recommended to adopt strategies to increase the motivation of physiotherapists and reduce the risk of professional misconduct in the physiotherapy sector.Problems in clinical physiotherapy training should be addressed by policy-makers, and the preventive effects of physiotherapy interventions deserve more attention.Enhanced participation of physiotherapy stakeholders in relevant legislative processes is recommended to improve their services.
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http://dx.doi.org/10.1080/09638288.2021.1878563DOI Listing
February 2021

Mapping Research Trends of Universal Health Coverage From 1990 to 2019: Bibliometric Analysis.

JMIR Public Health Surveill 2021 01 11;7(1):e24569. Epub 2021 Jan 11.

Department of Health Sciences, School of Public Health, University of Genoa, Genoa, Italy.

Background: Universal health coverage (UHC) is one of many ambitious, health-related, sustainable development goals. Sharing various experiences of achieving UHC, in terms of challenges, pitfalls, and future prospects, can help policy and decision-makers reduce the likelihood of committing errors. As such, scholarly articles and technical reports are of paramount importance in shedding light on the determinants that make it possible to achieve UHC.

Objective: The purpose of this study is to conduct a comprehensive analysis of UHC-related scientific literature from 1990 to 2019.

Methods: We carried out a bibliometric analysis of papers related to UHC published from January 1990 to September 2019 and indexed in Scopus via VOSviewer (version 1.6.13; CWTS). Relevant information was extracted: the number of papers published, the 20 authors with the highest number of publications in the field of UHC, the 20 journals with the highest number of publications related to UHC, the 20 most active funding sources for UHC-related research, the 20 institutes and research centers that have produced the highest number of UHC-related research papers, the 20 countries that contributed the most to the research field of UHC, the 20 most cited papers, and the latest available impact factors of journals in 2018 that included the UHC-related items under investigation.

Results: In our analysis, 7224 articles were included. The publication trend was increasing, showing high interest in the scientific community. Most researchers were from the United States, the United Kingdom, and Canada, with Thailand being a notable exception. The Lancet accounted for 3.95% of published UHC-related research. Among the top 20 funding sources, the World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the National Institutes of Health (NIH) accounted for 1.41%, 1.34%, and 1.02% of published UHC-related research, respectively. The highest number of citations was found for articles published in The Lancet, the American Journal of Psychiatry, and the Journal of the American Medical Association (JAMA). The top keywords were "health insurance," "insurance," "healthcare policy," "healthcare delivery," "economics," "priority," "healthcare cost," "organization and management," "health services accessibility," "reform," "public health," and "health policy."

Conclusions: The findings of our study showed an increasing scholarly interest in UHC and related issues. However, most research concentrated in middle- and high-income regions and countries. Therefore, research in low-income countries should be promoted and supported, as this could enable a better understanding of the determinants of the barriers and obstacles to UHC achievement and improve global health.
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http://dx.doi.org/10.2196/24569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834945PMC
January 2021

Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review.

Heart Fail Rev 2021 May 24;26(3):587-601. Epub 2020 Nov 24.

Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada.

To assess the cost-effectiveness of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation and heart failure, a systematic literature search was conducted in various electronic databases to January 3, 2020. Eligibility criteria are the population (patients with mitral regurgitation (MR)), intervention (transcatheter mitral valve repair using the MitraClip), comparator (conventional medical treatment), outcomes, and designs (Model-based or trial-based full economic evaluations).The quality of included studies was assessed using the CHEERS checklist. Mortality and survival rate, quality-adjusted life year (QALY), life years gained (LYG), total cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of MitraClip System were considered as the key outcomes. Eight articles were eligible for full-text assessment. Ultimately, a total of seven studies were considered in the current systematic review. Results demonstrated that MitraClip reduces mortality rate and increases survival rate. The mortality rate at 1 year and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively. Total cost data based on 2019 USD show that the MitraClip has the highest cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The results showed that in all selected countries, willingness-to-pay (WTP) thresholds are upper than the cost per QALY; also, the highest ICER for the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy ($10,616/QALY). To conclude, evidence from this systematic review suggests that MitraClip Delivery System improved both life expectancy and QALY compared with medical treatment in patients at high surgical risk and it was also a cost-effective treatment option for patients with mitral regurgitation.
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http://dx.doi.org/10.1007/s10741-020-10055-9DOI Listing
May 2021

One health approach to tackle brucellosis: a systematic review.

Trop Med Health 2020 20;48:86. Epub 2020 Oct 20.

Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.

Background: Brucellosis is the most significant and common bacterial zoonosis and is recognized as a re-emerging and neglected disease. Tackling zoonosis is very important for the health and the economy. One Health is an approach characterized by the integration of human and animal health, plants, and ecosystems and encourages joining local, national, and global multidisciplinary efforts to achieve optimal levels of health and collaboration among different disciplines to address complex health problems.

Objectives: The present study aimed to review published scientific literature related to the use of the One Health approach to tackle human brucellosis.

Methods: Web of Science (WoS), PubMed, Scopus, The Cochrane Library, and Embase databases were searched from inception until 30 January 2020. The reference lists of all relevant papers were hand-searched. Two authors extracted data from published studies independently. The Joanna Briggs Institute tool was used to assess the quality of studies.

Results: Of 2297 studies, 10 studies were deemed eligible, which were conducted between 2013 and 2019. Studies were performed in Uganda, Malta, Serbia, Greece, Mongolia, Azerbaijan, Israel, India, Ethiopia, and the USA. All studies suggested that brucellosis is still a major public health problem and that the most important aspect of the One Health approach is the interdependence of humans, ecosystems, and animals .Some studies have focused on livestock vaccination as the most effective way to prevent disease, and others have focused on the biology of infection and its transmission patterns. Some studies have pointed to the effectiveness of the One Health approach in all the phases of disease management as well as to its role in reducing health costs.

Conclusion: The success of the approach depends on the willingness of the decision-makers to implement the necessary policies. Due to the heterogeneity of current practices, and organizations involved in One Health approach-based programs, it will be incomplete without proper planning. To better implement the approach, strategies should be appraised and disseminated by experts and relevant stakeholders.
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http://dx.doi.org/10.1186/s41182-020-00272-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574566PMC
October 2020

The 'Health Transformation Plan' in Iran: A policy to achieve universal health coverage in slums and informal settlement areas.

Int J Health Plann Manage 2021 Mar 29;36(2):267-272. Epub 2020 Sep 29.

Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.

Universal health coverage (UHC) is one of the strategies that health decision- and policy-makers worldwide are implementing to guarantee a good health status to everyone. Living in slums is characterized by several issues, including homelessness and malnutrition, environmental challenges, lack of sanitation and access to safe, healthy drinking water, waste disposal problems, widespread social disruptions, job insecurity, feelings of dissatisfaction and inadequacy. In Iran, the 'Health Transformation Plan' (HTP), despite its weaknesses, has had good effects on the health level of people living in slums, ensuring insurance coverage and reducing many economic, social and cultural problems, with a dramatic decline in out-of-pocket expenditures. Good governmental financial support and an adequate revision of the initial packages of health services and provisions have resulted in a higher access rate to healthcare. The HTP has been, indeed, a major step towards reaching UHC in Iran. If policy- and decision-makers can further improve the present situation and provide more and better-quality services to these people, it can be expected that health indicators in suburbs will be significantly improved. Researchers should monitor the impact of HTP and examine its effects on health indicators, specifically among particularly vulnerable groups such as children, women and the elderly.
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http://dx.doi.org/10.1002/hpm.3082DOI Listing
March 2021

Cost-effectiveness of allopurinol versus febuxostat in the treatment of gout patients: A systematic review.

Med J Islam Repub Iran 2020 30;34:41. Epub 2020 Apr 30.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

In recent years, increased longevity, poor dietary habits, and the rising prevalence of metabolic syndrome and hypertension have increased the prevalence of gout. Gout significantly increases direct and indirect costs and reduces the quality of life. Allopurinol and febuxostat are the most commonly used drugs for reducing uric acid levels and controlling this disease with different cost-effectiveness. The present systematic review compares the cost-effectiveness of these drugs. This was a systematic review of economic evaluations. Cochrane CENTRAL, Web of Science, PubMed, Embase, and the Cost-Effectiveness Analysis (CEA) Registry were searched up to April 30, 2018, based on the specific search strategy of each database. Keywords used in the search include gout, cost-effectiveness, allopurinol, and febuxostat in MeSH and free-text forms. Screening of identified studies, data extraction, and quality assessment were done independently by 2 reviewers. The quality of studies was assessed based on Drummond Checklist. Finally, a qualitative analysis was done to analyze the results. A total of 94 studies were identified through database search and the review of references. After screening the titles, abstracts, and full-texts, 6 economic evaluations were included in the review. The majority of the studies had been conducted in the US using the Markov model, within a 5-year horizon, and from the payer's perspective, with the quality of life as a measure of effectiveness. In most studies, the incremental cost-effectiveness ratios (ICERs) of febuxostat per quality-adjusted life year (QALY) were below the threshold (10 000$/QALY and 30 000€/QALY). Febuxostat has been shown to be more cost-effective than allopurinol in all treatment sequences in studies that have used uric acid levels as the measure of effectiveness. Furthermore, in studies with the quality of life as the measure of effectiveness, febuxostat has been shown to be very cost-effective as the second-line treatment.
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http://dx.doi.org/10.34171/mjiri.34.41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456432PMC
April 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Prevalence of self-medication in university students: systematic review and meta-analysis.

East Mediterr Health J 2020 Jul 23;26(7):846-857. Epub 2020 Jul 23.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: Self-medication can lead to serious consequences but its overall prevalence in students is not known.

Aims: The aim of this study was to determine the prevalence of self-medication in students through a systematic review and meta-analysis of studies on the prevalence of self-medication in students across the world.

Methods: PubMed/MEDLINE, EMBASE, ISI/Web of Science and Google Scholar were searched up to October 2017. Studies reporting the prevalence of self-treatment in university students were selected. Data recorded included year of publication, country where the study was conducted, sample size, prevalence of self-medication, sex and mean age of students, and faculty of students (medical or non-medical). A random-effect model was used to determine effect size with a 95% confidence interval (CI). Heterogeneity across studies was assessed with the I test. A sensitivity analysis assessed stability of the findings.

Results: A total of 89 studies were included in the analysis, which comprised 60 938 students. The overall prevalence of self-medication in university students was 70.1% (95% CI: 64.3-75.4%). Female students self-medicated more often than male students: odds ratio = 1.45 (95% CI%: 1.17-1.79). The prevalence of self-medication in medical students (97.2%) was higher than in non-medical students (44.7%). The I test indicated high, statistically significant heterogeneity. The sensitivity analysis showed that the results were stable.

Conclusion: The prevalence of self-medication among students worldwide is high. Programmes on the risks of self-medication and increasing control and monitoring of the sale of drugs are recommended. Facilitating students' access to doctors and health centres could reduce self-medication in students.
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http://dx.doi.org/10.26719/emhj.20.052DOI Listing
July 2020

Zonisamide add-on therapy for focal epilepsy.

Cochrane Database Syst Rev 2020 07 24;7:CD001416. Epub 2020 Jul 24.

Department of Health Sciences, Postgraduate School of Public Health, Genoa, Italy.

Background: The majority of people with epilepsy have a good prognosis, and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop dug-resistant epilepsy, especially those with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RCT) of zonisamide, used as an add-on treatment for focal epilepsy uncontrolled by one or more concomitant antiepileptic drug. This is an updated version of the Cochrane review previously published in 2018.

Objectives: To evaluate the efficacy and tolerability of zonisamide, when used as an add-on treatment for people with focal epilepsy uncontrolled by one or more concomitant antiepileptic drugs.

Search Methods: For the latest update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE Ovid (September 2019). In addition, we contacted Eisai Limited (makers and licensees of zonisamide) and experts in the field, to seek any ongoing or unpublished studies.

Selection Criteria: Randomised controlled trials, in which add-on zonisamide was compared with placebo or another antiepileptic drug in people with focal epilepsy, uncontrolled by one or more concomitant antiepileptic drugs.

Data Collection And Analysis: Two review authors independently selected trials for inclusion, extracted data, assessed for risk of bias using the Cochrane 'Risk of bias' tool, and assessed the certainty of the evidence, using the GRADE approach. The primary outcome was at least a 50% reduction in total seizure frequency; the secondary outcomes were (1) tolerability; and (2) adverse effects. We used an intention-to-treat approach for our primary analyses. We estimated summary risk ratios (RRs) for each outcome. We displayed a summary of the estimates of effects and certainty of the evidence for each outcome in a 'Summary of findings' table.

Main Results: We did not find any new studies since the last version of this review. We included eight studies (1636 participants) from previous versions of this review. The overall RR with 95% confidence interval (CI) for at least a 50% reduction in seizure frequency for 300 mg to 500 mg/day of zonisamide compared to placebo was 1.90 (95% CI 1.63 to 2.22; 7 trials, 1371 participants; moderate-certainty evidence). The RR for 50% reduction in seizure frequency compared to placebo for any dose of zonisamide (100 mg to 500 mg/day) was 1.86 (95% CI 1.60 to 2.17; 7 trials, 1429 participants; moderate-certainty evidence). The number needed to treat for an additional beneficial outcome was six (95% CI 4.1 to 6.8). Two trials provided evidence of a dose-response relationship for this outcome. The RR for treatment withdrawal for 300 mg to 500 mg/day of zonisamide compared to placebo was 1.59 (95% CI 1.18 to 2.13; 6 trials, 1099 participants; moderate-certainty evidence), and for 100 mg to 500 mg/day was 1.44 (95% CI 1.08 to 1.93; 6 trials, 1156 participants; moderate-certainty evidence). The number needed to treat for an additional harmful outcome was 15 (95% CI 9.3 to 36.7). The following adverse effects were more likely to be associated with zonisamide than with placebo: ataxia (RR 3.85, 99% CI 1.36 to 10.93; 4 trials, 734 participants; low-certainty evidence); somnolence (RR 1.52, 99% CI 1.00 to 2.31; 8 trials, 1636 participants; moderate-certainty evidence); agitation (RR 2.35, 99% CI 1.05 to 5.27; 4 trials, 598 participants; low-certainty evidence); and anorexia (RR 2.74, 99% CI 1.64 to 4.60; 6 trials, 1181 participants; low-certainty evidence). Across the eight studies, we rated risk of bias domains at low or unclear risk of bias, apart from two studies, which we rated at high risk of attrition bias. Five of the eight studies were sponsored by the drug companies that produced zonisamide.

Authors' Conclusions: When used as an add-on treatment in people with focal epilepsy, uncontrolled by one or more concomitant antiepileptic drugs, moderate-certainty evidence found that zonisamide was more successful than placebo at reducing the frequency of seizures by at least 50%. We were unable to identify minimum effective and maximum tolerated doses. The included trials evaluated a maximum stable-dose phase of 18 weeks, so results cannot be used to confirm longer periods of efficacy in seizure control. The results cannot be extrapolated to monotherapy, or to people with other seizure types or epilepsy syndromes.
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http://dx.doi.org/10.1002/14651858.CD001416.pub5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7389315PMC
July 2020

Prevalence rate of laboratory defined aspirin resistance in cardiovascular disease patients: A systematic review and meta-analysis.

Caspian J Intern Med 2020 ;11(2):124-134

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Cardiovascular disease (CVD) is the first cause of mortality worldwide, with all the healthcare systems facing this very challenging issue. Aspirin continues to be the major gold-standard treatment worldwide in the prevention of thrombotic disease in patients with CVD, even though not all individuals respond to antiplatelet therapy in a similar way, being resistant to aspirin. The aim of this study was to determine the prevalence of laboratory defined aspirin resistance in CVD patients worldwide.

Methods: Relevant articles were identified through searching EMBASE, PubMed/ MEDLINE, ISI /Web of Science, Scopus, and the Cochrane Library, from January 2000 to February 2018. The methodological quality of the included studies was critically appraised using the Newcastle-Ottawa scale. The pooled prevalence of laboratory defined aspirin resistance was computed using the Der Simonian-Laird random-effect model.

Results: We included 65 studies, with a total of 10,729 patients. The overall prevalence of laboratory defined aspirin resistance in CVD patients was 24.7% ([95%CI 21.4-28.4]. Women were found to be at increased risk of laboratory defined aspirin resistance compared to men, with an odds ratio of 1.16 [95%CI 0.87-1.54].

Conclusion: Doctors and healthcare providers should pay special attention to aspirin resistance since lack of awareness could cause problems and increase mortality in these patients, if not properly treated with higher aspirin doses.
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http://dx.doi.org/10.22088/cjim.11.2.124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265510PMC
January 2020

Ensuring adequate health financing to prevent and control the COVID-19 in Iran.

Int J Equity Health 2020 05 6;19(1):61. Epub 2020 May 6.

Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.

On February 19 2020, the Iranian Ministry of Health and Medical Education (MoHME) has announced the first 2 cases of SARS-CoV-2, a novel emerging coronavirus which causes an infection termed as COVID-19, in Qom city. As such, the Iranian government, through the establishment of the "National Headquarters for the management and control of the novel Coronavirus", has started implementing policies and programs for the prevention and control of the virus. These measures include schools and universities closure, reduced working hours, and increased production and delivery of equipment such as masks, gloves and hygienic materials for sterile environments. The government has also made efforts to divulge high-quality information concerning the COVID-19 and to provide laboratories and hospitals with diagnostic kits and adequate resources to treat patients. However, despite such efforts, the number of cases and deaths has progressively increased with rising trends in total confirmed cases and deaths, as well as in new daily cases and deaths associated with the COVID-19. Iran is a developing country and its economic infrastructure has been hit hardly by embargo and sanctions. While developed countries have allocated appropriate funding and are responding adequately to the COVID-19 pandemics, Iran has experienced a serious surge of cases and deaths and should strive to provide additional resources to the health system to make healthcare services more accessible and to increase the fairness of that access. All relevant actors and stakeholders should work together to fight this disease.
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http://dx.doi.org/10.1186/s12939-020-01181-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201390PMC
May 2020

How Big Data and Artificial Intelligence Can Help Better Manage the COVID-19 Pandemic.

Int J Environ Res Public Health 2020 05 2;17(9). Epub 2020 May 2.

Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada.

SARS-CoV2 is a novel coronavirus, responsible for the COVID-19 pandemic declared by the World Health Organization. Thanks to the latest advancements in the field of molecular and computational techniques and information and communication technologies (ICTs), artificial intelligence (AI) and Big Data can help in handling the huge, unprecedented amount of data derived from public health surveillance, real-time epidemic outbreaks monitoring, trend now-casting/forecasting, regular situation briefing and updating from governmental institutions and organisms, and health facility utilization information. The present review is aimed at overviewing the potential applications of AI and Big Data in the global effort to manage the pandemic.
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http://dx.doi.org/10.3390/ijerph17093176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246824PMC
May 2020

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis.

BMC Health Serv Res 2020 Apr 19;20(1):327. Epub 2020 Apr 19.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: Healthcare policy- and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms. In May 2014, the Iranian Ministry of Health and Medical Education has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP). This study aimed to determine the effect of the HTP on hospitalization rate in Iranian public hospitals affiliated to the Ministry of Health and Medical Education.

Methods: This study was designed as a quasi-experimental, counterfactual study utilizing the interrupted time series analysis (ITSA), comparing the trend of hospitalization rate before and after the HTP implementation in 16 hospitals in the Lorestan province. Data was collected from March 2012 to February 2019.

Results: In the first month of the HTP implementation, an increase of 2.627 [95% CI: 1.62-3.63] was noted (P < 0.001). Hospitalization rate increased by 0.68 [95% CI: 0.32-0.85] after the HTP implementation compared to the first month after the launch of the HTP (P < 0.001). After the HTP implementation, monthly hospitalization rate per 1000 persons significantly increased by 0.049 [95% CI: 0.023-0.076] (P < 0.001).

Conclusions: The HTP implementation has resulted in an increased hospitalization rate. Health planners should continue to further improve this service. ITSA can play a role in evaluating the impact of a given health policy.
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http://dx.doi.org/10.1186/s12913-020-05186-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168862PMC
April 2020

Seroprevalence of hepatitis E virus infection in pregnant women: a systematic review and meta-analysis.

Ann Saudi Med 2020 Mar-Apr;40(2):136-146. Epub 2020 Apr 2.

From the Department of Clinical Biochemistry/Medical Education, King Abdulaziz University, Jeddah, Saudi Arabia.

Background: Hepatitis E virus (HEV) infection has emerged as a global public health problem that affects millions of people every year.

Objective: Systematically review data on the prevalence of HEV IgG antibody among pregnant women around the world.

Data Sources: Potentially relevant studies were identified by a search of PubMed and ScienceDirect, and by a manual search of the reference lists of identified studies.

Study Selection: Observational studies in English with no age or area restriction. Reviews, duplicate, book chapters, and other irrelevant studies were excluded.

Data Extraction: Independent searching by two investigators (TA, THM).

Data Synthesis: In the 6137 retrieved studies, 15 studies met the inclusion criteria. The studies included 7160 pregnant subjects from 11 countries. Most studies were from Africa. Of the 7160 subjects, 1182 were positive to anti-HEV IgG antibody, and only 66 were anti-HEV IgM antibody positive. The highest seroprevalence of anti-HEV IgG antibody (61.29%) was reported in Sudan and the lowest (3.41%) was reported in Italy. The overall pooled prevalence was 16.51% (95% CI: 0.10-0.23). The heterogeneity level was I = 98%; P≤.01.

Conclusion: The seroprevalence of anti-HEV IgG antibody among pregnant women differs by geographic location. Further studies are recommended to evaluate incidence, morbidity, and mortality in those areas where the disease is prevalent.

Limitations: Seroprevalence was only determined for the anti-HEV IgG antibody, which mostly indicates past infection. Heterogeneity was high among the studies in the analysis.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2020.136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118233PMC
December 2020

Sleep Disturbances Rate among Medical and Allied Health Professions Students in Iran: Implications from a Systematic Review and Meta-Analysis of the Literature.

Int J Environ Res Public Health 2020 02 5;17(3). Epub 2020 Feb 5.

Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy.

Medicine and healthcare professions are prestigious and valued careers and, at the same time, demanding, challenging, and arduous jobs. Medical and allied health professions students, experiencing a stressful academic and clinical workload, may suffer from sleep disturbances. In Iran, several studies have been conducted to explore the prevalence rate among medical and healthcare professions students. The aim of this systematic review and meta-analysis was to quantitatively and rigorously summarize the existing scholarly literature, providing the decision- and policy-makers and educators with an updated, evidence-based synthesis. Only studies utilizing a reliable psychometric instrument, such as the Pittsburgh sleep quality index (PSQI), were included, in order to have comparable measurements and estimates. Seventeen investigations were retained in the present systematic review and meta-analysis, totaling a sample of 3586 students. Studies were conducted between 2008 and 2018 and reported an overall rate of sleep disturbances of 58% (95% confidence interval or CI 45-70). No evidence of publication bias could be found, but formal analyses on determinants of sleep disturbances could not be run due to the dearth of information that could be extracted from studies. Poor sleep is highly prevalent among Iranian medical and healthcare professions students. Based on the limitations of the present study, high-quality investigations are urgently needed to better capture the determinants of poor sleep quality among medical and healthcare professions students, given the importance and the implications of such a topic.
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http://dx.doi.org/10.3390/ijerph17031011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037918PMC
February 2020

Current and former smokers among adolescents aged 12-17 years in Iran: a systematic review and meta-analysis.

BMC Public Health 2020 Jan 31;20(1):155. Epub 2020 Jan 31.

Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.

Background: Smoking, especially among adolescents, is considered a serious public health concern worldwide being associated with increased mortality. The present study was designed as the first systematic review and meta-analysis of the prevalence of current and former smoking behavior among adolescents in Iran.

Methods: Seven international scholarly databases, namely Scopus, Embase, Pubmed/Medline, ISI/Web of Science (WOS), the Cochrane Library, Psyc Info and Cinahl, were extensively searched from January 2000 to September 18, 2019. Google Scholar was also mined. Iranian databases were searched as well (namely, MagIran, Scientific Information Database (SID), and Barakatkns). The DerSimonian-Laird's approach, via the Freeman-Tukey double arcsine method, was used to synthesize the prevalence estimates.

Results: The prevalence of current smokers among Iranian adolescents was estimated to be 9% (95% CI: 7 to 10). Stratifying based on gender, the prevalence was 12% among boys (95% CI: 10 to 14) and 6% among girls (95% CI: 5 to 8). The prevalence of former smokers among Iranian adolescents using the random-effect model was computed to be 24% (95% CI: 21 to 27).

Conclusion: The findings of this study showed that the prevalence of current and former smoking behavior among Iranian adolescents is a relevant public health concern. The country's young population should be given more attention by health policy- and decision-makers and implementation of ad hoc prevention and control policies should be on their agenda.
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http://dx.doi.org/10.1186/s12889-020-8255-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995203PMC
January 2020

A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran.

BMC Public Health 2020 Jan 14;20(1):62. Epub 2020 Jan 14.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: Hepatitis C virus (HCV) infection is one of the major public health challenges generating a relevant burden. High-risk groups, including people who inject drugs (PWID), are at serious risk for developing HCV. In recent years, several investigations have been conducted in Iran to assess the prevalence e of HCV among PWID. The aim of the present study was to synthesize the literature performing a comprehensive search and meta-analysis.

Methods: A comprehensive literature search was carried out from January 2000 to September 2019. Several international databases, namely Scopus, PubMed/MEDLINE, Embase, ISI/Web of Science, PsycINFO, CINAHL, the Cochrane Library and the Directory of Open Access Journals (DOAJ), as well as Iranian databases (Barakathns, SID and MagIran), were consulted. Eligible studies were identified according to the following PECOS (population, exposure, comparison/comparator, outcome and study type) criteria: i) population: Iranian population; ii) exposure: injection drug users; iii) comparison/comparator: type of substance injected and level of substance use, iv) outcome: HCV prevalence; and v) study type: cross-sectional study. After finding potentially related studies, authors extracted relevant data and information based on an ad hoc Excel spreadsheet. Extracted data included the surname of the first author, the study journal, the year of publication, the number of participants examined, the type of diagnostic test performed, the number of positive HCV patients, the number of participants stratified by gender, the reported prevalence, the duration of drug injection practice and the history of using a shared syringe.

Results: Forty-two studies were included. 15,072 PWID were assessed for determining the prevalence of HCV. The overall prevalence of HCV among PWID in Iran was computed to be 47% (CI 95: 39-56). The prevalence ranged between 7 and 96%. Men and subjects using a common/shared syringe were 1.46 and 3.95 times more likely to be at risk, respectively.

Conclusion: The findings of the present study showed that the prevalence of HCV among PWIDs in Iran is high. The support and implementation of ad hoc health-related policies and programs that reduce this should be put into action.
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http://dx.doi.org/10.1186/s12889-020-8175-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961327PMC
January 2020

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

Inj Prev 2020 10 8;26(Supp 1):i46-i56. Epub 2020 Jan 8.

Department of Public Health, Mizan-Tepi University, Teppi, Ethiopia.

Background: The 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.

Methods: We 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.

Results: Globally, 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.

Conclusions: While 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.
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http://dx.doi.org/10.1136/injuryprev-2019-043302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571357PMC
October 2020

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 8;26(Supp 1):i12-i26. Epub 2020 Jan 8.

School of Public Health, Auckland University of Technology, Auckland, New Zealand.

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.

Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.

Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.

Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
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http://dx.doi.org/10.1136/injuryprev-2019-043296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571356PMC
October 2020

Cost-effectiveness analysis of PCSK9 inhibitors in cardiovascular diseases: a systematic review.

Heart Fail Rev 2020 11;25(6):1077-1088

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Aims: To assess the cost-effectiveness of pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in cardiovascular disease.

Methods And Results: We performed a comprehensive search strategy in electronic databases from January 2015 to January 2019. Out of 475 articles, 16 were entered into the study. Quality-adjusted life year, life years gained (LYG), annual cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of PCSK9 inhibitors were considered as the key outcomes. The cost-effectiveness threshold varied from $45,000 in Spain to $150,000 in the USA. The annual cost of PCSK9 inhibitors for studies undertaken in the USA was in the range of $14,000 to $15,000, while it was about $7000 for other developed countries. The results showed that reduction in the price of PCSK9 inhibitors changed from 20 to 88%. The means of QALY were 0.65 and 0.67 in the Markov and Cardiovascular Disease Policy Modeling (CVDPM) models; also, the ICER means were $197,707 and $625,555 for the Markov and CVDPM model, respectively.

Conclusion: According to the current study, the effectiveness of PCSK9 inhibitors is well documented, although all studies pointed out a higher cost of these inhibitors.

Trial Registration: This study was registered within the International Prospective Register of Systematic Reviews (PROSPERO) database of the University of York (CRD42018088472).
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http://dx.doi.org/10.1007/s10741-019-09874-2DOI Listing
November 2020
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