Ardabil University of Medical Sciences
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Types of Complementary and Alternative Medicine in the Treatment of Pediatric Asthma: A Review Study
No full textMeasuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground
Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.
Methods
Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023.
Findings
Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia.
Interpretation
The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC
HPV and its high-risk genotypes in Middle Eastern countries: a meta-analysis
No full textHPV is the main cause of cervical cancer. Determining the geographic distribution of HPV genotypes is a major step in the implementation of cervical cancer screening. This study aimed to evaluate the prevalence of HPV and its high-risk genotypes in Middle Eastern countries. Materials & methods:
MEDLINE, ISI Web of Science, PubMed, EMBASE, Scopus and ProQuest were searched from 2005 to 2018.
The quality of the studies was determined by Strengthening the Reporting of Observational Studies in Epidemiology checklist. Fixed/random effects models were conducted to estimate the pooled prevalence.
Results: The pooled prevalence of HPV was 12.3 and 5.2%. The prevalence of HPV in Africa (22%) was higher than that in Eurasia (8.3%) and Asia (12.6%). The prevalence of HPV was 14.4, 8.3, 22 and 10.2% in Iran, Turkey, Egypt and Arab countries, respectively. The prevalence of high-risk-HPV in the abovementioned countries was 6.5, 6.2, 6.5 and 3.7%. Conclusion: Prevalence of HPV was increased in the Middle
East. This highlights the need for public education, screening and vaccination programs
The Relationship between Apelin Serum Levels with Epicardial Fat Thickness in Patients with Acute Myocardial Infarction (AMI) and Comparison with Patients with Stable Angina
No full textBackground: Apelin, as an endogenous peptide, is considered a regulator of cardiovascular homeostasis.
Aim: The aim of the present study was to evaluate the association of serum apelin levels with echocardiographic findings such as epicardial fat thickness (EFT) in patients with acute myocardial infarction compared with those without coronary artery disease (CAD).
Methods: Out of 90 candidates for angiography based on inclusion criteria, three groups were included in the study, including the group without angiographic findings (Con group), the group with stable angina (S.A.P), and the group with acute myocardial infarction (A.M.I). Angiographic, echocardiographic, and biochemical parameters were measured for all patients. Comparison between groups was performed using ANOVA statistical test and the relationship between variables was evaluated using Pearson test.
Results: Serum apelin levels were higher in the control group compared with S.A.P and A.M.I groups (P < 0.001 for both). Also, serum apelin levels were lower in the A.M.I group compared to the S.A.P group (P <0.001). A significant negative association was also observed between serum levels of apelin and Ck-MB, EFT, Gensini score, and troponin-T.
Conclusion: Although one of the sources of apelin secretion is adipose tissue, the results of the present study revealed that despite the increase in EFT values, the secretion of apelin decreased. The results suggest that cardiomyocytes damage due to myocardial infarction has a greater impact on serum apelin concentrations, which requires further investigatio
MiR-196: emerging of a new potential therapeutic target and biomarker in colorectal cancer
No full textDeregulation of microRNAs, as key elements in colorectal cancer (CRC) pathogenesis, is correlated with various stages of this cancer. miR-196 is involved in the initiation and progression of a verity of malignances, especially CRC. miR-196 in CRC cells could target different types of genes with oncogenic and/or tumor suppressor function such as HOX genes, GATA6, SOCS1, SOCS3, ANXA1, DFFA, PDCD4, ZG16 and ING5. Therefore, these genes could be up or down-regulated in cells and subsequently change the capacity of CRC cells in terms of tumor development, progression and, response to therapy. Comprehension of miR-196-associated aberrations underlying the CRC pathogenesis might introduce promising targets for therapy. Additionally, it seems that miR-196 expression profiling, especially circulatory exosomal miR-196, might be useful for diagnosis and prognosis determination of the CRC patients. In this review, at first, we summarize the roles of miR-196 in different types of cancers. After that, a detailed discussion about this miRNA and also their targets in CRC pathogenesis, progression, and response to treatment are represented. Moreover, we highlight the potential utilization of miR-196 and its targets as therapeutic targets and novel biomarkers in early detection and prediction of prognosis in CRC patients
Evaluation of Antibiotics utilization in Dr fatemi Hospital hospital, Ardabil, Iran During the Second Half of the Year 1398
No full textIntroduction:
Antibiotics are one of the most widely used medications class in clinical practices. Irrational use of antibiotic leading to increase in health care system cost, increase patient’s morbidity and mortality as well as increase the chance of antibiotics resistant. In a recent decade microbial resistant caused by the overuse and misuse of antibiotics is one of the most challenging problems in infectious disease fields. First step for rational use of antibiotic is evaluating the pattern of antibiotics utilization in clinical setting, so we decided to evaluate the pattern of antibiotic use for the first time in Fatemi hospital, Ardebil, Iran.
Method:
Study was conducted on 300 hospital admitted patients during second half of 1398 in different wards of Fatemi hospital including: general surgery, Orthopedics, neurosurgery, Ear Nose Throat, neurology and burns. Patient data including demographic, clinical and para-clinical data were recorded. Antibiotics utilization data were reported as DDD/100 bed days and DDD/patient indices, according global updated ACT/DDD system which proposed by World Health Organization for drug utilization studies.
Results:
Out of recruited patients, 170(56.7%) were male and 130 (43.3%) were female with Mean± standard deviation (SD) age of 44.3±19.91. Mean± SD of hospital stay was 6.80 ± 9.50 day. Antibiotics as most prescribed medication class, account for 25.55% of the total prescribed medications and 253 (84.33%) of study patients Received at least one antibiotic agent. The most widely used antibiotics based on DDD/100 bed days were: cefazolin (29.83), ceftriaxone (12.79), metronidazole (11.76), ciprofloxacin (6.03), vancomycin (5.44) and clindamycin (5.39). the most widely used antibiotics based on DDD/patient were: cefazolin (2.03), ceftriaxone (0.87), metronidazole (0.80), ciprofloxacin (0.41) and vancomycin (0.37).
Conclusion and Discussion:
Due to the high consumption of antibiotics in the hospital, it is necessary to prepare the standard protocol for rational use of antibiotics especially for high-consumption antibiotics agents, such as Cefazolin, ceftriaxone and metronidazol