International Journal of Preventive Medicine最新文献

Background: Inappropriate use of healthcare services not only represents inefficient use of limited healthcare resources but also incurs an additional cost burden. Therefore, this study aimed to estimate the inappropriateness of admission and hospitalization in the EMRO region. A systematic review and meta-analysis study was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Methods: The data were collected between April and June 2024 from four databases: Web of Science, ProQuest, Scopus, and PubMed. The data collection period ranged from January 1, 1980, to February 30, 2024. The search involved a combination of terms such as "Appropriate," "Inappropriate," "Admission," "Stay," "hospital admission," "hospital use," "Hospital stay," "AEP," "Hospitalization," "Avoidable admission," "Bed utilization," "Appropriateness Evaluation Protocol," and "countries of EMRO" in interventional and observational studies. Excel and STATA, version 11, were used for data analysis.

Results: Among 14,430 published articles, 19 studies were included in the review. The inappropriate admission rate was 14.6 in Eastern Mediterranean region countries (95% CI: 10.45-20.54). Inappropriate admission in Iran was lower than in other countries in the EMRO region (10.20 vs 22.28) (P = 0.001). The inappropriate hospitalization rate in EMRO countries was 15.63 (CI: 9.61-25.41). The highest number of inappropriate admissions and hospitalization was reported before 2010 (22.14, CI: 9.42-52.05) and (42.52 CI: 29.10-62.13), respectively (P value 0.001).

Conclusions: This study showed that the rate of inappropriate admission and hospitalization in EMRO countries is lower than in some European countries, such as Turkey, Italy, and Switzerland. Adopting appropriate policies for patient admission, physician training, employing experts, and fully utilizing the hospital's referral system for home care can help optimize hospital facilities and services.

Backgrounds: Vanillin is the active component of Vanillus planifolia seeds and is widely used as a flavoring agent in food and pharmaceutical industries. It has shown anti-inflammatory and antinociceptive properties. The aim of the present research was to investigate its possible mechanism(s) in formalin test.

Methods: Male Swiss mice (25-30 g) were used. Formalin test was used to evaluate the antinociceptive effect. Different groups of mice were pretreated with prazocin (2 mg/kg), yohimbine (5 mg/kg), propranolol (2 mg/kg), cyproheptadine (2 mg/kg), ondansetron (2 mg/kg), naloxone (5 mg/kg), sulpiride (20 mg/kg), arginine (100 mg/kg), L-NAME (20 mg/kg), methylene blue (5 mg/kg), or glibenclamide (10 mg/kg) to evaluate the role of pertinent receptors or pathways on vanillin-induced antinociception.

Results: Vanillin showed antinociceptive effect in the second phase of formalin test. Pretreatment with ondansetron, sulpiride, L-NAME, methylene blue, or glibenclamide prevented vanillin antinociceptive effect.

Conclusions: Vanillin showed antinociceptive effect in formalin test, and according to the results, the NO/cGMP/K_ATP pathway and serotonin 5HT₃ and dopamine D₂ receptors have an important contribution to its antinociceptive effect, but opioid and adrenergic receptors are not involved in this effect.

Background: This study aimed to evaluate the effect of hemoglobin (Hb) levels on 3-year clinical outcomes and long-term cardiovascular-related mortality in MI patients.

Methods: This study is a secondary study of the ST Elevation Myocardial Infarction Cohort Study (SEMI-CI) in Isfahan, Iran, that included 844 STEMI patients. The Hb level and other clinical and biochemical data during hospitalization were recorded at admission and also for 3 years annually. Cox regression analyses (univariate and multivariate) were performed to identify hazard ratios for CVD events.

Results: The prevalence of anemia was 16.7% in our population. Anemia was associated with an increased risk of the composite event (HR: 2.38, 95% CI: 1.77-3.19), mortality (HR: 2.91, 95% CI: 2.03-4.15), and unstable angina (HR: 2.22, 95% CI: 1.07-4.58) during a 3-year follow-up. After adjusting factors including smoking, diabetes, hypercholesterolemia, atrial fibrillation, treated hypertension, and BMI, anemia was only associated with an increased risk of the composite event and mortality. The 3-year cardiovascular survival curve showed better results in the nonanemic group (P value < 0.0001).

Conclusions: Anemia was associated with a higher prevalence of 3-year mortality in STEMI patients, especially in the first year. In addition, there were associations between anemia and some CVD events in long-term follow-ups such as composite CVD events and unstable angina in our population.

Background: Obesity imposes a heavy burden on healthcare systems and society. Despite various treatment options, choosing cost-effective pharmacological interventions remains a key concern for health policymakers. This study systematically reviews economic evaluations of antiobesity drugs, comparing their costs and outcomes with those of lifestyle interventions.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases (PubMed, Scopus, Web of Science, and Embase) were searched for full economic evaluations of FDA-approved antiobesity drugs, including semaglutide, liraglutide, tirzepatide, phentermine-topiramate, and orlistat. Inclusion criteria required studies to report cost-effectiveness, cost-utility, or cost-benefit outcomes. Data on incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALY), or disability-adjusted life years (DALY) were extracted and adjusted to 2024 USD using PPP. Study quality was assessed using CHEERS 2022.

Results: Fifteen studies met the inclusion criteria. Most used Markov models and cost-effectiveness analyses. The review of articles showed that 60% of the articles were conducted in the United States of America, 33.33% of the articles in Europe, and 6.66% of the articles in Australia. Among the reviewed studies, semaglutide was found to be the most cost-effective and clinically effective drug in most scenarios. Phentermine-topiramate showed acceptable cost-effectiveness, particularly in low-resource settings. Orlistat and naltrexone-bupropion were also considered affordable options, though with lower effectiveness. Tirzepatide, despite its high efficacy, demonstrated a higher ICER, making its cost-effectiveness context-dependent.

Conclusions: These findings highlight the importance of integrating cost-effective pharmacological treatments into obesity management strategies. Semaglutide appears to be a highly effective and economically favorable option, while phentermine-topiramate and orlistat offer practical alternatives in resource-limited settings. Economic evaluations can inform policy decisions and optimize healthcare resource allocation in combating obesity.

Children are extremely vulnerable to secondhand smoke (SHS) and this is mainly because their lungs and airways are still growing, making them more sensitive to the harmful chemicals. The available scientific and clinical evidence has demonstrated an association between exposure to SHS and the development of multiple cardiovascular diseases and conditions. Acknowledging the wide number of cardiovascular diseases and conditions that have been attributed to exposure to SHS, it is the need of the hour to implement targeted public health measures to reduce the exposure among children. In conclusion, exposure to SHS has been linked with the development of varied cardiovascular ailments. Considering the presence of multiple challenges that act as a barrier in minimizing the exposure to SHS among children, there is an urgent need to adopt a comprehensive approach supported by policies, legal enforcement, and community efforts.

Background: First-year university students often face challenges in adapting to new academic, social, and living environments, which can lead to significant lifestyle changes and negatively impact their sleep quality (SQ) and overall quality of life (QoL). However, these issues remain insufficiently explored, particularly in low- and middle-income contexts; therefore, this study aims to examine the relationships among social support, lifestyle behaviors, SQ, and QoL among first-year students in Vietnam.

Methods: A cross-sectional study was conducted from August 2021 to August 2022 involving 1,201 students from six universities within the Vietnam National University, Hanoi. Participants completed a structured questionnaire assessing socio-demographic characteristics, personal health behaviors, SQ using the Jenkins Sleep Scale (JSS), and QoL with the EuroQol-5 dimensions (EQ-5D-5L) scale. Descriptive statistics were used to summarize participants' characteristics, health status, and lifestyle behaviors. Multivariate linear regression models with stepwise selection were employed to identify factors associated with SQ and QoL.

Results: The study found that 40.1% of participants experienced sleep disturbances, with those affected reporting a significantly lower QoL (mean EQ-5D-5L: 0.86) compared to those without disturbances (mean EQ-5D-5L: 0.96). Poor lifestyle behaviors, including increased alcohol consumption and internet use, were prevalent among students facing sleep disruptions. Conversely, higher perceived social support was associated with improved QoL and SQ.

Conclusions: This research highlights the concerning prevalence of sleep disturbances and unhealthy lifestyle practices among first-year students, emphasizing social support's critical role in promoting better health outcomes. Interventions aimed at enhancing social support and addressing detrimental behaviors are essential for improving QoL and SQ in this demographic, particularly during their transition to university life.

Background: This research aims to investigate and compare the effect of high-intensity interval training on some effective factors in these metabolic diseases and the possibility of signaling thermogenesis and browning in white and brown adipose tissue.

Methods: In this study, 16 male Wistar rats were divided into two control and exercise groups. The training group did HIIT exercises for 10 weeks and 5 days per week. next, the rats were euthanized, and blood samples were collected to assess glycemic indices. Additionally, samples of white and brown adipose tissue were obtained for the analysis of protein expression and histological examination.

Results: In white adipose tissue PGC1α expression significant increases in the exercise group (P = 0.003) also PRDM16 expression was significantly increased in the exercise group (P = 0.03) but There was no significant increase in UCP1 (P = 0.65) and There was no significantly increased AMPK the exercise group (P = 0.33). In brown adipose tissue, UCP1 expression was significantly increased in the exercise group compared to the control group (P = 0.001) but There was no significant increase in PRDM16 in the exercise group compared to the control group (P = 0.16) This research demonstrated that physical activity can enhance metabolic health, exhibiting distinct and substantial effects on both white and brown adipose tissue. However no significant effect on body weight, food consumption, and glycemic indices was observed.

Conclusions: In conclusion, we show exercise can affect thermogenesis in different ways on white and brown adipose tissue.

Background: Physical inactivity is related to the development of functional dyspepsia (FD); however, the available evidence about association between physical activity (PA) levels with risk of FD is scarce and indecisive. In this cross-sectional study, we aimed to investigate this association in enormous number of Iranian adult people.

Methods: This study was conducted on 4763 general public adults in Isfahan, Iran. The data of the present study are collected from SEPAHAN study of Isfahan city. The PA levels were estimated using general practice physical activity questionnaire (GPPAQ). The presence of FD was explored using a modified Persian version of the ROME III questionnaire. In addition, the association of PA and FD according to diagnostic symptoms including postprandial fullness, early satiation, and epigastric pain separately was analyzed.

Results: Totally, 22.2% (n = 748) of study participants had FD. Participants were classified to two groups based on their daily physical activity: 1. moderately inactive and inactive and 2. moderately active and active. Participants those have lower levels of physical activity were more likely to have functional dyspepsia compared with those who had higher level of activity (OR = 1.29; 95% CI: 1.09-1.53, P value: 0.004). Low-level physical activity tended to be associated with an increased prevalence of FD in women (OR = 1.23; 95%, CI: 0.98-1.54, P value: 0.06). After controlling for all confounders, we found that subjects with low PA were 16% more likely to have epigastric pain (OR = 1.16; 95% CI: 1.00-1.34, P value: 0.03) and early satiation (OR = 1.27; 95% CI: 1.07-1.47, P value: 0.005) compared with those who had high-level PA.

Conclusions: Conclusively, in fully adjusted models, there was marginally significant association between PA level and FD.

Background: Poor glycemic control and oxidative stress can accelerate the development of type 2 diabetes (T2D) complications. Recently, the potential benefits of herbs in managing T2D have received more attention. Therefore, we examined the effect of consuming dried Ziziphus jujube (ZJ) on plasma insulin, blood pressure, oxidative stress markers, and advanced glycation end products (AGEs) in T2D patients with excess weight.

Methods: Forty-eight diabetic patients with excess weight were selected and randomly assigned to the ZJ group (n = 24) or the control group (n = 24). The case group received 30g of dried ZJ fruit daily for three months. Concentrations of fasting insulin, malondialdehyde (MDA), total antioxidant capacity (TAC), carboxymethyl lysine (CML), and blood pressure (BP) were measured.

Results: After adjusting for baseline values, the ZJ group showed a significant decrease in systolic BP (up to 7 mmHg) and diastolic BP (up to 5 mmHg) compared to the control group (P < 0.05). Moreover, plasma insulin levels significantly decreased (up to 4.6 mIU/L) in the ZJ group compared to the control group (P < 0.05). However, there were no significant differences in the mean changes of plasma TAC, MDA, and CML between the two groups.

Conclusions: The present study suggests that consuming 30g/day of dried ZJ fruit may improve some cardiometabolic profiles, including plasma insulin and blood pressure in T2D patients with excess weight.

Trial registration: The present clinical trial has been enrolled in the Iranian registry of clinical trials with the registration number IRCT20181210041913N1.

Background: This study aims to evaluate the relationship of pulmonary symptoms and co-morbidity diseases with lung function in adult smokers.

Methods: Three hundred and fifty men adults over the age of 20 were involved. Spirometry tests were performed for measuring FVC, FEV1, and FEV1% FVC. COPD was categorized into four stages (I-IV) by the (GOLD) criteria of post-bronchodilator FEV1/FVC <0.70. For comparing the mean of pulmonary functions regarding the following variables, pulmonary symptoms, and co-morbidity diseases, t-test was used. Spearman's correlation analysis was performed to get association between stages of COPD and study variables. Further analysis using multiple regressions was conducted to confirm the predictors of the pulmonary functions. The level of significance is taken as P < 0.05.

Results: The mean age of participants was 54.7543 ± 13.44. A total of 43 (19.5%) participants were COPD; 7% of them were Stage I, 23.3% were Stage II, 39.5% were Stage III, and 30.2% were Stage IV. The mean of FEV1 in participants with shortness of breath (P < 0.001), cough (P = 0.001), wheezing (P = 0.023), as well as cardiovascular disease (P = 0.038) was significantly less in compared to those without these symptoms and disease. Also the mean of FVC in participants with shortness of breath (P < 0.001) and cough (P = 0.029) was significantly less in compared to others. Finally, the mean of FEV1/FVC in participants with shortness of breath (P < 0.001), cough (P = 0.001), and wheezing (P = 0.01) was less. The relationship between stages of COPD and other variables indicated a significant association between stages of COPD and diabetes mellitus (β = -.342P = 0.030). According to linear regression model, shortness of breath was the only influential variable on FEV1 (B = -.383CI: -23.729, -12.155 P < 0.001), FVC (B = -.296CI: -.365CI: -15.336, -6.082 P < 0.001), and FEV1/FVC (B = -.365, CI: -18.362, -9.029 P < 0.001).

Conclusions: Pulmonary symptoms including shortness of breath, cough, and wheezing influenced the lung function in adult smokers. Additionally, shortness of breath was associated with FEV1, FVC, and FEV1/FVC. Cardiovascular disease decreased FEV1 in smokers, whereas diabetes mellitus was associated with milder COPD stages.