Morteza Khafaie

Reiner RC Jr, Hay SI. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 1779–801—In this Article, the author byline has been amended to Local Burden of Disease Diarrhoea Collaborators. This correction has been made to the online version as of June 4, 2020, and the printed version is correct

Background: The COVID-19-related deaths are growing rapidly around the world, especially in Europe and the United States. Purpose: In this study we attempt to measure the association of these variables with case fatality rate (CFR) and recovery rate (RR) using up-to-date data from around the world. Methods: Data were collected from eight global databases. According to the raw data of countries, the CFR and RR and their relationship with different predictors was compared for countries with 1,000 or more cases of COVID-19 confirmed cases. Results: There were no significant correlation between the CFR and number of hospital beds per 1,000 people, proportion of population aged 65 and older ages, and the number of computed tomography per one million inhabitants. Furthermore, based on the continents-based subgroup univariate regression analysis, the population (R2 = 0.37, P = 0.047), GPD (R2 = 0.80, P < 0.001), number of ICU Beds per 100,000 people (R2 = 0.93, P = 0.04), and number of CT per one million inhabitants (R2 = 0.78, P = 0.04) were significantly correlated with CFR in America. Moreover, the income-based subgroups analysis showed that the gross domestic product (R2 = 0.30, P = 0.001), number of ICU Beds per 100,000 people (R2 = 0.23, P = 0.008), and the number of ventilator (R2 = 0.46, P = 0.01) had significant correlation with CFR in high-income countries. Conclusions: The level of country's preparedness, testing capacity, and health care system capacities also are among the important predictors of both COVID-19 associated mortality and recovery. Thus, providing up-to-date information on the main predictors of COVID-19 associated mortality and recovery will hopefully improve various countries hospital resource allocation, testing capacities, and level of preparedness.

Removal of ammonia from wastewater in the wastewater treatment plants due to its dangerous and toxic effects on human health and biotic resources is essential. This study was aimed to investigate the effective operational parameters on the efficiency of the air stripping process, determine their priority and degree of effect on ammonia removal and compare the ammonia removal efficiency during the air stripping process in the municipal treatment plants using synthetic and real wastewater.In this study, the effect of each operating parameter on the ammonia removal efficiency including initial ammonia concentration, pH and temperature during the air stripping process for synthetic and real wastewater, respectively, based on standard methods (the Nesslerization method, preparation of standard solutions) using a spectrophotometer, pH meter and temperature module were evaluated.The results of this study showed that the maximum of ARE for synthetic wastewater with Air to water ratio 80 and an initial ammonia concentration of 59. 6 mg /l, pH 12.05 and temperature 46.3°C was %91. Also, the results of the study on the ARE during the air stripping process showed that the maximum of ARE (%91) for real wastewater (primary sedimentation tank effluent (PST)) with Air to water ratio 80 and an initial ammonia concentration of 61.04 mg/l, pH 12.53 and temperature 45.9 ° C was obtained.Based on the results of univariate regression model, initial ammonia concentration˃ temperature˃ pH have the greatest effect on the ammonia removal efficiency in synthetic wastewater and real wastewater, respectively. In the multivariate regression model, the effect of temperature and pH on the ammonia removal efficiency in synthetic and real wastewater is increasing and decreasing, respectively. Based on the findings of this study, the air stripping process can be successfully used to remove ammonia from wastewater in the municipal treatment plants, especially in the tropics.

Introduction: Accidents are one of the most important health problems that always threaten children, and inability caused by them not only affects their health but also their education and other dimensions of their life and their families. Therefore, mothers&#39; awareness of incident prevention methods, especially choking, is very important. Therefoe, this study aimed to determine the prevalence of choking in children less than 2 years old and to assess the awareness of mothers referring to health centers in Ahvaz city. Methods: In this cross-sectional study, 100 mothers with at least one under two years old child who referred to Ahvaz health centers to receive routine mother and child care were selected during 2017. Four health centers were randomly selected as clusters from all listed centers and subsequently 53 mothers from west and 47 mothers from East of Ahvaz were recruited.  Mother&#39;s awareness measured using a standardized researcher made questionnaire  . The groups difference was investigated by chi-square and one-way ANOVA as appropriate. Logistic regression was also used to investigate the association between history of chocking and mother&#39;s awareness. Results: The present study showed that the prevalence of choking in children younger than 2 years old was 19%, and the mean level of awareness of mothers was 16.53 ± 3.51; corresponding for 60% of total awareness score. Despite the higher awareness score among mothers with a child with history of choking there was no significant relationship between the prevalence of choking and awareness of mothers. Conclusion: Although most of mothers had awareness about choking, the frequency of choking was considerable. Therefore, it is suggested to conduct more extensive studies using qualitative method to extract important and effective factors in the occurrence of such events among mothers with child choking experience and design effective interventions for preventative measures in mothers.

Background: Case fatality rates (CFRs) and case recovery rates (CRRs) are frequently used to define health consequences related to a certain disease epidemics, as well as for COVID-19 outbreak. Objectives: This study aimed to compare various introduced methods and models for the calculation of CFR and CRR related to COVID-19 over a present period of time based on the recent global and national data. Methods: This analytical epidemiological study was conducted on the detail data from 210 countries and territories around the world on 17 April 2020. We used three different formulas to measure CFR and CRR, considering all possible scenarios. Results: We committed to show only 72 countries with more than 1000 cases of COVID-19. Overall, using first, second and third estimation models, the CFR were 6.22%, 21.20%, and 8.67%, respectively; similarly, the CRR were estimated as 23.21%, 78.86%, 32.23%, respectively. We have shown CFR vary so much from spatially depend on the methods of estimation which have been implemented and timing of cases reports, that is a lowest CFR of 0.31 in the Singapore, and a CFR of 98.82 in UK. Overall, European region witnessing the highest CFR (9.38 to 24.88). Conclusion: Even with the more precise method of CFRs estimation, the value is overestimated. Case fatality and recovery rate is not only measure of severity of disease and the better estimation would be the more reliable indicator of country performance fighting against COVID-19.

Abstract This study was aimed to evaluate ammonia removal efficiency (ARE) in the air stripping process in different operating conditions for wastewater with a low concentration of ammonia such as municipal wastewater treatment plants (WWTPs) on the laboratory scale. The experiments were performed at different pH (9.7 ± 0.26, 10.93±0.16 and 11.94±0.32), temperature (34.25±0.44, 38.57±3.4 and 40.5 ± 7.68 in °C), initial concentration (26.98 -47.34, 19.49 -47.48 and 41–98 in mg/L) and air-water (G/L) ratio (60:1, 70:1 and 80:1). The results showed that ARE in the operating conditions (initial NH4+concentration 26.98 -98 mg/L, pH 9.4–12.38, temperature 34–45.8 °C and G/L 60:1–80:1) was increased from 6.6% to 98% with the range of 1 to 14 h. Based on the results, ARE with 1 standard deviation (SD) increase per unit of pH, temperature and initial NH4+concentration was 13.03%, 3.99% and 2.3%, respectively. Also, based on multivariate regression model at high and low G/L, temperature and pH had the most significant effect on ARE for a synthetic solution as well as a municipal WWTPs stream, respectively. ARE (91%) was obtained during the stripping process of synthetic and actual municipal wastewater.

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-ofpocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Cooperation and Development (OECD)&amp;#39;s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9•2 trillion (95% uncertainty interval [UI] 9•1-9•3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7•3 trillion (95% UI 7•2-7•4) in 2019; 293•7 times the $24•8 billion (95% UI 24•3-25•3) spent by low-income countries in 2019. That same year, $43•1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1•8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37•8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12•2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the healthrelated COVID-19 response is 252•2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM 2•5 originating from ambient and household air pollution. Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM 2•5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM 2•5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM 2•5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM 2•5 exposure, with an estimated 3•78 (95% uncertainty interval 2•68-4•83) deaths per 100 000 population and 167 (117-223) disabilityadjusted life-years (DALYs) per 100 000 population. Approximately 13•4% (9•49-17•5) of deaths and 13•6% (9•73-17•9) of DALYs due to type 2 diabetes were contributed by ambient PM 2•5 , and 6•50% (4•22-9•53) of deaths and 5•92% (3•81-8•64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM 2•5. Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM 2•5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding Bill &amp;amp; Melinda Gates Foundation.

Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the ...

SummaryBackgroundVitiligo is an autoimmune depigmentation disorder, commonly associated with systemic autoimmune diseases. Deficient serum 25‐hydroxyvitamin D (25(OH)D) levels have been noted in some patients with autoimmune diseases.AimTo evaluate serum 25(OH)D levels in vitiligo patients with and without systemic autoimmune diseases.MethodsA case‐control study was conducted on 40 vitiligo patients (20 patients with systemic autoimmune diseases and 20 patients without autoimmune diseases) and 40 age‐, gender‐ and skin phototype‐matched healthy controls. Serum 25(OH)D was measured in all subjects, divided into: normal or sufficient (≥ 30 ng/ml), insufficient (&lt; 30–&gt; 20 ng/ml) and deficient (≤ 20 ng/ml) levels.ResultsOne patient with vitiligo (2.5%) versus 33 healthy controls (82.5%) have sufficient serum 25(OH)D levels while 39 patients (97.5%) versus 5 controls (12.5%) have deficient 25(OH)D levels with significantly lower serum 25(OH)D levels in patients compared to controls...

Background: Climatic conditions, especially changes in temperature are associated with cardiovascular (CV) events but underlying mechanisms are not well understood. We investigated association between air temperature and C-reactive protein (CRP), in type 2 diabetes patients. Methods: The subjects were resident of Pune city and suburbs (n=1700). The relationships between air temperature at lag 0-5 and different averaging time periods (3 and 7 days) and CRP concentration were analyzed using robust regression models. Sensitivity of our result to possible influence of additional adjustments for season, and air pollutants variable including PM10, NOx, and SO2 were investigated. Result: Mean daily air temperature during study period varied between 15°C to 34°C. A 5°C decrease in the air temperature was associated with significant increase of 15.26% (95% CI=4.42 to 24.88) in geometric mean of CRP concentration with a lag of 1-day. Conclusion: This study suggests that decrease in temperatur...

Introduction: Human immunodeficiency virus (HIV) infection is a known risk factor for abnormal cervical cytology and cervical cancer. The aim of this study was to investigate cervical cytological abnormalities and its relation with CD4 (T4 Lymphocyte) count among HIV seropositive women. Methods: We conducted a study on 58 HIV positive women referred to Ahvaz Counseling Center for Behavioral Disease, southwest of Iran between 2016 and 2017. Pap smear was performed for all participants from the cervix and endocervix. Patient&#39;s characteristics including age, duration of disease, treatment with anti-retroviral treatment (ART), marital status, number of children, and contraception method were also recorded. Cervical cytological abnormalities reported as Bethesda system (TBS). A regular blood sample was taken from all the patients to evaluate the CD4 cells counts. Logistic regression models were used to obtain OR of presences of cytological abnormalities related to CD4 counts, control...

Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of &amp;quot;leaving no one behind&amp;quot;, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from…

Previous studies that described thunderstorm asthma, which is a rare event, are not being well explained. This study was conducted, to describe the patient perspective on their asthma attack experience during Ahvaz post-rain phenomenon. We have interviewed patients present in the Naft clinic of Ahvaz, during 28th October and the first week of November 2015. Recruitment was continued as saturation ensued by 33 participants. An inductive content analysis was used to evaluate the interviews. The key finding indicated a climatic condition, direct or indirect contact with rain, history of allergy, and physical conditions are the main categories. The patient emphasized the importance of dust, humidity, first autumn rainfall, and environmental air pollution in occurrences of the event. When exposed to further rains (third rainfall onward), they were less likely to experience dyspnea or shortness of breath. However, being indoor or out at the time of rainfall reported not to be related to t...

Dust is an atmospheric phenomenon that causes adverse environmental effects. It is deemed to have harmful effects on health, economics, and climate. This study aimed to analyze the content published on the phenomenon of dust in the widely circulated newspapers in Iran. We investigated the content of all national and provincial newspapers that were published between July and August 2014. Data on the materials related to the dust phenomenon in the newspapers were categorized and coded. From a total of 510 newspaper issues, 143 articles were devoted to the dust phenomenon which 74.1% of them were published in provincial newspapers. Among the national newspapers, Hamshahri newspaper with 16 headlines and from the provincial newspapers; Karoon with 23 headlines published the highest number of articles on dust phenomenon. 45.5% of content on dust were printed on the first page of the newspapers. The most common approach to the type of content published in these newspapers was an interview...

A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers ...