mehdi najmi

The purpose of this study is to investigate the effect of air pollutants and noise on the prevalence of childhood asthma in Tehran, Iran.
The standardized questionnaire was completed by one of the parents of children aged 6–7 years or by adolescents aged 13–14 years.
The asthma prevalence in ages 6-7 and 13–14 was found to be 8.8% and 17.44%, respectively. A significant positive association was observed between “ever wheezing” and monoxide carbon (CO) concentration (OR=1.84, 1.05-3.25 in 13–14 years), the occurrence of 4 to 12 wheezing attacks and sulfur dioxide (SO2) concentration (Odds Ratio (OR)=1.39, 1.04-1.91) and particulate matter less than 2.5 micron (PM2.5) concentration (OR=1.38, 1.05-1.98 and OR=1.13, 0.98-1.39 in 6-7 and 13–14 years, respectively), as well as one night per week of sleep disturbances and nitrogen dioxide (NO2) concentration (OR=1.09, 1.03-1.16 in 6–7 years, respectively). It was also found that there was a significant interaction between the noise level and particulate matter less than 10 micron (PM10) level.
Based on the findings, exposure to certain outdoor air pollutants and noise can affect prevalence of asthma symptoms in residence of Tehran. The simultaneous presence of air pollutants and noise has an aggravating effect on the prevalence of asthma symptoms. Therefore, controlling sources of pollutants for reducing asthma symptoms is suggested.

 Reviewing the experiences of different countries and organizations, along with evaluating the implementation dimensions of the asthma management program, plays a key role in designing and implementing a new program at the national level. The purpose of this study is to investigate and compare the implementation of asthma control programs at the global, national and regional levels and how to use the factors affecting the implementation of the program in Iran's health system of Iran.

 This comparative study was conducted according to a model including definition, interpretation, juxtaposition and comparison. Valid documentation of asthma control programs including scientific articles and publications and official government and organizational reports at different levels were extracted. The validity of the documents was examined both internally and externally. The data were collected using the tool for extracting six main dimensions of implementing asthma control programs. These dimensions include 1) organizational institutions to implement the program, 2) human resources to implement the intervention, 3) nature of interventions, 4) target population, 5) consequences, and 6) cost analysis.

 Proposed interventions and key promoters of the program in Iran's health system include 1) political will to prioritize the problem of asthma and support primary health services, 2) use of clinical medicine guidelines, 3) rewards commensurate with appropriate performance, 4) provision of necessary resources to provide services and organization, and 5) providing human resources with defined roles. It is also necessary to pay full attention to measures based on home visits and school-based interventions according to the existing valid evidence.

 The effective strategy of implementing the asthma control program at the global, national and regional level by prioritizing the primary health service system is clear. Paying attention to these strategies can help improve the capacity of Iran's health system to deal with asthma as an important public health problem.

The economic burden of asthma is a major public health concern. This study estimates the economic burden of asthma in Northwest of Iran. A longitudinal study was conducted between 2017 and 2018 in Tabriz, Iran using the Persian version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Direct and indirect costs associated with asthma were estimated based on the societal perspective, prevalence-based approach, and bottom-up method. Annual indirect costs were estimated using the human capital (HC) method. The structural equation model was used to evaluate the relationship between costs, sex, and asthma severity.  A total of 621 patients with asthma were enrolled in the study. Significant differences were found between female and male patients for the mean cost of radiology (P=0.006), laboratory (P=0.028), and diagnostic (P=0.017) tests at baseline, and for laboratory (P=0.012), and diagnostic (P=0.027) tests at one-year follow-up. The more severe asthma, the more significant the costs for annual physician office visits (P=0.040) and medications (P=0.013). As asthma severity increased, significantly higher expenditures were observed in women for days lost from work at baseline (P=0.009) and one-year follow-up (P=0.001), and in men for productivity loss at work due to impairment at baseline (P=0.045). A significant association between indirect costs and the cost of impairment-related lost productivity at work (β=3.29, P<0.001), and between severe asthma and indirect costs (β=32.36, P<0.001) was observed.  High costs are incurred by Iranian asthma patients, especially because of impairment-related productivity loss at work associated with asthma exacerbation.

 Given the importance of appropriate response to prevent and manage Non-Communicable Diseases (NCDs), this study aimed to analyze the state of NCDs services at the level of the PHC system during the COVID-19 pandemic and to determine the main strategies.

 In this qualitative study, first, the circulars and guides in Iran's PHC system from the beginning of the pandemic to the end of September 2020 were retrieved manually and by searching the internal websites of the Ministry of Health. All documents about decision-making or governance and coordination mechanisms for the provision of NCDs services were enrolled and analyzed. In the second phase, the status of service delivery for major NCDs was presented in a model, and finally, SWOT analysis was used to analyze the situation and determine the main strategies. 

 25 out of 199 circulars and guides were eligible and analyzed. In the crisis phase, most risk assessment, screening, and diagnosis services for NCDs have been suspended, and follow-up and care of patients with major NCDs were done by telephone. In the reopening phase, the general strategies and strategies to increase capacity and provide delayed care were adopted, and the PHC model of the provision of essential services for the major NCDs was developed in low-risk, intermediate and high-risk pandemic conditions. Finally, 16 main strategies were determined with the approach of integrating and focusing on essential services, considering vulnerable groups and the use of E-health technologies.

 The results indicate on interruption of NCDs services in the crisis phase while adopting strategies for responding to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs is recommended.

 Lower respiratory tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis, and lung cancer are among the leading 10 causes of death worldwide. The Board of Respiratory Diseases Research Network (RDRN), a sub-committee of the Iranian Non-Communicable Diseases Committee (INCDC) is particularly concerned that there should be a coordinated National strategy to address the burden caused by chronic respiratory diseases.
    

 Iranian Ministry of Health and Medical Education (MoHME) has decided to give promotion to the establishment of research networks and use them as the milestones for research management, particularly for the national health priorities.
    

 National Service Framework (NSF), which was designed for Chronic Respiratory Diseases, is one of the main outcomes of the chronic respiratory diseases sub-committee of INCDC. The main seven strategies were represented by the Steering Committee in 2010 for a period of 10 years. Successful development and implementation of our goals provide the CRDs sub-committee of INCDC with the opportunity to develop a paradigm to prevent chronic respiratory diseases.
   

 A stronger national plan for controlling chronic respiratory diseases will ensure stronger advocacy to support respiratory health at national, sub-national, and regional levels.

Evidence shows that COVID-19 pandemic affects non-communicable diseases (NCDs), significantly. This study aimed to analyze the status of prevention and management services of NCDs at the level of primary health care (PHC) system during the COVID-19 pandemic.

In this situation analysis study, first the circulars communicated at the level of PHC system from beginning of the pandemic to the end of September 2020 were manually and electronically retrieved, and those which included a decision or action in terms of governance and coordination mechanisms to provide NCDs in crisis and reopening stages, were analyzed. Then, the plans of major NCDs services in low-risk, intermediate, and high-risk conditions were developed and finalized based on the circulars. Finally, situation analysis was performed using SWOT analysis, and proposed strategies were extracted.

25 out of 199 circulars were analyzed. In the crisis phase, most screening, risk assessment and diagnostic services were suspended, and the follow-ups and care of patients with NCDs were mainly done by telephone. In the reopening phase, general strategies were adopted to increase capacity and to compensate delayed care, and the plan of major NCDs services at the PHC system was developed in the three-pandemic settings. Finally, main strategies were proposed with integration approach and focusing on essential services, considering vulnerable groups and the use of E-health technologies.

The results indicated an interruption in NCDs services during the crisis phase, while adopting strategies to respond to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs prevention and management services is recommended in national response plan.

Globally, COPD was reported as the fourth leading cause of death (5.1%) in 2004 and is projected to occupy the third position (8.6%) in 2030. From a global perspective, exposure to indoor and outdoor biomass fumes and air pollution are important risk factors chronic respiratory diseases. Sub-committee of Iranian Non-Communicable Diseases Committee (INCDC) is particularly concerned that there should be a coordinated National strategy to address the burden caused by chronic respiratory diseases.

In 2011, Iranian Ministry of Health and Medical Education (MoHME) has decided to give promotion to the establishment of research networks and use them as the mile stones for research management particularly for the national health priorities. General assembly of the national was held in April 2011. We are to present a decade’s experience of chronic respiratory diseases sub-committee of INCDC.

Chronic Respiratory Diseases National Service Framework (NSF) is one of the main outcomes of chronic respiratory diseases sub-committee of INCDC. We consider NSF as long-term strategies for improving specific areas of lung care. we set measurable goals within time frames. These documents from INCDC will evolve with greater clinical experience and publication of new information in national and sub-national levels.

Drawing upon our experience, we should develop all the infrastructure and resource available among the centers to support respiratory health at national, sub-national, and regional levels.