ObjectivesTo investigate the impact of gender on multimorbidity in northern Iran.DesignA cross-sectional analysis of the Golestan cohort data.SettingGolestan Province, Iran.Study population49 946 residents (age 40–75 years) of Golestan Province, Iran.Main outcome measuresResearchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors.ResultsWomen had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40–49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01).ConclusionPrevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women.

Advances in medicine and health policy have resulted in growing of older population, with a concurrent rise in multimorbidity, particularly in Iran, as a country transitioning to a western lifestyle, and in which the percent of the population over the age of 60 years is increasing. This study aims to assess multimorbidity and the associated risk factors in Iran.We used data from 50,045 participants (age 40–75 y) in the Golestan Cohort Study, including data on demographics, lifestyle habits, socioeconomic status, and anthropometric indices. Multimorbidity was defined as the presence of 2 or more out of 8 self-reported chronic conditions, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, liver disease, gastroesophageal reflux disease, tuberculosis, and cancer. Multivariate logistic regression models were used to examine the associations between multiple different factors and the risk factors.Multimorbidity prevalence was 19.4%, with the most common chronic diseases being gastroesophageal reflux disease (76.7%), cardiovascular diseases (72.7%), diabetes (25.3%), and chronic obstructive pulmonary disease (21.9%). The odds of multimorbidity was 2.56-fold higher at the age of >60 years compared with that at <50 years (P < 0.001), and 2.11-fold higher in women than in men (P < 0.001). Other factors associated with higher risk of multimorbidity included non-Turkmen ethnicity, low education, unemployment, low socioeconomic status, physical inactivity, overweight, obesity, former smoking, opium and alcohol use, and poor oral health.Apart from advanced age and female sex, the most important potentially modifiable lifestyle factors, including excess body weight and opium use, and opium user, are associated with multimorbidity. Policies aiming at controlling multimorbidity will require a multidimensional approach to reduce modifiable risk factors in the younger population in developing countries alongside adopting efficient strategies to improve life quality in the older population.

BackgroundLoss of human resources in the health sector through migration has caused many problems in the delivery of healthcare services in developing countries.ObjectiveThe aim of this study was to determine factors influencing intention to migrate in skilled human resources in Iran’s healthcare sector.MethodsThis cross-sectional study was carried out in 2016 in Iran. The study population included health sector human resources at the Tehran and Iran University of Medical Sciences. Using multi-stage cluster sampling, 827 people were selected for participation. Participants included four groups: hospital staff, health workers, medical students, and postgraduate students (Masters and PhD). Data were collected using a valid and reliable questionnaire and analyzed by descriptive parameters, chi-square and logistic regression test using SPSS version 18.ResultsInclination to migrate, in the study population, was 54.77%. There was a significant relationship between inclination to migrate and age, work experience, employment status, marital status, familiarity with a foreign language, foreign language skills, foreign language courses, having relatives or family living abroad, and prior experience of being abroad (p<0.05). The most important factors influencing inclination to migrate were: reaching out for better life (81.92±21.95), interdisciplinary discrimination (80.83±20.75), and experience of living and studying abroad. (80.55±18.12),ConclusionConsidering the high rate of intention to emigrate in the studied population (54.77%), a lot of whom will emigrate if their situation is ready, it can be a serious problem for the health system in the near future in which it will face lack of skilled health workers, and so requires more attention of health sector authorities.

The rather high prevalence of UI among middle-aged women has negative impact on women's quality of life; therefore, strategies regarding prevention and management, medical education, and research programs have been proposed.

Background: National plans have an important role in defining vision, goals, priorities, and action plans. The present paper examined the international experience in developing upstream documents concerning women's health; it regards the necessity of developing Iranian women's health plan. Methods: This review, conducted with search in electronic databases and literature of no limitation in terms of years conducted. The phrases such as "woman health policy", "woman health promotion", "woman health strategy" and "woman health plan” were searched. The criteria based on which the countries were chosen were the degree to which they were developed in health system, health indexes, the accessibility of required information, and the possibility of benchmarking the new methods. Results: Emphasize on gender as a determinant of health, increasing the economic activities of women, decreasing the violence against women, gender-based researches, and inter-sectorial approach are some common items in the women’s health plans in selected countries. The main upstream documents about women health in Iran such as ‘Research policies and principles of women issues’, “Women Charter of Rights in Iran” were not developed and implemented in form of a comprehensive plan so we need to formulate a full women health national plan that summarizes all previous policies with addition of new needed strategies inclusion. Conclusion: Developing a national plan for Iranian women’s health regarding with selected countries experiences makes a long-term vision for health and obtains the institutional and organizational efforts and resources necessary for women health promotion in Iran.

Climate extremes, in particular droughts, are significant driving forces towards riverine ecosystem disturbance. Drought impacts on stream ecosystems include losses that can be either direct (e.g., destruction of habitat for aquatic species) or indirect (e.g., deterioration of water quality, soil quality, and increased chance of wildfires). This paper combines hydrologic drought and water quality changes during droughts and represents a multistage framework to detect and characterize hydrological droughts while considering water quality parameters. This method is applied to 52 streamflow stations in the state of California, USA, over the study period of 1950–2010. The framework is assessed and validated based on two drought events declared by the state in 2002 and 2008. Results show that there are two opposite drought propagation patterns in northern and southern California. In general, northern California indicates more frequent droughts with shorter time to recover. Chronology of drought shows that stations located in southern California have not followed a specific pattern but they experienced longer drought episodes with prolonged drought recovery. When considering water quality, results show that droughts either deteriorate or enhance water systems, depending on the parameter of interest. Undesirable changes (e.g., increased temperature and decreased dissolved oxygen) are observed during droughts. In contrast, decreased turbidity is detected in rivers during drought episodes, which is desirable in water systems. Nevertheless, water quality deteriorates during drought recovery, even after drought termination. Depending on climatic and streamflow characteristics of the watersheds, it was found that it would take nearly 2 months on average for water quality to recover after drought termination.

Ecosystem water-use efficiency (WUE) is defined as the ratio of carbon gain (i.e., gross primary productivity; GPP) to water consumption (i.e., evapotranspiration; ET). WUE is markedly influential on carbon and water cycles, both of which are fundamental for ecosystem state, climate and the environment. Drought can affect WUE, subsequently disturbing the composition and functionality of terrestrial ecosystems. In this study, the impacts of drought on WUE and its components (i.e., GPP and ET) are assessed across the Contiguous US (CONUS) at fine spatial and temporal resolutions. Soil moisture simulations from land surface modeling are utilized to detect and characterize agricultural drought episodes and remotely sensed GPP and ET are retrieved from the moderate resolution imaging spectroradiometer (MODIS). GPP, as the biome vitality indicator against drought stress, is employed to investigate drought recovery and the ecosystems’ required time to revert to pre-drought condition. Results show that drought recovery duration indicates a positive correlation with drought severity and duration, meaning that a protracted drought recovery is more likely to happen following severe droughts with prolonged duration. WUE is found to almost always increase in response to severe (or worse) drought episodes. Additionally, ET anomalies are negatively correlated with drought severity and ET is expected to decrease during severe (or worse) drought episodes. Lastly, the changes of WUE are decomposed in relation to its components and the cross-relation among the variables is revealed and a consistent changing pattern is detected.

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