مجله علمی دانشگاه علوم پزشکی کردستان
سال بیست و ششم شماره 5 (پیاپی 115، مهر و آبان 1400)

This study was designed to investigate the results of the non-communicable diseases prevention and control program in Isfahan province under the supervision of the Vice Chancellor for Health of the University of Medical Sciences during the years 2017 to March 2021.

In this cross-sectional study, the target group was all the population over 30 years of age in Isfahan province who had referred to health centers for screening programs for non-communicable diseases and risk factors (cardiovascular and diabetes). Breast cancer screening has been performed in women aged 30 to 70 years and colorectal cancer screening has been performed in men and women aged 50 to 70 years.

The number of people diagnosed with diabetes at the end of March 2021 was 148,250 and its prevalence was 11.59%. Also, the number of patients with high blood pressure registered in electronic patient record from 2017 to the end of March 2021 was 249294 (prevalence 19.74%). In colorectal cancer screening, 1593 cases of polyps were detected from 5367 colonoscopy during 4 years of program. Also, by screening 46.9% of the target population, 513 cases of breast cancer were detected.

In the evaluation of the process of diagnosis and patient care, an increase is evident during the years 2017 to 2019, but the decrease in the number of risk assessments and patient care in 2020-2021 is due to the COVID19 pandemic.

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.

Overweight and obesity disrupt people's quality of life and increase the risk of cardiovascular diseases, diabetes, hypertension, gastrointestinal diseases and cancer. It also reduces the immunity of people against epidemic diseases.

In this article, extensive search of electronic databases, review of national upstream documents as well as review of documents and reports of the Ministry of Health were conducted to comprehensively review the prevalence of obesity and its associated factors, measures taken to control this risk factor, and challenge of a syndemic of obesity and Covid-19 in Iran.

Based on the results of the national non-communicable diseases risk factors study (STEPS) in Iran, the prevalence of overweight and obesity was estimated to be 59.3% in people aged 18 years and older. Moreover, overweight and obesity were not homogeneously distributed in the country and the mean body mass index (BMI) changed from the lowest in the Southeastern to the highest in the Northwestern provinces. Covid-19 pandemic has made the situation even worse as the social distancing measures along with mental problems have made tremendous changes in people's lifestyles including physical activity and eating behaviors and this resulted in higher prevalence of non-communicable diseases (NCDs) risk factors especially overweight and obesity. Moreover, obesity increased the risk of hospitalization, admission to the intensive care units, the need for mechanical ventilation, and even mortality in patients with Covid-19. Meanwhile, anti-obesity services faced problems during the epidemics and posed a serious challenge to the world.

This study highlighted the need for targeted national policies to simultaneously control the obesity and Covid-19 pandemics.

Covid-19 pandemic has caused significant disruptions in the provision of non-communicable disease prevention and management services in many countries and there is a concern that this disorder will lead to long-term complications of these diseases; This study aimed to quantitatively analyze the status of some prevention and management services of non-communicable diseases in the primary health care system of Iran during the Covid-19 pandemic.

In this study, the routine data of 8 services related to the prevention and management of non-communicable diseases in the integrated electronic health record system (SIB) within 10 months after the outbreak of Covid-19 were compared to the same period last year.

Non-communicable disease prevention and management services have decreased by an average of 18.89% compared to the same period last year; this decrease was much more severe at the beginning of the epidemic period (up to 75% in some services) and more in the services provided by physicians than in the services provided by non-physicians. Also, observation of the course of selected services during this period showed that after the initial reduction of services, a process of gradual compensation is evident.

like other areas involved in the pandemic, the effect of the Covid-19 epidemic on non-communicable disease prevention and management services in the primary health care system of Iran, has been significant and although partial compensation of some services is promising, more attention and effort is needed to revive the other programs.

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.

Control and prevention of non-communicable diseases(NCD) and their risk factors require programs and policies that their adoption and implementation is beyond the capacity of the health sector alone. The purpose of this study is to express the experience of the Islamic Republic of Iran in advancing the goals of the National Document on Control and Prevention of Non-Communicable Diseases through inter-sectoral collaboration and its achievements.

This study was done by reviewing documents (including decrees, reports, policy briefs, progress reports, minutes) and by qualitative analysis of these documents based on a predetermined framework. All documents related to control and prevention of NCDs in the Secretariat of the Supreme Council for Health and Food Security (SCHFS) from 2013 to 2020 were used.

The para-sectoral collaboration Advisory Committee is one of the task forces of the National Committee for Control and Prevention of NCD, which through the SCHFS and its subdivisions facilitated the participation of other agencies and stakeholders to implement the National Document on Disease Control and Prevention. Most of the SCHFS decrees and programs are related to the nutritional factors of NCDs (saturated fatty acids and trans fatty acids, salt in industrial and traditional food products, pollutants and residual pesticides in Agricultural products), reduction of air pollution and mental health, which are the main targets of national documents for the Control and Prevention of Non-Communicable Diseases.

Involvement of stakeholders and cooperation of other sectors in the health system to control and prevent NCDs and their risk factors requires the establishment of structures and processes at the highest levels of policy making as well as at the intermediate and operational levels of the management. Avoiding frequent and early changes in the structures and processes of para-sectoral collaboration, and adopting participatory based approaches to follow the implementation of policies and programs in a coherent and coordinated manner are necessary.

The incidence rate of cancer in Iran is lower than the global average, but this rate is increasing both in the world and in Iran in the next two decades

"Iran National Cancer Control" was developed in 2013 with a strategic planning approach and consists of 4 main processes and 7 support processes.

Some of the significant interventions taken in the main processes are: implementation of training programs, vaccinations and multi-sectoral collaboration to reduce the burden of risk factors, in the prevention component; implementation of breast, cervical and colon cancer screening programs and development of relevant protocols, cheap HPV testing with insurance coverage, and production of FIT kits, in the early detection component; development of 12 National Practice Guidelines for anticancer drugs and standardizing chemotherapy and radiotherapy services, in diagnosis and treatment component; development of supportive and palliative care management protocols and standardizing these services. In the supporting processes, the main measures taken in the form of 7 components of this program are: developing National Cancer Control Program and forming its secretariat, designing and implementing a geospatial infrastructure program, creating, developing and equipping early detection, and cancer treatment centers and referral laboratories, holding training courses, promoting insurance coverage for cancer services, and implementing an integrated cancer information management system.

This program has been able to achieve its short-term objectives in the defined periods, but in order to fully implement the program and achieve the expected outcomes, it is necessary to strengthen its governance structure and the commitment of health system policy makers to this program.

Since the discovery of the SARS-Cov-2 coronavirus on December 30, 2019, in China, and the declaration of the COVID-19 pandemic on March 11, 2020, healthcare systems and economies around the world have faced unprecedented challenges. The impact of the crisis on non-communicable diseases and the delivery of related services, which could lead to a second crisis, has been a particular source of concern. We review the world's experience in this area here.

This is a systematic review of studies related to the effects of COVID-19 pandemic and non-communicable diseases (NCDs) on eachother, and its impact on provision of related healthcare services for NCDs, carried out in 2021 by defining search keywords and database including PubMed / MEDLINE ، ISI / Web of Sciences (WOS) and Scopus.

625 articles were found in the first search, that 98 duplicate onees were removed. Following a review of the article titles, 216 studies were removed as well. The abstracts of the articles were then reviewed, and 139 items were removed too. Finally, the study included 81 articles that met the previously mentioned criteria. The studies' findings were divided into seven groups: increased disease severity, decreased referrals to medical centers, decreased care delivery, increased anxiety and depression, decreased diagnosis of diseases, reduced elective surgeries, and strategies used to provide services to patients.

A review of country policies and experiences and the loss of thousands of human resources in the field of health during the Covid-19 pandemic crisis showed that country governance systems should prioritize capacity building and updating action plans to deal with similar crises. In the meantime, a resilient national program for the prevention and effective fight against NCDs, as the most important cause of death of citizens that is also preventable, and its uninterrupted implementation during crises of the health system is of fundamental importance

Non-communicable diseases were the first cause of death in the country from 1990 to 2015, which has increased significantly according to National reporting of mortality data. Among these, cardiovascular diseases was the first cause of death Considering the need to reduce 25% of premature mortality from non-communicable diseases by 2025, Cardiovascular Diseases Working Group of the National Committee for the Prevention and Control of Non-Communicable Diseases of Iran, and the Deputy Minister of Health and the Scientific Committee for Management of Acute Myocardial Infarction and stroke of the Deputy Minister of Health were obliged to create a coordinated national strategy for reducing the burden of cardiovascular disease in the country.

The main objectives of the Working Group on Cardiovascular Diseases of the National Committee for the Prevention and Control of Non-Communicable Diseases of Iran, include policy-making based on the current situation, alignment of national programs for prevention, control, treatment, follow-up and rehabilitation at different levels of health care, and prioritizing necessary interventions for the most common cardiovascular diseases.

The Cardiovascular Diseases Working Group has designed the National Cardiovascular Disease Prevention, Control and Treatment Program in 8 main stages, according to its responsibilities in achieving the goals of the National Document for the Prevention and Control of Non-Communicable Diseases and Related Risk Factors. It includes recording risk assessment information, referrals, care and rehabilitation, pre-hospital triage and pre-hospital emergency services, and standardization of medical services and monitoring and evaluation to compare annual information on the rate of premature death with baseline.

According to the experiences gained, National Cardiovascular Diseases Working Group has the main role in policy-making, monitoring, and implementing the related policies. Having a stable and dynamic national plan to control cardiovascular disease ensures more decisive results to support cardiovascular health at the national and regional levels

COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the acute respiratory syndrome, acute inflammatory response of the respiratory system, vascular injury, microangiopathy, angiogenesis, and widespread thrombosis.
Four stages of COVID-19 have been determined; the first stage starts with an upper respiratory tract infection, the second stage starts by the onset of shortness of breath and pneumonia, the third stage starts by worsening of clinical symptoms followed by hyperinflammation, and the fourth stage is death or recovery of the patient. There is currently no successful treatment specifically for SARS-CoV-2 infection. Based on the pathological features and different clinical stages of COVID-19, especially in patients with moderate to severe COVID-19, the drug groups used includeed antiviral agents, anti-inflammatory drugs/anti-trauma drugs, and heparin with Low molecular weight, plasma, and hyperimmune immunoglobulin. During the emergency of the COVID-19 outbreak, clinical researchers are using a variety of possible therapies to test them. It seems that the precision medicine approach can answer the COVID-19 treatment questions. Therefore, the way to precision medicine in COVID-19 needs an extremely rapid pace. The aim of the present study was to discuss the most up-to-date effective drugs and vaccines against SARS-CoV-2 infection.