Validation of the Persian version of the Stanford Health Assessment Questionnaire (HAQ) in patients with rheumatoid arthritis

    Evaluation of functional disability using proper instruments, like Health Assessment Questionnaire (HAQ) in patients with rheumatoid arthritis (RA), is necessary not only for quality of life assessment, but also as a useful marker for disease activity. HAQ has been translated into many languages. To validate the Persian version of Stanford HAQ. Persian version of the HAQ (PE-HAQ) with culturally necessary modifications of the arising, eating, hygiene, reach and activities category questions was administered to 872 RA patients (87% female; mean age 57.5 years; mean onset age 51.5 years; mean disease duration 6.1 years). The arising, hygiene and activities scores were higher in the PE-HAQ than in the original HAQ, because futons and squat toilets are very common in Iranian culture and most of patients are bound to praying even in the standing position. Arising from a futon, squatting in a squat toilet and kneeling are generally more difficult for disabled individuals than are arising from a bed, getting on and off the toilet and doing chores, respectively. The overall disability index was higher in the PE-HAQ (0.89 ± 0.84) than in the original HAQ (0.82 ± 0.79), although the correlation coefficient was high (r=0.881). The test-retest reliability value studied at a 10-day interval, showed a strong correlation coefficient of 0.90 measured on the two occasions. PE-HAQ showed excellent internal consistency (Cronbach’s α= 0.892). The PE-HAQ is a reliable and valid instrument that can be self-administered to Iranian RA patients to evaluate their functional disability

A Multidisciplinary Work-Related Low Back Pain Predictor Questionnaire: Psychometric Evaluation of Iranian Patient-Care Workers

Study DesignPsychometric evaluation design.PurposePsychometric evaluation of a multidisciplinary work-related low back pain predictor questionnaire (MWRLBPPQ) of Iranians patient-care workers based on the social cognitive theory.Overview of LiteratureHealthcare is one of the professions in which work-related musculoskeletal disorders are prevalent. The chronic low back pain experienced by patient caregivers can negatively impact their professional performance, and patient handling in a hospital is the main cause of low back pain in this population.MethodsThis was a cross-sectional study carried out in Qom, Iran from July 2014 to November 2014. A MWRLBPPQ based on nine concepts of the social cognitive theory and existing literature regarding chronic low back pain was developed. Ten patient-care workers first completed the questionnaire as a pilot test, allowing the ambiguities of the instrument to be resolved. Exploratory factor analysis was used to confirm construct validity. This questionnaire was distributed among 452 patient-care workers in hospitals located in different geographically areas in Qom, Iran. Cronbach's Alpha was calculated to assess reliability.ResultsIn all, 452 caregivers of patients with mean age of 37.71 (standard deviation=8.3) years participated in the study. An exploratory factor analysis loaded seven concepts of self-efficacy, knowledge, outcome perception, self-control, emotional coping, and self-efficacy in overcoming impediments and challenges in the environment. All concepts were jointly accounted for 50.08% of variance of behavior change. The Cronbach's alpha coefficient showed favorable internal consistency (alpha=0.83), and test-retest of the scale with 2-week intervals indicated an appropriate stability for the MWRLBPPQ.ConclusionsThe MWRLBPPQ is a reliable and valid theory-based instrument that can be used to predict factors influencing work-related low back pain among workers who lift and transfer patients in hospitals

An Investigation of Factors Effective on Foreign Students’ Educational Problems in Isfahan University of Medical Sciences, Iran

Background & Objective: Foreign students encounter educational problems which make studying in the host country difficult. Given the importance of the educational problems of foreign students, and identifying the factors which alleviate these problems, this study examined the educational problems of international students of Isfahan University of Medical Sciences, Iran. Methods: This was a quantitative-qualitative study with a descriptive-analytical design. In the qualitative section, interviews were conducted with 14 foreign students, and in the quantitative section, 56 students were selected through random sampling proportional to sample size. Semi-structured interviews and a researcher-made questionnaire were used to collect information. Data analysis was conducted using categorization methods, descriptive statistics, univariate t-test, ANOVA, post hoc test, and multiple regression in SPSS software. Results: In the qualitative section, the foreign students’ educational problems included weakness in understanding Persian, different educational system, the professors’ inappropriate teaching method, and dissatisfaction with textbooks. In the quantitative section, the educational problems were not significant at a 0.05 level. Moreover, the students' problems in terms of culture and the length of stay in Iran showed significant differences. Conclusion: The results of predictor factors of educational problems revealed that cultural dissimilarity and short presence in Iran are the main predictor factors. Therefore, in order to motivate learning in foreign students, and thereby, decrease their educational problems, it is necessary to familiarize them with Iranian customs and hold classes to introduce them to the Iranian educational system. Key Words: Foreign students, Host country, Educational problems, Medical sciences, Iran, Qualitative-quantitative stud

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran

Study DesignInterventional research with a 6-month follow-up period.PurposeWe aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory.Overview of LiteratureWRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP.MethodsWe included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data.ResultsThe comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p<0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups (p=0.07).ConclusionsWe showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals

Estimation and prediction of avoidable health care costs of cardiovascular diseases and type 2 diabetes through adequate dairy food consumption: a systematic review and micro simulation modeling study

Background: Recent evidence from prospective cohort studies show a relationship between consumption of dairy foods and cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM). This association highlights the importance of dairy foods consumption in prevention of these diseases and also reduction of associated healthcare costs. The aim of this study was to estimate avoidable healthcare costs of CVD and T2D through adequate dairy foods consumption in Iran. Methods: This was a multistage modelling study. We conducted a systematic literature review in PubMed and EMBASE to identify any association between incidence of CVD and T2DM and dairy foods intake, and also associated relative risks. We obtained age- and sex-specific dairy foods consumption level and healthcare expenditures from national surveys and studies. Patient level simulation Markov models were constructed to predict the disease incidence, patient population size and associated healthcare costs for current and optimal dairy foods consumption at different time horizons (1, 5, 10 and 20 years). All parameters including costs and transition probabilities were defined as statistical distributions in the models, and all analyses were conducted by accounting for first and second order uncertainty. Results: The systematic review results indicated that dairy foods consumption was inversely associated with incidence of T2DM, coronary heart disease (CHD) and stroke. We estimated that the introduction of a diet containing 3 servings of dairy foods per day may produce a $0.43 saving in annual per capita healthcare costs in Iran in the first year due to saving in cost of CVD and T2DM treatment. The estimated savings in per capita healthcare costs were$8.42, $39.97 and$190.25 in 5, 10 and 20-years’ time, respectively. Corresponding total aggregated avoidable costs for the entire Iranian population within the study time horizons were $33.83,$661.31, $3,138.21 and$14,934.63 million, respectively. Conclusion: Our analysis demonstrated that increasing dairy foods consumption to recommended levels would be associated with reductions in healthcare costs. Further randomized trial studies are required to investigate the effect of dairy foods intake on cost of CVD and T2DM in the population

An Intercultural Translation and Psychometric Analysis of 18-item Spirituality at Work Questionnaire

For downloading the full-text of this article please click here.Background and Objective: Spirituality in job is a new topic but with a limited theoretical-scientific development in organizational literature. The importance of this issue and its impact on work efficiency call for a proper instrument for evaluation purposes. Longevity and incomprehensiveness of some of the questionnaires motivated the authors to provide an Intercultural Translation and psychometric analysis of the standard comprehensive instrument of Spirituality at Work.Methods: In this cross-sectional descriptive study, English version of Spirituality at Work scale, adopted from Val Kinjersk’s study, was used as the main instrument. An attempt was made to complete English-to-Persian translation as well as to provide cultural conformities using the Wild pattern and recursive translation method and retranslation phases, respectively. Afterwards, face validity was performed based on 10 experts’ views and 18 accessible samples and then reliability and validity of the questionnaire were examined and internal correlation was determined in a cross-sectional study on 393 health workers. Construct validity was assessed with a sample size of 268 people through factor analysis. In this study, all the ethical considerations have been observed and no conflict of interest was reported by the authors.Results: To determine construct validity, principal components analysis was performed using Varimax rotation method, in which 70.31% of total variance was explained by two factors. Its face validity was also desirable. In assessing the questionnaire’s reliability using internal consistency method, Cronbach’s alpha coefficient was found to be 96%, which ranged from 78% to 91% for the subscales. There was a high correlation among subscales of this questionnaire (0/82-0/97).Conclusion: The questionnaire had good consistency and the high correlation between the subscales is indicative of a god cultural consistency in translation of the questionnaire. The questionnaire of Spirituality at Work, which aimed at  assessing the experience of spirituality in job based on individuals’ experience of spirituality and workplace morale has proper construct validity and face validity.For downloading the full-text of this article please click here.Please cite this article as: S, Tavafian SS, Wagner J, Jamshidi AR, Mohammadi-Valadani A. An Intercultural Translation and Psychometric Analysis of 18-item Spirituality at Work Questionnaire. Journal of Pizhūhish dar dīn va salāmat. 2020;5(4):114-126. https://doi.org/10.22037/jrrh.v5i4.2234

National, sub-national, and risk-attributed burden of thyroid cancer in Iran from 1990 to 2019

An updated exploration of the burden of thyroid cancer across a country is always required for making correct decisions. The objective of this study is to present the thyroid cancer burden and attributed burden to the high Body Mass Index (BMI) in Iran at national and sub-national levels from 1990 to 2019. The data was obtained from the GBD 2019 study estimates. To explain the pattern of changes in incidence from 1990 to 2019, decomposition analysis was conducted. Besides, the attribution of high BMI in the thyroid cancer DALYs and deaths were obtained. The age-standardized incidence rate of thyroid cancer was 1.57 (95% UI: 1.33–1.86) in 1990 and increased 131% (53–191) until 2019. The age-standardized prevalence rate of thyroid cancer was 30.19 (18.75–34.55) in 2019 which increased 164% (77–246) from 11.44 (9.38–13.85) in 1990. In 2019, the death rate, and Disability-adjusted life years of thyroid cancer was 0.49 (0.36–0.53), and 13.16 (8.93–14.62), respectively. These numbers also increased since 1990. The DALYs and deaths attributable to high BMI was 1.91 (0.95–3.11) and 0.07 (0.04–0.11), respectively. The thyroid cancer burden and high BMI attributed burden has increased from 1990 to 2019 in Iran. This study and similar studies’ results can be used for accurate resource allocation for efficient management and all potential risks’ modification for thyroid cancer with a cost-conscious view

Burden of tracheal, bronchus, and lung cancer in North Africa and Middle East countries, 1990 to 2019: Results from the GBD study 2019

ObjectiveTo provide estimates on the regional and national burden of tracheal, bronchus, and lung (TBL) cancer and its attributable risk factors from 1990 to 2019 in the North Africa and Middle East (NAME) region.Methods and materialsThe Global Burden of Disease (GBD) 2019 data were used. Disability-adjusted life years (DALYs), death, incidence, and prevalence rates were categorized by sex and age groups in the NAME region, in 21 countries, from 1990 to 2019. Decomposition analysis was performed to calculate the proportion of responsible factors in the emergence of new cases. Data are presented as point estimates with their 95% uncertainty intervals (UIs).ResultsIn the NAME region, TBL cancer caused 15,396 and 57,114 deaths in women and men, respectively, in 2019. The age-standardized incidence rate (ASIR) increased by 0.7% (95% UI -20.6 to 24.1) and reached 16.8 per 100,000 (14.9 to 19.0) in 2019. All the age-standardized indices had a decreasing trend in men and an increasing trend in women from 1990 to 2019. Turkey (34.9 per 100,000 [27.6 to 43.5]) and Sudan (8.0 per 100,000 [5.2 to 12.5]) had the highest and lowest age-standardized prevalence rates (ASPRs) in 2019, respectively. The highest and lowest absolute slopes of change in ASPR, from 1990 to 2019, were seen in Bahrain (-50.0% (-63.6 to -31.7)) and the United Arab Emirates (-1.2% (-34.1 to 53.8)), respectively. The number of deaths attributable to risk factors was 58,816 (51,709 to 67,323) in 2019 and increased by 136.5%. Decomposition analysis showed that population growth and age structure change positively contributed to new incident cases. More than 80% of DALYs could be decreased by controlling risk factors, particularly tobacco use.ConclusionThe incidence, prevalence, and DALY rates of TBL cancer increased, and the death rate remained unchanged from 1990 to 2019. All the indices and contribution of risk factors decreased in men but increased in women. Tobacco is still the leading risk factor. Early diagnosis and tobacco cessation policies should be improved

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe