Comparison of Some Multivariate Nonparametric Tests in Profile Analysis to Repeated Measurements

Through Monte Carlo simulations, the performance of six multivariate nonparametric tests for testing the hypothesis of parallelism in profile analysis was studied. In conclusion, the tests based on ranks were as efficient as Hotelling\u27s T2 under multivariate normal distribution. For the heavy tailed distribution, the tests based on signs performed best

Caregiver-related predictors of thermal burn injuries among Iranian children: a case-control study

Purpose Burns are a common and preventable cause of injury in children. The aim of this study was to investigate child and caregiver characteristics which may predict childhood burn injuries among Iranian children and to examine whether confounding exists among these predictors. Methods A hospital based case-control study was conducted using 281 burn victims and 273 hospital-based controls, which were matched by age, gender and place of residence (rural/urban). The characteristics of the children and their caregivers were analyzed using crude and adjusted models to test whether these were predictors of childhood burn injuries. Results The age of the caregiver was significantly lower for burn victims than for the controls (P<0.05). Further, the amount of time the caregiver spent outdoors with the child and their economic status had a significant positive association with the odds of a burn injury (P<0.05). A multivariate logistic regression found that Type A behaviour among caregivers was independently associated with the child's odds of suffering a burn injury (OR = 1.12, 95% CI: 1.04–1.21). The research also found that children with ADHD (Inattentive subscale: Crude OR = 2.14, 95% CI: 1.16–3.95, Adjusted OR = 5.65, 95% CI: 2.53–12.61; Hyperactive subscale: Crude OR = 1.73, 95% CI: 1.23–2.41, Adjusted OR = 2.53, 95% CI: 1.65–3.87) also had increased odds of suffering a burn injury. However, several variables were identified as possible negative confounder variables, as the associations were stronger in the multivariate model than in the crude models

Burnout in Primary Health Care Providers in Mazandaran Province

Background: Burnout describes negative changes in attitude, mood and behavior in people under work-related stress. This study determines the degree of job burnout inprimary health care providers in Sari, Mazandaran Province, Iran.Methods: This cross-sectional research was conducted on 208 primary health care providers working in Sari in 2015using the Maslach Burnout Inventory. The self-administered questionnaire was completed by the participants and data were analyzed using the Chi-square test. The mean scores of the four dimensions of burnout were calculated using the frequency and intensity scores.Results: A total of 62.9% of the participants were female  and a majority was married (91%). Approximately 21% of the participants were completely satisfied with their essential workplace facilities. The mean scores of the intensity and frequency of emotional exhaustion were 17.19±14.65 and 15.84±12.27. The mean scores of the intensity and frequency of the lack of personal accomplishment were 36.8±12.17 and 30.34±9.72. As for depersonalization, the mean scores of intensity and frequency were 4.22±5.36 and3.95±4.53. The mean scores of  the intensity and frequency of conflict were 6.67±5.12 and 6.18±4.26. The mean scores of the intensity and frequency of overall burnou twere also 64.89±22.95 and 56.31±19.87. There were significant relationships between the intensity and frequency of overall burnout and dissatisfaction with work experience, income, interest in the job and workplace facilities (P&lt;0.05).Conclusions: Given the relationship between job burnout and variables including income and essential workplace facilities, it is imperative to improve health care providers’payment and salary and provide them with any essential facilities at their workplace and enable career advancement so as to help reduce burnout in different dimensions

Burnout in Primary Health Care Providers in Mazandaran Province

Background: Burnout describes negative changes in attitude, mood and behavior in people under work-related stress. This study determines the degree of job burnout inprimary health care providers in Sari, Mazandaran Province, Iran.Methods: This cross-sectional research was conducted on 208 primary health care providers working in Sari in 2015using the Maslach Burnout Inventory. The self-administered questionnaire was completed by the participants and data were analyzed using the Chi-square test. The mean scores of the four dimensions of burnout were calculated using the frequency and intensity scores.Results: A total of 62.9% of the participants were female  and a majority was married (91%). Approximately 21% of the participants were completely satisfied with their essential workplace facilities. The mean scores of the intensity and frequency of emotional exhaustion were 17.19±14.65 and 15.84±12.27. The mean scores of the intensity and frequency of the lack of personal accomplishment were 36.8±12.17 and 30.34±9.72. As for depersonalization, the mean scores of intensity and frequency were 4.22±5.36 and3.95±4.53. The mean scores of  the intensity and frequency of conflict were 6.67±5.12 and 6.18±4.26. The mean scores of the intensity and frequency of overall burnou twere also 64.89±22.95 and 56.31±19.87. There were significant relationships between the intensity and frequency of overall burnout and dissatisfaction with work experience, income, interest in the job and workplace facilities (P&lt;0.05).Conclusions: Given the relationship between job burnout and variables including income and essential workplace facilities, it is imperative to improve health care providers’payment and salary and provide them with any essential facilities at their workplace and enable career advancement so as to help reduce burnout in different dimensions

Gluten restriction in irritable bowel syndrome, yes or no?: a GRADE-assessed systematic review and meta-analysis

BackgroundMore than half of patients with irritable bowel syndrome (IBS) report aggravating their symptoms with certain foods. Currently, Low fermentable oligo-, di-, and monosaccharides and polyols diet (LFD) is the most accepted dietary intervention for IBS. Recent randomized controlled trials (RCTs) have been suggested that gluten restriction may reduce the symptoms of patients with IBS. However, the results from these studies are conflicting. This study filled this knowledge gap by evaluating the impact of the gluten-free diet (GFD) on IBS symptoms.MethodsA systematic search was carried out in Pubmed/Medline, Cochrane CENTRAL, Scopus, and Web of Science up to April 2023. A random-effect model was applied to estimate the standardized mean difference (SMD) and 95% confidence interval (95% CI) for each outcome.ResultsA total of nine controlled trials were included in the meta-analysis. In contrast to gluten-containing diet, GFD was unable to reduce overall symptoms (SMD − 0.31; 95% CI −0.92, 0.31), bloating (SMD −0.37; 95% CI −1.03, 0.30), and quality of life (SMD −0.12, 95% CI −0.64, 0.39); but had a slight trend to reduce abdominal pain (SMD –0.68; 95% CI −1.36, −0.00). Also, LFD significantly reduced the IBS-Severity score system (SMD 0.66, 95% CI 0.31, 1.01) and improved quality of life (SMD −0.36, 95% CI −0.70, −0.01), compared to GFD.ConclusionA GFD is not robust enough to be routinely recommended for IBS patients, and its efficacy is significantly lower than that of an LFD. Only a certain subgroup of IBS patients may benefit from GFD; further studies are needed to target this subgroup

Estimating the Risk for Chromosomal Abnormalities and Heteromorphic Variants in Azoospermic and Severe Oligozoospermic Men

Objectives: A reasonable number of male infertility cases are related to genetic factors. Considering the high prevalence of chromosomal abnormalities related to male infertility, this study investigated the association of the chromosomal aberrations and chromosome variants with hormonal levels, a positive family history, parental consanguinity and a specific lifestyle. We also aimed to find a predictive factor to estimate the risk of the presence of an abnormal karyotype in the azoospermic and especially sever oligozoospermic men. Materials and Methods: A total of 230 infertile men and 50 healthy controls enrolled in the study for cytogenetic evaluation. Data on patients" characteristics were gathered, accurately. Results: Among aforementioned factors, only luteinizing hormone (LH) >12 IU/l raised the chance of detecting a chromosomal abnormality (P < 0.05). The results also showed a higher level of follicle stimulating hormone (FSH) and parental consanguinity and a positive family history of infertility in infertile men compared with the control group (P < 0.05). The incidence of chromosome abnormalities and chromosomal variants were 15.2% and 10.9%, respectively. The investigated variables revealed no association with the prevalence of chromosome heteromorphic variants. Conclusiond: This study suggests a positive family history of infertility, parental consanguineous marriages and high levels of FSH as strong determinants or risk factors for male infertility. Nonetheless, the presence of these patient characteristics did not prove to have a direct correlation with chromosomal abnormalities in male infertility. Among the various possible risk factors studied, an elevated gonadotropin level provides a better risk assessment for the incidence of chromosomal abnormality in infertile men

Comparison of three malnutrition screening tools prior to allogeneic hematopoietic stem-cell transplantation

BackgroundPrevious studies have shown that malnutrition before hematopoietic stem cell transplantation (HSCT) is associated with poor patient prognoses. There is inconsistency among studies on which nutritional status screening tool is appropriate for malnutrition diagnosis before allo-HSCT. The present study aimed to compare nutritional screening tools in patients with leukemia before allo-HSCT.MethodsAn observational, cross-sectional, and single-center study was conducted in Tehran, Iran. One hundred four adults allo-HSCT candidates aged 18-55 years with leukemia were selected sequentially. Malnutrition assessment was done using three tools, the Global Leadership Initiative on Malnutrition (GLIM), nutritional risk screening 2002 (NRS-2002) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria. The agreement between malnutrition assessment tools was evaluated with Cohen’s kappa.ResultsThe agreement between GLIM and NRS-2002 was perfect (κ = 0.817, p &lt; 0.001), while the agreement between GLIM and ESPEN was fair (κ = 0.362, p &lt; 0.001). The agreement between NRS-2002 and ESPEN was fair (κ = 0.262, p &lt; 0.001). We also found a moderate agreement for all tools (κ = 0.489, p &lt; 0.001).ConclusionNRS-2002 is an accepted tool for screening malnutrition in hospitalized patients. In the current study, the GLIM criterion perfectly agreed with the NRS-2002. Further studies in the HSCT setting are needed to introduce a valid tool

Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran

Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year.This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups.The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million).T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority