Reliability analysis of a newly developed questionnaire for quality control of follow-up visits in polyiran study

Background: The PolyIran study is a large-scale pragmatic cluster randomized controlled trial of fixed-dose combination therapy (Polypill) for prevention of cardiovascular diseases (CVD) in Iran. The PolyIran Quality Control Program (PIQCP) including a new questionnaire was developed to assess the quality of data collection during follow-up visits. The aim of this study was to assess the inter-rater reliability of PIQCP questionnaire. Methods: The study was conducted in 26 (11%) randomly selected clusters (from a total of 236 PolyIran clusters). All participants within these 26 clusters were enrolled. The quality scores were measured according to the PIQCP guidelines by two independent raters. The intraclass correlation coefficients (ICC) were measured. In addition, the quality scores were categorized into good (370%) and poor (<70%). The kappa coefficient was used to assess inter-rater agreement for this categorical quality scores. Results: A total number of 945 PolyIran participants were enrolled of which, 501 (53%) were from intervention arm. In 934 participants (98.8%), the quality score could be successfully identified by both raters. The ICC (95%CI) ofthe overall quality scores was 0.985 (0.983-0.987). It was 0.976 (0.972-0.980) and 0.988 (0.986-0.990) in intervention and control arms, respectively. We found excellent agreement between the two raters in identifying participants with good and poor quality scores (kappa = 0.988, P < 0.001). The kappa values were 0.972 (P < 0.001) and 1.000 (P < 0.001) in intervention and control arms, respectively. Discussion: Our results suggested that the PIQCP questionnaire is a reliable tool for assessing quality of data collection in PolyIran follow-up visits. Using this measure will help us in efficient monitoring of the PolyIran follow-ups and may ensure high quality data. © 2016, Academy of Medical Sciences of I.R. Iran. All rights reserved

10-year trends in dietary intakes in the high- and low-risk areas for esophageal cancer: A population-based ecological study in Northern Iran

BACKGROUND We assessed dietary intakes in the high- and low-risk areas for esophageal cancer (EC) in Golestan province, Northern Iran. METHODS Considering the EC rates, Golestan province was divided into high- and low-risk regions. Data on households� food consumption were obtained from the Statistical Center of Iran. We used multivariable logistic regression to assess the relationships between consumption of main food and EC risk. Adjusted odds ratios (aOR) were calculated. Joint point program was used for time trend analysis and average annual percent changes (AAPC) were reported. RESULTS Overall, 11910 households were recruited during 2006-2015. 4710 (39.5) households were enrolled from the high-risk region. There were significant positive relationships between high consumption of sweets (aOR = 1.62; 95 CI: 1.24-2.10), oil/fat (aOR = 1.36; 95 CI: 1.04-1.79), and red meat (aOR = 1.33; 95 CI: 1.07-1.65) with EC risk. We found significant negative relationships between high consumption of dairy products (aOR = 0.62; 95 CI: 0.46-0.82), vegetables (aOR = 0.66; 95 CI: 0.50-0.87) and fruit (aOR = 0.72; 95 CI: 0.55-0.95) with the risk of EC. Time trend analysis showed a significant increasing trend in the proportions of households with low consumption of vegetables (AAPC = 4.71, p = 0.01) and dairy products (AAPC = 5.26, p = 0.02) in the low-risk region for EC. CONCLUSION Dietary intakes may be important etiological factors for EC in Northern Iran. Further studies are warranted to assess the role of dietary factors in this high-risk population. © 2020 The Author(s)

Challenges in the implementation of an electronic referral system: A qualitative study in the Iranian context

Referral chain reduces patient costs and results in more efficient use of workforce and equipment. Despite the implementation of the Family Physician Programme in Iran, the referral system does not function as intended. Therefore, this study was conducted to explain the challenges in the implementation of an electronic referral system in Iran. This qualitative study was performed in Golestan province in northern Iran. The participants were 46 family physicians, specialist physicians, healthcare managers, experts, and patients who were selected through purposive sampling. Data were collected using in-depth individual interviews and were analysed using content analysis. Implementation of the electronic referral system faces management challenges (planning, organisation, motivation, control), administrative challenges (scheduling, patient load and waiting time, visit and diagnosis, feedback), and educational, policy, sociocultural, technological, and economic challenges. Policymakers can adopt appropriate strategies to improve the quantity and quality of their electronic referral system according to the challenges identified herein. © 2022 John Wiley & Sons Ltd

The effect of green tea extract supplementation on sputum smear conversion and weight changes in pulmonary TB patients: A randomized controlled trial

Background: Acceleration in sputum smear conversion helps faster improvement and decreased probability of the transfer of TB. In this study, we aimed to investigate the effect of green tea extract supplementation on sputum smear conversion and weight changes in smear positive pulmonary TB patients in Iran. Methods: In this double blind clinical study, TB patients were divided into intervention, (n = 43) receiving 500 mg green tea extract (GTE), and control groups (n = 40) receiving placebo for two months, using balanced randomization. Random allocation and allocation concealment were observed. Height and weight were measured at the beginning, and two and six months post-treatment. Evaluations were performed on three slides, using the ZiehlNeelsen method. Independent and paired t test, McNemar's, Wilcoxon, Kaplan-Meier, Cox regression model and Log-Rank test were utilized. Statistical significance was set at p 0.05). In terms of shortening the duration of conversion, the case to control proportion showed a significant difference (p = 0.032). Based on the Cox regression model, the hazard ratio of the relative risk of delay in sputum smear conversion was 3.7 (p = 0.002) in the higher microbial load group compared to the placebo group and 0.54 (95 CI: 0.31-0.94) in the intervention compared to the placebo group. Conclusion: GTE decreases the risk of delay in sputum smear conversion, but has no effect on weight gain. Moreover, it may be used as an adjuvant therapy for faster rehabilitation for pulmonary TB patients

Effect of motivational interviewing on weight efficacy lifestyle among women with overweight and obesity: A randomized controlled trial

Obesity and overweight have become increasingly a major public health problem across the world. This study aimed at exploring the effects of motivational interviewing on weight efficacy lifestyle among women with obesity and overweight. A single-blind randomized clinical trial study was conducted on 100 overweight and obese women who attended a nutrition clinic. The samples were selected based on the clinical records and assigned into two groups, namely motivational interviewing arm (50 samples) and nutrition education arm (50 samples). Data were collected using a standard validated questionnaire entitled “weight efficacy lifestyle”. The intervention was designed according to five motivation sessions and four nutrition education programs, such that the participants of the nutrition education arm were also provided with the nutrition pamphlets related to weight control. Data were finally analyzed using the SPSS statistical software by performing the independent t-test, chi-square, LSD and repeated measures ANOVA tests. P<0.05 were considered statistically significant. The mean age of women was 39.9±9.1 and 36.3±8.9 years in the control and motivational interviewing arms, respectively. Compared with the control group, the score of the motivational interviewing group was statistically significant in terms of weight efficacy lifestyle P=0.0001) and all subscales including social pressure (P=0.0001), physical discomfort (P=0.005), food accessibility (P=0.0001), positive and entertainment activities (P=0.0001), as well as negative emotions (P=0.003). Motivational interviewing appeared to be effective in increasing weight efficacy lifestyle among women with overweight and obesity. © 2017, Shiraz University of Medical Sciences. All rights reserved

Effectiveness of Integrated and Comprehensive Geriatric Care Program of Ministry of Health on Physical and Mental Health of Older Adults in Golestan Province

Objectives In order to maintain and improve older adults� health, the integrated and comprehensive geriatric care program has been developed and run by ministry of health. The present study was conducted to evaluate the effectiveness of this program on physical and mental health of older adults in Golestan province in 2019. Methods & Materials The present retrospective cohort study employed a multistage clustered random sampling technique to obtain 500 e-health records of older adults during 2017-2019. The data on blood pressure, depression, and BMI were extracted from e-health records. Data analysis was conducted using repeated measure anova, paired t-test and Wilcoxon tests. The SPSS statistics software v. 20 was used to perform data analysis Results Of the 500 cases studied, were male and female, respectively. The Mean±SD age of the participants was 69.97±7.45 years. The results of inferential statistics showed that the mean score of systolic blood pressure was significantly decreased through study period (P<0.001). However, through study period depression score was significantly increased (P�0.05). There was no significant difference in BMI index. Conclusion The results of this study showed that the integrated and comprehensive geriatric program was effective for controlling blood pressure, however was not effective for preventing depression. Therefore, stakeholders should pay more attention towards establishing appropriate program to improve older adults� mental health. © 202

Eleven year epidemiological study of tuberculosis in Golestan Province, Northern of Iran

Background: At present, researchers were aimed at exploring the epidemiology of tuberculosis (TB) in Golestan Province in North of Iran that usually ranks 2nd or 1st, alternatively. Methods: An epidemiological study of 11 years was carried out over 8405 patients with TB from 2005 to 2014 years. Data were collected from Health System of the Ministry of Health in Iran using a patient-sheet. Descriptive statistics were applied to report the results. Results: Of those screened, the vast majority of patients with newly diagnosed smear-positive 1799 (41.6) and smear-positive with relapse 203 (56.5) were referred from Health System (outpatient cases). Given the newly diagnosed TB, 3559 and 264 of smear-positive were treated and died, respectively; while, 1196 and 119 of smearnegative cases were accordingly treated completely and died. Conclusion: The vast majority of TB cases are infected by pulmonary TB, educational preventive programs seem likely more useful to control the disease. © 2020, Iranian Journal of Public Health. All rights reserved

Developing basic health services packages: Defining a prioritization of effectiveness criteria

Background: Basic health services package (BHSP) is one of the key strategies for improving the effectiveness of health systems and equitable distribution of resources. Required factors to services included in the BHSP are based on some criteria that must be agreed on them. It is generally agreed that there is a little consent about the issue that what services can be provided with the aforementioned package. Aim: This study investigated the prioritization of effective criteria in developing BHSP for Iranian society. Methods: In this mixed-method study, senior managers and experts in the related fields were purposively selected. The sample sizes were considered 25 and 27 in the qualitative and quantitative study, respectively. Data was collected using structured and semi-structured questionnaire; moreover, personal deep interview and self- administered questionnaire were also used. To analyze, content analysis and SPSS software were finally implemented. Findings: In total, 54 criteria were categorized into 8 main groups of health priority including service delivery system, people demands, cost-effectiveness, utilization, financial resources, service social acceptability, commitments, and sovereignty. �Burden of disease�, �Vulnerable target groups�, and �community needs� had the greatest impact in determining BHSP in Iran, accordingly. Conclusion: To design evidence-based BHSP in Iran; it is recommended that some of the criteria such as Burden of disease, vulnerable target groups, and community needs should be replaced. © 2019 Informa UK Limited, trading as Taylor & Francis Group

Years of Life Lost due to accidents and injuries in Iran: A trend of five years (2014-2018)

Background: Accidents and injuries are known around the world as the leading cause of disability and mortality. Objective: This study aimed to investigate the epidemiology of deaths due to accidents and injuries and years of life lost due to it. Methods: The method used in this research is the documentary method analysis. The study population was all deaths recorded in the Statistics and Performance Analysis Unit of Golestan University of Medical Sciences during the years 2014-2018. Results: During the years 2014 to 2018, more than 4318 deaths due to accidents occurred in Golestan province, of which 76.3 were related to men and 23.7 were related to women. There were about 99,531 years of life lost due to premature death during the study period, with the proportion of men (75,737 years, 16 per 1,000) higher than women (23,794 years, 5.1 per 1,000). Conclusion: Promoting knowledge and education, especially in the younger age group, interventions to solve accident-prone areas, adopting policies to reduce traffic accidents and lack of easy access to pesticides, teaching safety principles are also recommended. © 2022 Heidari, Kabir, Khatirnamani, Jafari, Gholami, Honarvar, Lotfi, licensee HBKU Press