The inappropriateness of brain MRI prescriptions: a study from Iran

Background: Inappropriate prescriptions can lead to adverse consequences for patients. It also imposes excessive cost on the patients, payers and health systems. The current study aimed at estimating the rate of inappropriate brain Magnetic Resonance Imaging (MRI) prescriptions and their financial burden in Iran. Methods: Using systematic stratified sampling method, this cross-sectional study recruited 385 participants from three public teaching hospitals in Shiraz, Iran. Demographic information, questions related to brain MRI prescription and its indications checklist were collected using study-specific data collection tools. The completed indications checklist was compared to the appropriateness status table of indications and scenarios to detect the percent of the appropriateness of prescriptions. Results: About 21 percentage of total brain MRI prescriptions are inappropriate. Previous treatment, number of referrals to physician, having other diagnostic tests and the applicant of MRI (P < 0.01) had significant relationships with prescription appropriateness. The estimated financial burden of inappropriate brain MRIs in Shiraz teaching hospitals was 99,988 US dollar in 2017. Conclusions: More than one-fifth of brains MRIs were inappropriate (i.e. prescriptions without medical indications). It caused 99,988 United States Dollar (USD) financial burden which is 17 times that of Iran's Gross Domestic Product (GDP) per capita. To better allocate resources for the provision of MRI services to health system, rationing policies for controlling moral hazard and reducing provider induced demand can be helpful

The Effectiveness of Integrative Group Therapy on the Sexual Function of Women with Systemic Scleroderma

Aims: Systemic scleroderma is a multiple chronic autoimmune disease that has important clinical and psychological consequences, including sexual dysfunction. The purpose of this study was to determine the efficacy of integrated treatment group on sexual function and its domains in women with scleroderma. Materials & Methods: This research was a semi-experimental design with pre-test, post-test, and follow-up with the experimental and control groups. The statistical population included women with scleroderma referred to Shariati Hospital in Tehran and Iran's Rheumatism Center in the second half of 2017. Of these, 30 patients were selected as available samples and randomly were placed in the control and the experimental groups. The experimental group was subjected to an integrated approach intervention in 9 sessions of 90-minutes, where as the control group did not receive such an intervention. The instrument of this study was the Female Sexual Function Index (FSFI) Questionnaire. Data were analyzed using SPSS24 software and repeated measures ANOVA. Findings: Unilateral psychotherapy intervention significantly increased the mean post-test of sexual function and its six sub-components in both control and experimental groups (p<0.01, F=19.59). The satisfaction component with 0.82 (p<0.01, F=125.35) and psychological stimulation with 0.74 (F=77.9, p<0.01) had the most effect on intervention, and the component of orgasm with 0.33 (F=13.54, p<0.01) had the least effect among the components. After three months, there was no statistically significant difference between the post-test and the follow-up of the experimental group, which indicated the stability of intervention effects. Conclusion: Unified psychotherapy is effective in increasing the sexual function of patients with systemic sclerosis and can play a significant role in improving the quality of life of these people

Correlation of clinical signs and symptoms of Behçet�s disease with mean platelet volume (MPV) and red cell distribution width (RDW)

Background: A strong correlation was previously found between mean platelet volume (MPV), red blood cell distribution width (RDW), and the severity of signs and symptoms in patients suffering from inflammatory and autoimmune diseases. The current study evaluated these correlations in patients with Behçet�s disease (BD) as well the relationship between MPV and RDW and disease activity score on the Iranian Behçet�s Disease Dynamic Activity Measurement (IBDDAM). Methods: This cross-sectional study included 319 patients with BD for whom demographic and epidemiological data, IBDDAM scores, and duration of illness was recorded. Blood samples were then obtained and the relationships between their disease status and manifestations and their laboratory parameters were evaluated with statistical models to find possible correlations. Results: Our analysis showed a significantly higher RDW in patients with BD who had ocular manifestations (p < 0.001) and oral aphthae (p = 0.004). Patients with active BD had higher RDW (p < 0.001) and MPV (p < 0.001) in comparison to those with currently inactive BD. Similarly, patients who had any type of ocular manifestation had higher RDW (p < 0.001) and MPV (p < 0.001). Regression analyses identified a statistically significant model for the effect of RDW and MPV in predicting active BD status (p < 0.001), as well as its significant relationship with active ocular manifestations (p < 0.001). Conclusion: BD was found to be associated with an increase in MPV and RDW, particularly during active phases. RDW and MPV were also found to have predictive value for screening to detect BD activity and its ocular complications. © 2020, The Author(s)

Prevalence of influenza A infection in the Middle-East: A systematic review and meta-analysis

Objective: This systematic review and meta-analysis was performed to determine the prevalence rate of influenza virus from different parts of Middle East region, and present an overall relative frequency (RF) for this region. Methods: The authors performed a systematic literature review from several reliable databases such as PubMed, ISI Web of Science and Scopus during 2000�2016. Furthermore, the keywords of this research were �Influenza�, �Subtype�, �Seroprevalence�, �Incidence�, �Seroepidemiology�, �H1N1�, �H3N2�, �H5N1�, �H9N2�, �Middle-East� and �Meta-analysis�. The reported data were selected according to inclusion and exclusion criteria. Results: The authors selected 71 studies out of 1147 for the present review. The overall estimation of the prevalence of influenza virus was 10.2 95% confidence interval (CI): 10.1%�10.3%. However, based on our records, the evident heterogeneity of influenza virus was observed among the studies (Cochran Q test, P value <.001 and I-squared = 100%). It should be noted that influenza virus infection's RF varied from 0.5% in Qatar to 70% in Syria. Conclusions: The results of this review are remarkable, they show that influenza infection RF is variable due to several factors. Thus, further researches should be taken to minimize the emergence and transmission of influenza virus. © 2018 John Wiley & Sons Lt

Prevalence of influenza A infection in the Middle-East: A systematic review and meta-analysis

Objective: This systematic review and meta-analysis was performed to determine the prevalence rate of influenza virus from different parts of Middle East region, and present an overall relative frequency (RF) for this region. Methods: The authors performed a systematic literature review from several reliable databases such as PubMed, ISI Web of Science and Scopus during 2000�2016. Furthermore, the keywords of this research were �Influenza�, �Subtype�, �Seroprevalence�, �Incidence�, �Seroepidemiology�, �H1N1�, �H3N2�, �H5N1�, �H9N2�, �Middle-East� and �Meta-analysis�. The reported data were selected according to inclusion and exclusion criteria. Results: The authors selected 71 studies out of 1147 for the present review. The overall estimation of the prevalence of influenza virus was 10.2 95% confidence interval (CI): 10.1%�10.3%. However, based on our records, the evident heterogeneity of influenza virus was observed among the studies (Cochran Q test, P value <.001 and I-squared = 100%). It should be noted that influenza virus infection's RF varied from 0.5% in Qatar to 70% in Syria. Conclusions: The results of this review are remarkable, they show that influenza infection RF is variable due to several factors. Thus, further researches should be taken to minimize the emergence and transmission of influenza virus. © 2018 John Wiley & Sons Lt

MMS Observations of Energetic Particles in the Magnetosheath: Preliminary Case Studies

Previous studies have shown the formation of large diamagnetic cavities around the Earth’s magnetopause that are filled with highly energetic ions and electrons at 90 degree pitch angles. Statistical study has shown that cavity locations are consistent with expected location of magnetic bottle formation for anti-parallel or component reconnection for given IMF orientation. However, there are few cases that are not consistent with either. In this work we consider the possibility that these particles could originate from foreshock. As a first step we have analyzed MMS magnetosheath crossings to understand the IMF and SW conditions for which we see energetic particles in the magnetosheath

Legal and policy requirements of basic health insurance package to achieve universal health coverage in a developing country

OBJECTIVES: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. RESULTS: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC