Determining and prioritizing indicators of public health coverage in Iran: A qualitative study

Introduction: Universal health coverage is an important step towards achieving and benefiting from health services. To measure universal health coverage, appropriate indicators are needed. This study was conducted to select priority indicators for use in general health measurements. Materials and Methods: This study is a qualitative study. The population of the research was experts in the country and the sampling was done purposefully. The study was conducted in three stages. In the first phase, 393 indicators related to public health coverage were selected by reviewing texts related to international and domestic indicators and use of experts' opinion, and duplicates were removed. In the second phase, using valid sources such as WHO, Millenium Development Goals, and Sustainable Development Goals of Universal Health Coverage, 100- Core Health Indicators and using expert opinions, 40 indicators were selected for the final survey. In the third stage, 47 experts ranked these 40 indicators. Results: The most important indicators of universal health coverage from the viewpoints of experts were death rate of pregnant women, vaccination coverage of children under 5 years old, life expectancy at birth, infant mortality rate, death rate of children under 5 years of age, death rate of children under 1 years of age, high blood sugar levels in adults, access to healthy water, death rates due to cancer and general health insurance. Also in the ranking, according to the Healt Indicators of Iran, amoung demographic indicators, death of pregnant women; amoung the indicators of diseases, the coverage rate of vaccinations; amoung the indicators of health coverage, access to healthy water; and amoung the health system indicators, the amount of public insurance coverage were the first priorities. Conclusion: In general, until the acquisition, more precise determination and prioritization, the indexes ranked among the top ten amoung 40 indciators, and also the first priotity indicator of each of the four components of population and mortality, diseases and risk factors, the coverage of health services, and the health system should be taken into account in reaching the goals of universal health coverage. © 2018, Semnan University of Medical Sciences. All rights reserved

The attainment of physician's professional identity through meaningful practice: A qualitative study

Background: Medical professional identity is how an individual perceives him/herself as a doctor. Formation of professional identity includes development, advancement, and socialization through social learning of specific knowledge, skills obtained while performing professional roles, practicing, and new attitudes and values. A qualitative study was performed to examine live experience of undergraduate medical science students with regards to obtaining professional identity. Methods: This qualitative study was performed using a conventional content analysis method. Participants were students who were studying medicine at Iran University of Medical Sciences. Sampling was done based on a purposeful sampling method. A total of 23 students took part in semi-structured interviews until data saturation was reached. The interviews were transcribed verbatim. Also, to develop themes, data were analyzed using conventional content analysis. Moreover, data management was done using MAXQDA software. Results: Based on data analysis, 2 main themes were as follow: meaningful medical practice" and "professional medical practice". The first theme had 3 categories: (i) self-insight; (ii) manner; and (iii) values and beliefs. The second theme had 2 categories: (i) professionalism; and (ii) holistic view of medicine. Conclusion: Certain individual characteristics and personality type were factors that affected participants' choice of their field of study. The participants' understanding of their profession was formed, not only by studying in the university through learning relevant knowledge, skills, and practice, but also by perceived attitude, views, and values in their profession. © Iran University of Medical Sciences

Psychometric properties of the Persian version of the Anesthetic Trainee Theatre Educational Environment Measure (ATEEM)

Background: The quality improvement of medical education programs and the ongoing reform of the curriculum should be done in the light of clinical training fields and identifying the strengths and improving the weaknesses. Therefore, this study was conducted to evaluate the validity and reliability of ATEEM (Anesthetic Trainee Theatre Educational Environment Measure) questionnaire for assessing learning environment of anesthesiology residents in educational centers affiliated to 3 main medical schools in Tehran, Iran. Methods: This study was conducted on first to fourth year anesthesiology residents using a questionnaire. Validity (face, content, construct) and reliability of ATEEM questionnaire was investigated. Construct validity was measured by confirmatory factor analysis, stability of reliability by test-retest, and internal consistency by Cronbach's alpha. Results: A total of 156 questionnaires out of 190 were fully answered, returned by residents of anesthesiology, and analysis were performed (82 response rate; 44.5 male (n=69); 55.5 female (n=86)). The age range of respondents was 26 to 48 years. The mean total ATEEM score was 114.03 out of 160. Face and content validity of the questionnaire was approved. Content validity ratio (CVR) and content validity index (CVI) were 0.63 and 0.88, respectively. Fitness indices in confirmatory factor analysis were greater than 0.9, and RMSEA (root mean square error of approximation) index was less than 0.08 (0.07). This indicator measures the acceptability of fitness and it is an appropriate measurement model. The average reliability coefficient was 0.73 and the overall Cronbach's alpha coefficient was 0.959. Conclusion: The results of this study showed that the Persian version of the ATEEM questionnaire, with appropriate psychometric properties, can be used to evaluate the anesthetic trainee theatre learning environment used in hospitals. © Iran University of Medical Sciences

Men�s willingness to pay for prostate cancer screening: a systematic review

Background: This study aimed to review studies on willingness to pay (WTP) for prostate cancer screening. Methods: This systematic-review was conducted based on the Preferred Reporting Items for Systematic Reviews guidelines. By searching six-health-database, WTP studies on prostate cancer screening using contingent valuation method published in English until March 2020 were included and those with unavailable full-text and inadequate quality-assessment scores were excluded. Smith checklist was used for the quality assessment. Extracted WTPs were converted to US dollar in 2018 using exchange rate parity and net present value formula to make comparison. Factors� effect was assessed by vote counting. Results: Six final studies published after 2006 reported above 70 Smith checklist items needed to be considered in contingent valuation study reports. Seven factors have positive effects on WTP. The reported WTP value varied from 11 to 588 in Japan and Germany, respectively. Conclusion: WTP for prostate cancer screening was positive among all studied men. The results of factors� effect assessment showed that better understanding prostate cancer risks or screening tests and factors such as age, income, family history of cancer, hospitalization history, and educational level have positive effects. Moreover, prostate-specific antigen history, health insurance, employment, and subject�s health assessment received less attention. The results� generalization to all countries is not applicable because there are no studies for low- and middle-income countries. Systematic review registration: PROSPERO 2020 CRD42020172789 © 2020, The Author(s)

Medicinal plants in the adjunctive treatment of patients with type-1 diabetes: a systematic review of randomized clinical trials

Propose: This study aims to systematically review the randomized controlled trials that address the effectiveness and safety of herbal medicine in patients with type 1 diabetes. Methods: The Cochrane Library (latest issue); MEDLINE (until recent); EMBASE (until recent); AMED (Allied and Complementary Medicine Database) (until recent); and CINHAL (until recent) were searched electronically for the identification of trials until October 2019. Articles were initially screened based on title and abstract and then by full text by two independent authors. References of retrieved studies were hand-searched for further studies. Risk of bias was assessed according to the Cochrane handbook of systematic reviews of interventions. The results were summarized into GRADE (grading of recommendations, assessment, development and evaluation) tables. No meta-analysis was applicable as only one study was found for each intervention. Results: Four RCTs were finally included in the systematic review with an overall moderate quality of conduct and low quality of reporting. The sample sizes were very small. The results of these RCTs show that cinnamon pills and Berberine/Silymarine compound capsules may decrease blood glucose indices from baseline, while fenugreek seeds and fig leaf decoction do not show any statistically significant effect. Conclusions: The evidence is scarce and no recommendations can be made based on current evidence. Further trials with more rigorous methodology and stronger quality of reporting are needed to make conclusions. © 2020, Springer Nature Switzerland AG

Assessing validity and reliability of Dundee ready educational environment measure (DREEM) in Iran

Background: If an institute is looking for improvement of its learning environment, a reliable and valid assessment tool is needed for measurement of the educational environment .The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem necessary, for all known versions of the instrument. The aim of this study was to investigate the reliability and validity of Persian version of the DREEM in the major clinical wards in teaching hospitals affiliated to Iran University of Medical Sciences. Methods: This descriptive - analytical study, involved medical students (clinical stagers and interns) in 4 major clinical wards. In this study, DREEM questionnaire was reviewed in content, face validity and construct validity through confirmatory factor analysis. The reliability was calculated according to test - retest and the internal consistency was measured using Cronbach's alpha coefficient. Results: A total number of 267 questionnaires were completed by medical stagers (60) and interns (40) including 181 females and 82 males. The mean age of stagers and interns were 23.60 ± 1.27 and 25.45 ± 1.22 years, respectively. The total mean of the questionnaire was calculated as 96.15 (93.5375, 98.7547) out of 176, with 95 confidence interval. The face validity of the questionnaire was confirmed. The mean of content validity ratio (CVR) was calculated as 0.35, and 6 questions were omitted in this step. The content validity index (CVI) was 0.39. The reliability coefficient mean was 0.71. In confirmatory factor analysis five factors were confirmed that changed the orientation of some questions. The Cronbach's alpha coefficient of the whole questionnaire was obtained as 0.914. Conclusion: The modified and validates DREEM questionnaire in Persian language with 44 items and appropriate psychometric attributes is capable of being used in assessment of clinical education environments in Iran

Prevalence of high blood pressure in Iranian adults based on the 2017 ACC/AHA guideline

Background:: In 2017, American College of Cardiology (ACC) and the American Heart Association (AHA) presented a new guideline for assessing blood pressure in adults. This study aimed to assess the prevalence of hypertension in Iranian adults based on ACC/AHA 2017 guideline. Methods: Data from 9801 Iranian adults (59.2 women) aged between 20-69 years were obtained from the sixth round of National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD) performed in 2011. Blood pressure was classified as normal, elevated blood pressure, and stage 1 and 2 hypertension using a weighted analysis and 2017 ACC/AHA guidelines. Data were presented as prevalence and 95 confidence interval (95 CI). All analyses were performed in Stata/SE 14.0. Results: Overall prevalence of hypertension in Iranian men was 52.0. Also, 32.9 (95 CI: 29.9-36.0) and 19.1 (95 CI: 16.921.6) of men had stage 1 and 2 hypertension, respectively. In addition, 44.3 of women had hypertension, of whom 26.3 (95 CI: 24.5 - 28.2) had stage 1 and 18.0 (95 CI: 16.1-20.1) stage 2 hypertension. Furthermore, 16.5 (95 CI: 14.4-18.9) and 9.6 (95 CI: 7.86-11.7) of men and women had elevated blood pressure, respectively. Conclusion: The findings of this study indicated that adopting the 2017 ACC/AHA guidelines showed a higher prevalence of adult hypertension (48.2) in Iran. In this study, the prevalence of hypertension in men was higher than in women, which was steadily increased by age in older adults in both sexes. © Iran University of Medical Sciences

Prevalence of physical activity through the practice of sports among adolescents from Portuguese speaking countries

This study evaluated the prevalence of physical activity through the practice of sports in adolescents from schools in two Brazilian cities and a Portuguese school, and its association with independent variables, such as gender and age. A cross-sectional study was conducted of schoolchildren from two cities in Brazil and one in Portugal. The total study sample was 3694 subjects (1622 males and 1872 females). Physical activity levels were assessed using Baecke's questionnaire. Body weight was measured on electronic scales and stature was measured with a portable wooden stadiometer. Numerical variables were expressed as mean, categorical variables were expressed as percentages and the chi-square test analyzed associations. The prevalence of no sport was high (39.7%), being higher in the Portuguese school than in the Brazilian schools (p < 0.001). Irrespective of being an adolescent in a Brazilian or Portuguese school, boys showed higher engagement in sports practice than girls (p < 0.001). In both, differences were identified between adolescents aged 13 to 15 (P = 0.001) and 16 to 17 (P = 0.001). The prevalence of physical inactivity among schoolchildren from two cities in Brazil and a school in Portugal was high, with the girls practicing less sport than the boys and with this imbalance likely to be higher in adolescents

Herbal medicines for type 1 diabetes mellitus

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of herbal medicine for type 1 diabetes mellitus. © 2015 The Cochrane Collaboration

The effect of foot hyperpronation on spine alignment in standing position

Background: According to clinical observations, foot hyperpronation is very prevalent and may cause malalignment of the lower extremity, leading to structural and functional deficits in standing and walking. This study aimed at investigating the effect of foot hyperpronation on spine alignment in the standing position. Methods: Thirty-five healthy males with an age range of 18-30 years participated in this cross-sectional study. Evaluation was performed with two examiners in four standing positions (on the floor, and on the wedges angled at 10, 15, and 20 degrees) using a motion analysis system (Zebris). Moreover, each of the measurement methods was repeated for three short times. Paired t- test and repeated measures ANOVA test were used for statistical analysis. Results: Significant differences were observed between all modes in the sacral angle, pelvic inclination, lumbar lordosis, and thoracic kyphosis variables (except between the first and second mode). Finally, a positive correlation was obtained for the examiners and all the variables with an increasing slope of the angle of wedge. Conclusion: The results of the present study revealed sacral angle, pelvic inclination, lumbar lordosis, and thoracic kyphosis were increased with an increase in bilateral foot pronation. In fact, each one of them is a compensatory phenomenon