The effect of exercise therapy on knee osteoarthritis: A randomized clinical trial

Background: Knee osteoarthritis (OA) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair, standing, walking and climbing stairs. Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocols in combination to conventional conservative therapy for knee OA. Methods: It was a single blind RCT study with a 12-months follow-up. Totally, 56 patients with knee OA were assigned into 2 random groups. The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs (NSAIDs) and 10 sessions acupuncture and physiotherapy modalities. Non-exercise group received similar treatments except exercise program. The changes in patients' pain and functional status were evaluated by visual analog scale (VAS), knee and osteoarthritis outcome score (KOOS) questionnaire and functional tests (4 steps, 5 sit up, and 6 min walk test) before and after treatment (1 and 3 months after intervention), and 1 year later at the follow-up. Results: The results showed that the patients with knee OA in exercise group had significant improvement in pain, disability, walking, stair climbing, and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group. At third follow up (1 year later) there was significant difference between groups in VAS and in three items of KOOS questionnaire in functional status. Conclusion: Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy, acupuncture, and modalities for knee OA

Survey of sleep status and its related factors among Hospitalized patients with heart failure

Background: Sleep disorders among heart failure (HF) patients negatively influence the quality of life. Awareness of sleep disturbances, as one of the disturbing factors of the quality of life among HF patients, and its related factors would help health care staff to provide more comprehensive care. Hence, this study was conducted to determine the quality of sleep and its related factors in hospitalized patients with HF. Methods: This cross-sectional survey study was conducted on 240 patients with HF hospitalized in one of the health centers of Guilan University of Medical Sciences between July and December 2013. Samples were selected by convenience sampling. The Pittsburgh Sleep Quality Index and a researcher-designed questionnaire on sleep disturbing factors were the instruments of this study. The correlation and relationship between sleep quality and variables related to personal, environmental, and disease factors were assessed. Results: The majority of the samples (91.2) had a poor sleep quality. A significant positive correlation was found between sleep quality and age (r = 0.322; p value < 0.001), body mass index (r = 0.212; p value < 0.001), number of comorbidities (r = 0.205; p value = 0.001), number of hospitalizations (r = 0.202; p value < 0.001), number of drugs consumed (r = 0.178; p value = 0.003), and length of stay in hospital (r = 0.149; p value = 0.011). Also, significant differences were seen between sleep quality and sex (p value = 0.014), smoking (p value = 0.038), educational level (p value = 0. 047), and hospital noise (p value = 0. 004). Conclusion: Age, sex, educational level, smoking, and obesity were the most significant factors affecting the sleep quality in our HF patients. © 2015 Tehran Heart Center. All rights reserved

Cost-effectiveness analysis of confocal scan laser ophthalmoscope (HRT II) versus GDX for diagnosing glaucoma

Purpose: The aim of this study was to assess the cost-effectiveness of confocal scan laser ophthalmoscopy (HRT II) and compare it with scanning laser polarimetry (GDx) for diagnosing glaucoma. Methods: A cost-effectiveness analysis was performed at two eye hospitals in Iran. The outcome was measured as the proportion of correctly diagnosed patients based on systematic review and Meta analysis. Costs were estimated at two hospitals that used the HRT II (Noor Hospital) and current diagnostic testing technology GDx (Farabi Hospital) from the perspective of the healthcare provider. The incremental cost-effectiveness ratio (ICER) was estimated on the base scenario. Results: Annual average costs were estimated as 12.70 USD and 13.59 USD per HRT II and GDx test in 2012, respectively. It was assumed that 80 of the maximum feasible annual tests in a work shift would be performed using HRT II and GDx and that the glaucoma-positive (Gl+) proportion would be 56 in the referred eyes; the estimated diagnostic accuracies were 0.753 and 0.737 for GDx and HRT II, respectively. The incremental cost-effectiveness ratio (ICER) was estimated at USD44.18 per additional test accuracy. In a base sensitivity sampling analysis, we considered different proportions of Gl+ patients (30-85), one or two work shifts, and efficiency rate (60-100), and found that the ICER ranged from USD29.45to USD480.26, the lower and upper values in all scenarios. Conclusion: Based on ICER, HRT II as newer diagnostic technology is cost-effective according to the World Health Organization threshold of <1 Gross Domestic Product (GDP) per capita in Iran in 2012 (USD7228). Although GDx is more accurate and costly, the average cost-effectiveness ratio shows that HRT II provided diagnostic accuracy at a lower cost than GDx. © 2015 Iranian Society of Ophthalmology

Cost-effectiveness of rotavirus vaccination for under-five children in Iran

Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran�s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98 coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100 and 300 for Rotarix and 300 for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested. © 2015, Growth & Development Research Center

Efficacy of aftercare services for people with severe mental disorders in Iran: A randomized controlled trial

Objectives: This study aimed to determine whether after-care services reduced the number of rehospitalizations and length of hospital stay among patients with severe mental disorders. Methods: A total of 120 patients with schizophrenia and schizoaffective or bipolar disorder between the ages of 15 and 65 were recruited from 2010 to 2012 for a randomized controlled trial. The participants were followed up for 20 months after discharge from a university-affiliated hospital in Tehran, Iran. The selection procedure was random sampling. Sixty patients received aftercare services, which included treatment follow-up, family psychoeducation, and patient social skills training, and 60 patients received treatment as usual. Number of hospitalizations and length of hospital stay were primary outcome measures, and severity of psychopathology and severity of illness were secondary outcome measures. The quantitative primary and secondary outcomes measures were compared by using repeated-measures analysis. Results: Three members of the control group did not complete the study. The cumulative number of hospitalizations during the follow-up period was 55 for the control group and 26 for the intervention group. Length of stay was significantly greater in the control group compared with the intervention group (rate ratio=2.38, 95 confidence interval=2.17-2.62). Psychopathology was less severe in the intervention group compared with the control group (p<.001). Conclusions: Aftercare services are efficacious for reducing both the need for rehospitalization and the severity of psychopathology. © 2015, American Psychiatric Association. All rights reserved

Educational Program Evaluation Model, From the Perspective of the New Theories

Introduction: This study is focused on common theories that influenced the history of program evaluation and introduce the educational program evaluation proposal format based on the updated theory. Methods: Literature searches were carried out in March-December 2010 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface, ERIC (Education Resources Information Center) and the main journal of medical education regarding current evaluation models and theories. We included all study designs in our study. We found 810 articles related to our topic, and finally 63 with the full text article included. We compared documents and used expert consensus for selection the best model. Results: We found that the complexity theory using logic model suggests compatible evaluation proposal formats, especially with new medical education programs. Common components of a logic model are: situation, inputs, outputs, and outcomes that our proposal format is based on. Its contents are: title page, cover letter, situation and background, introduction and rationale, project description, evaluation design, evaluation methodology, reporting, program evaluation management, timeline, evaluation budget based on the best evidences, and supporting documents. Conclusion: We found that the logic model is used for evaluation program planning in many places, but more research is needed to see if it is suitable for our context

The prevalence of obesity in school children of Zahedan-Iran; Double burden of weight disorders

Background: Obesity has a permanent effect on childrens' health and acts as a major risk factor for chronic diseases. Therefore considering children BMI is a vital parameter at each visit. Objectives: This study was performed to assess the prevalence of obesity and its determinants in school children of Zahedan in Iran. Zahedan is the capital of Sistan-and-Balouchestan province known to have the highest prevalence of underweight in Iranian children. Patients and Methods: This cross-sectional study was performed on 3582 school children, among which 1786 were girls and 1796 boys in 2012. The students aged 6 to 13 years old and selected based on a stratified random method. The body mass index (BMI) was measured for each student and being overweight/obesity was determined based on CDC 2000 definitions. Prevalence proportions were estimated by weighing the sample. The study was performed at primary and guidance schools of Zahedan. Samples were stratified from two geographic regions of Zahedan (Zone 1 and 2). Results: In the sample, 78.9 were under 85th percentile, 11.8 were overweight (85th - 95th percentile) and 9.3 were obese (> 95th percentile). Weighted estimate for the prevalence of obesity/overweight in girls, boys and all 6 - 13 years old students were 16.2, 18.4 and 17.4, respectively. Presence of overweight/obesity was related to school type (private to public schools OR = 2.13, 1.80 - 2.52) and increasing age (OR = 1.12, 1.04 - 1.20). Conclusions: A high prevalence of obesity was found in Zahedan students. Concurrent high prevalence of obesity/overweight and underweight demonstrates amplitude of weight problems in school children. There is an urgent need for special health programs to conduct proper diagnosis and management of obesity in Zahedan. © 2015, Iranian Society of Pediatrics

Assessing the quality of meta-analyses in systematic reviews in pharmaceutical research in Iran by 2016: A systematic review

© Iran University of Medical Sciences. Background: Meta-analyses, like all other studies, may be poorly designed and implemented. This study was designed to determine the quality of meta-analyses in systematic reviews in the field of pharmaceutical research in Iran. Methods: Web of Science Core Collection, EMBASE, Ovid Medline, CINAHL, Scopus, and PubMed were systematically searched on June 4, 2017. The search was limited to the researches in the field of pharmaceutical studies. Based on inclusion criteria, 104 systematic reviews with meta-analysis (SRMA) were selected and assessed using quality assessment tools introduced by Higgins. Results: Participants, experimental interventions, and outcomes were reported in all the articles. Comparator intervention and study design were correctly reported in 103 (99.04%) and 101 (97.12%) articles, respectively. The comprehensive search strategy was available only in 48 articles (46.16%), and there was no evidence of a comprehensive search in 56 articles (53.84%). Risk of bias was investigated in 78 articles (75%). Also, funnel plots were the most commonly used method for reporting the bias in 64 articles (46.42%). Conclusion: In many of the meta-analyses, several items of the tool that represented a high-quality meta-analysis were absent. According to the findings, the comprehensive search and quality assessment were not at an appropriate level. Thus, the importance of reproducibility of information and quality assessment of included studies should be emphasized

Numerical study of compressor fouling mechanism based on Eulerian-Eulerian approach

AbstractThe paper describes a fluid dynamic numerical model to study the fouling mechanism for turbomachines (such as large gas turbines and small turbochargers). For this purpose, the gas-particle behaviour over a compressor blade is modelled using an open source CFD tool, OpenFOAM®. Through this model, two-fluid implicit equations system, with Eulerian-Eulerian approach is considered. This approach uses RANS turbulent models and also takes into account the particle fluid interactions. Applying Johnson-Kendal-Robert (JKR) theory, the particle deposition over the blade surface is predicted. According to the simulation results, there are certain regions which are facing the huge amount of deposition. The surfaces of these regions are prone to form an almost thick layer of sticked particles and affect the boundary layers and blade aerodynamics significantly. In order to capture this effect, a model to predict the deformation of the boundary with respect to deposition rate is also introduced

Health system responsiveness for outpatient care in people with diabetes Mellitus in Tehran

Background: World Health Organization (WHO) defines three goals to assess the performance of a health system: the state of health, fairness in financial contribution and responsiveness. We assessed the responsiveness of health system for patients with diabetes in a defined population cohort in Tehran, Iran. Methods: Total responsiveness and eight domains (prompt attention, dignity, communication, autonomy, confidentiality, choice, basic amenities and discrimination) were assessed in 150 patients with diabetes as a representative sample from the Tehran Glucose and Lipid Study (TLGS) population cohort. We used the WHO questionnaire and methods for analysis of responsiveness. Results: With respect to outpatient services, 67 (n=100) were classified as Good for total responsiveness. The best and the worse performing results were related to information confidentiality (84 good responsiveness) and autonomy (51 good responsiveness), respectively. About 61 chose "communication" as the most important domain of responsiveness; it was on the 4th rank of performance. The proportions of poor responsiveness were higher in women, individuals with lower income, lower level of education, and longer history of diabetes. "Discrimination" was considered discrimination as the cause of inappropriate services by 15, and 29 had limited access to services because of financial unaffordability. Conclusion: Health system responsiveness is not appropriate for diabetic patients. Improvement of responsiveness needs comprehensive planning to improve attitudes of healthcare providers and system behavior. Activities should be prioritized through considering weaker domains of performance and more important domains from the patients' perspective