Potential risk factors for diabetic neuropathy: a case control study

BACKGROUND: Diabetes mellitus type II afflicts at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the patient's quality of life. Since neuropathy often leads to ulceration and amputation, we have tried to elucidate the factors that can affect its progression. METHODS: In this case-control study, 110 diabetic patients were selected from the Shariati Hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to differentiate cases from controls. The diagnosis of neuropathy was confirmed by nerve conduction studies (nerve conduction velocity and electromyography). The multiple factors compared between the two groups included consumption of angiotensin converting enzyme inhibitors (ACEI), blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality. RESULTS: Statistically significant relationships were found between neuropathy and age, gender, quality of diabetes control and duration of disease (P values in the order: 0.04, 0.04, < 0.001 and 0.005). No correlation was found with any atherosclerosis risk factor (high BP, hyperlipidemia, cigarette smoking). CONCLUSION: In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control reduces the incidence of neuropathy, slows its progression and improves the diabetic patient's quality of life. More attention must be paid to elderly male diabetic patients with poor diabetes control with regard to regular foot examinations and more practical education

Integration of Medical Education in Medical Services: A Cross Sectional Study

Ministry of health and Medical Education (MOH&amp;amp;ME) with the goals of attaining the comprehensive self sufficiency in medical fields and accountability of universities to public health needs were established in Iran in 1985. After that, ministry moved one step towards the integration of medical education into the health services in 1994. A dilemma about returning the system into the prior situation was increased in 2002, during which the parliament tried to change the situation toward disintegration. We have studied the attitudes of key academic persons regarding the segregation of medical universities (MOH&amp;amp;ME establishment) and "Integration" of medical education into the health delivery system. A descriptive, cross sectional and correlation study was conducted on 556 universities staffs in 11 universities throughout the country. We applied a questionnaire with 28 questions on 5 axes. The analytical test used in this study was Pearson chi-square. The most understudied staffs, agreed with Integration philosophy. They believed that, although it seems the quality of medical education has declined, but some effective factors such as increasing admitted students, irregular increasing of universities and self controlling of educational hospitals, deficit of educational budget and other reasons were the main effective causes in this declining of quality, and most of them believed that the reintegration of MOH&amp;amp;ME into the ministry of sciences organization will not benefit for the country. This study has presented some reasons of proposed declining the quality of medical education and some suggestions for development of present system

A Multi-Objective Model for Risk Mitigating in Supply Chain Design

The goal of this study is to recognise various factors for responsive SCs that affect supply risk and model their impact on SC design and operation. We propose a conceptual model for SC responsiveness that encompasses practices such as flexibility, agility, internal integration, and visibility. This conceptual model is utilised to build up a multi-objective, multi-period SC design and operation model. A heuristic algorithm is developed to find the supplier, product, period, and production rate for the numerical problem. The improved genetic algorithm (GA) produces solutions with more accuracy in considerably less time than a traditional GA. Finally, an approach to prioritise the objective functions is developed that allows managers to focus on specific objective functions more than optimum values. This approach provides risk-averse, responsiveness-oriented, cost-effective managers the capability to set priorities based on their policies