Achievements of the Cochrane Iran Associate Centre: Lessons Learned

Healthcare decision-making is a process that mainly depends on evidence and involves increasing numbers of stakeholders, including the consumers. Cochrane evidence responds to this challenge by identifying, appraising, integrating and synthesizing high-quality evidence. Recently, a collaborative effort has been initiated in Iran with Cochrane to establish a representative local entity. A variety of multifaceted interventions were conducted according to Cochrane’s strategy to 2020, such as producing evidence, making Cochrane evidence accessible, advocating for evidence and building an effective and sustainable organization. In this report, the authors present the two and half year performance and achievements of Cochrane Iran based on a comprehensive and systematic approach. This case might be an example of health diplomacy, which is initiated by a successful international collaboration and proceed with recognizing the importance of adherence to the strategic action plans and goals

An epidemiological survey of psychiatric disorders in Iran

BACKGROUND: The nation-wide epidemiological survey of psychiatric disorders in term of lifetime prevalence is not adequately known in Iran. The prevalence of lifetime psychiatric disorders was estimated among the population of aged 18 and over on gender, age group, educational level, occupational status, marital status, and residential area. METHODS: The subjects were 25,180 individuals selected through a clustered random sampling method. The psychiatric disorders were diagnosed on the bases of Diagnostic and Statistical Manual of Mental Disorders-IV criteria. It is the first study in which the structured psychiatric interview administered to a representative sample of the Iranian population age 18 and over by the 250 trained clinical psychologist interviewers. The data was entered through EPI-Info software twice in an attempt to prevent any errors and SPSS-11 statistical software was also used for analyses. The odds ratios and their confidence intervals estimated by using logistic regression. RESULTS AND DISCUSSION: The prevalence of psychiatric disorders was 10.81%. It was more common among females than males (14.34% vs. 7.34%, P < 0.001). The prevalence of anxiety and mood disorders were 8.35% and 4.29% respectively. The prevalence of psychotic disorders was 0.89%; neuro-cognitive disorders, 2.78% and dissociative disorders, 0.77%. Among mood disorders, major depressive disorder (2.98%) and among anxiety disorders, phobic disorder (2.05%) had the higher prevalence. The prevalence of psychiatric disorders among divorced and separated 22.31%; residents of urban areas 11.77%; illiterates 13.80%; householders 15.48%; unemployed 12.33% that were more than other groups. CONCLUSION: The mental health pattern in Iran is similar to the western countries, but it seems that the prevalence of psychiatric disorders in Iran may be lower than these countries. It is estimated that at least about 7 millions of Iranian population suffer from one or more of the psychiatric disorders. It shows the importance of the role of the psychiatric disorders in providing preventive and management programs in Iran

Prevalence of obsessive-compulsive disorder in Iran

BACKGROUND: Estimates of the annual prevalence for Obsessive Compulsive Disorder (OCD) were consistent across the international sites range, 1.9% – 2.5%. The nine population surveys, which used Diagnostic Interview Schedule, estimated a six-month prevalence of OCD ranging from 0.7% to 2.1%. This study performed in order to determine the prevalence of OCD in a population-based study among Iranian adults aged 18 and older and to study the association of them with factors such as sex, marital status, education, type of occupation and residential area. METHODS: A cross-sectional nationwide epidemiological study of the Iranian population aged 18 and older was designed to estimate the prevalence of psychiatric disorders and their association with the above mentioned factors. 25180 individuals were selected and interviewed through a randomized systematic and cluster sampling method from all Iranian households. Schedule for Affective Disorders and Schizophrenia (SADS) and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used in diagnosis of OCD. 250 clinical psychologists interviewed the selected subjects face to face at their homes. RESULTS: The prevalence of OCD in Iran is 1.8% (0.7% and 2.8% in males and females; respectively). 50.3% of the survey sample were men, 49.9% women, 29.1% single, 67.45% married, 0.4% separated or divorced, 2.5% widow/widower and 4% undetermined. All of the above-mentioned factors were examined in the univariate and multivariate logistic regression models. Although the data did not fit the models well, but in univariate models, sex, the category "single" of marital status, age, the categories "business" and "housewife" and residential areas showed significant effect adjusting for the factors, but the models didn't fit the data properly. CONCLUSION: The study suggests that the prevalence of OCD is not rare in the community of Iran and is within the range of other countries. Similar to prior studies in other communities, OCD is more common in females than males

Search strategies and systematic review/meta-analysis on Off-label drug use

Objective: Medications are frequently prescribed outside their approved indications (off-label), particularly when appropriate therapies are not available. However, the risk/benefit ratio of drugs in off-label use needs to be critically appraised because it may differ substantially from approved on-label usage. Therefore, an extensive exploration of current evidence is well-advised. The objective of this study was to develop two search strategies that facilitate detection of off-label drug use documents in MEDLINE and EMBASE via OvidSP. Study Design and Setting: We compiled a gold standard reference set of reports classified as "relevant" or "not relevant" to off-label drug use. Search queries, including search words and strings, were conceived based on a definition of off-label use of medications as well as text analysis of 500 randomly selected relevant documents. The selected terms were searched in MEDLINE (from 1948 to 2011) and EMBASE (from 1988 to 2011). In comparison with the gold standard, we determined sensitivity and precision of search queries and their combinations. We developed a sensitivity-maximizing, and a sensitivity- and precision-maximizing search strategy for each bibliographic database. Results: Our gold standard set contained 4,067 relevant documents overall out of 6,785 records. The most sensitive single term was "off label*.af." in both MEDLINE (sensitivity 40.9%, precision 84.4%) and EMBASE (sensitivity: 77.5%, precision 88.1%). The highest sensitive search strategy in MEDLINE was achieved by combining 31 search queries (sensitivity 53.3%, precision 60.3%) and 36 search queries in EMBASE (sensitivity 94.0%, precision 69.5%). Two optimal sensitive and precise search strategies yielded a precision of 84.0% in MEDLINE and 87.4% in EMBASE at the expense of decreasing sensitivity to 49.0% and 89.4%, respectively. Conclusions: We empirically developed two versions of optimized sensitive search strategies which can achieve reasonable performance for retrieving off-label drug use documents in OvidSP MEDLINE and OvidSP EMBASE. Background: Erythropoiesis stimulating agents (ESAs) are prescribed in critically ill patients to treat anaemia. This indication is off-label, because it is not licensed by regulatory authorities. Recently ESAs were suspected to cause harm in case of critical illness. Objectives: Our objective was to assess whether ESAs are safe and reduce overall mortality in critical illness. Search methods: In April 2012, we conducted a systematic search on EMBASE, MEDLINE, all EBM reviews, IPA, PASCAL and PsycINFO via OvidSP as well as SCI-Expanded, Conference Proceedings Citation Index- Science, CINAHL, BIOSIS Previews and TOXLINE. We also searched trials registeries, checked reference lists of relevant studies and tracked their citations by using SciVerse Scopus. Selection criteria: We considered randomized controlled trials (RCT) and controlled observational studies in any language that compared scheduled systemic administration of ESAs with other effective interventions, placebo or no treatment in critically ill patients. Data collection and analysis: Two authors independently screened and evaluated the eligibility of retrieved records, extracted data and assessed risk of bias (ROB) and quality of included studies. Differences in opinion were settled by consensus or involving a third author. We used fixed or random effects models depending on heterogeneity between studies. Results: We screened 12,888 citations and included 48 studies (34 RCTs and 14 observational studies), involving a total of 944,856 participants (6,332 in RCTs and 938,524 in observational studies) from 21 countries. Overall, 95 adverse events were identified in 37 studies and mortality was reported in 38 studies. We classified 27 RCTs and 10 observational studies as being at low to medium risk of bias for safety outcome. Harm assessment and reporting in the included studies was of medium to low quality. In summary, ESA treatment did not significantly increase the risk of frequently reported adverse events and mortality but decreased the risk of central and peripheral nervous system disorders (RR= 0.37, 95% CI: 0.15- 0.91). Conclusions: Our findings indicate that ESAs treatment in critically ill patients was not associated with a significant increase in most frequently reported adverse events and had no effect on mortality.submitted by Bita MesgarpourAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in dt. SpracheWien, Med. Univ., Diss., 2012OeBB(VLID)171654

Search strategies to identify reports on “off-label” drug use in EMBASE

Abstract Background Medications are frequently prescribed outside their regulatory approval (off-label) by physicians particularly where appropriate therapies are not available. However, the risk/benefit ratio of drugs in off-label use needs to be critically appraised because it may differ from approved on-label usage. Therefore, an extensive exploration of current evidence on clinical data is well-advised. The objective of this study was to develop a search strategy that facilitates detection of the off-label drug use documents in EMBASE via OvidSP. Methods We constructed two sets of gold standards from relevant records to off-label drug use by a sensitive search of MEDLINE and EMBASE. Search queries, including search words and strings, were conceived based on definition of off-label use of medications as well as text analysis of 500 randomly selected relevant documents. The selected terms were searched in EMBASE (from 1988 to 2011) and their retrieval performance was compared with the gold standards. We developed a sensitivity-maximizing, and a sensitivity- and precision-maximizing search strategy. Results From 4067 records relevant to off-label drug use in our full gold standard set, 3846 records were retrievable from EMBASE. “off label*.af.” was the most sensitive single term (overall sensitivity 77.5%, sensitivity within EMBASE 81.9%, precision 88.1%). The highest sensitive search strategy was achieved by combining 36 search queries with overall sensitivity of 94.0% and precision of 69.5%. An optimal sensitive and precise search strategy was yielded precision 87.4% at the expense of decreasing overall sensitivity to 89.4%. Conclusion We developed highly sensitive search strategies to enhance the retrieval of studies on off-label drug use in OvidSP EMBASE.</p

Expectations of Health Researchers From Academic Social Network Sites: Qualitative Study

BackgroundToday, academic social network sites' role in improving the quality of education and how investigators conduct their research has become more critical. ObjectiveThis study aimed to investigate Iranian health researchers' requirements for academic social network sites from a low-income country perspective. MethodsThis qualitative study with a phenomenological approach was done in 2020. In this study, 23 researchers in the health system were selected by purposive sampling. Semistructured interviews were used to collect data. Data were analyzed by MaxQDA-10 software and the content analysis method. ResultsWe identified 2 categories of functional and technical characteristics in the study participants' expectations. Functional characteristics included facilitating communication and team activities, managing scientific publications, enhancing the process of conducting research, being informative, and sharing and trading laboratory materials and equipment. Technical characteristics of an academic social network include user management capabilities, high security and privacy, being user-friendly, and other technical features. ConclusionsHealth researchers emphasized 2 functional and technical characteristics required to meet academic social network sites' expectations

Lipids in Health and Disease / A population-based analysis of the risk of drug interaction between clarithromycin and statins for hospitalisation or death

Background Clarithromycin, known as a potent inhibitor of the cytochrome P450 isoenzyme CYP3A, may increase the plasma concentration of statins metabolized by this pathway; therefore, increase the risk of interaction with statins in reference to pharmacokinetic studies. This study aimed to characterize whether the concomitant use of a statin with clarithromycin is associated with serious outcomes among adult persons. Methods Health claims data of adult persons in the Regional Sickness Fund of Burgenland, Austria, who filled a prescription for clarithromycin between July 1, 2009 and June 30, 2012 were reviewed retrospectively. We assumed that the risk of hospitalisation increases acutely with the indication for taking an antibiotic, whereas statin use can be considered a chronic exposure with a low constant effect on hospitalisation. When defining the population as persons taking clarithromycin and the use of statins as the exposure we could achieve a comparable effect in both groups from the acute condition on hospitalisation. Therefore, we defined exposed patients as those who had overlapping treatment with a statin and unexposed controls as those who had filled a prescription for clarithromycin without concomitant statin therapy. Outcome was defined as a composite of hospital admission or death within 30 days after starting clarithromycin. We used generalised linear regression to model an association between outcome and exposure to statins. Results Among 28,484 prescriptions of clarithromycin, 2317 persons were co-exposed to statins. Co-administration of CYP3A4 metabolized statins and clarithromycin was associated with a 2.11 fold increased risk of death or hospitalisation (95 % confidence interval [CI]: 1.792.48). This effect was explained by age, evidence of cardiovascular disease, diabetes mellitus and utilization of other antibiotics (multivariable adjusted risk ratio: 1.02, 95 % CI: 0.851.22). The sensitivity analyses did not change the significance of effect. Conclusions The risk for hospitalisation or death in persons receiving clarithromycin increases with age and cardiovascular disease but is not causally associated with statin-clarithromycine co-administration.(VLID)486431

Additional file 1: of A population-based analysis of the risk of drug interaction between clarithromycin and statins for hospitalisation or death

Drug Interactions for clarithromycin and statins. Synergistic Interactions with Clarithromycin. Major Inducers of CYP3A4. Synergistic Interactions with Simvastatin, Lovastatin, Pravastatin, Fluvastatin, Atorvastatin, Rosuvastatin. Antagonistic Interaction with Simvastatin, Lovastatin, Pravastatin, Fluvastatin, Atorvastatin. (PDF 470 kb

Acupuncture or acupressure for pain management during labour

Background: Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence about the use of acupuncture and acupressure for pain management in labour. This is an update of a review last published in 2011. Objectives: To examine the effects of acupuncture and acupressure for pain management in labour. Search Methods: For this update, we searched Cochrane Pregnancy and Childbirth’s Trials Register, (25 February 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019, Issue 1), MEDLINE (1966 to February 2019), CINAHL (1980 to February 2019), ClinicalTrials.gov (February 2019), the WHO International Clinical Trials Registry Platfory (ICTRP) (February 2019) and reference lists of included studies. Selection Criteria: Published and unpublished randomised controlled trials (RCTs) comparing acupuncture or acupressure with placebo, no treatment or other non‐pharmacological forms of pain management in labour. We included all women whether nulliparous or multiparous, and in spontaneous or induced labour. We included studies reported in abstract form if there was sufficient information to permit assessment of risk of bias. Trials using a cluster‐RCT design were eligible for inclusion, but quasi‐RCTs or cross‐over studies were not. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. Main Results: We included 28 trials with data reporting on 3960 women. Thirteen trials reported on acupuncture and 15 trials reported on acupressure. No study was at a low risk of bias on all domains. Pain intensity was generally measured on a visual analogue scale (VAS) of 0 to 10 or 0 to 100 with low scores indicating less pain. Acupuncture versus sham acupuncture: Acupuncture may make little or no difference to the intensity of pain felt by women when compared with sham acupuncture (mean difference (MD) ‐4.42, 95% confidence interval (CI) ‐12.94 to 4.09, 2 trials, 325 women, low‐certainty evidence). Acupuncture may increase satisfaction with pain relief compared to sham acupuncture (risk ratio (RR) 2.38, 95% CI 1.78 to 3.19, 1 trial, 150 women, moderate‐certainty evidence), and probably reduces the use of pharmacological analgesia (RR 0.75, 95% CI 0.63 to 0.89, 2 trials, 261 women, moderate‐certainty evidence). Acupuncture may have no effect on assisted vaginal birth (very low‐certainty evidence), and probably little to no effect on caesarean section (low‐certainty evidence). Acupuncture compared to usual care: We are uncertain if acupuncture reduces pain intensity compared to usual care because the evidence was found to be very low certainty (standardised mean difference (SMD) ‐1.31, 95% CI ‐2.14 to ‐0.49, 4 trials, 495 women, I2 = 93%). Acupuncture may have little to no effect on satisfaction with pain relief (low‐certainty evidence). We are uncertain if acupuncture reduces the use of pharmacological analgesia because the evidence was found to be very low certainty (average RR 0.72, 95% CI 0.60 to 0.85, 6 trials, 1059 women, I2 = 70%). Acupuncture probably has little to no effect on assisted vaginal birth (low‐certainty evidence) or caesarean section (low‐certainty evidence). Acupuncture compared to no treatment: One trial compared acupuncture to no treatment. We are uncertain if acupuncture reduces pain intensity (MD ‐1.16, 95% CI ‐1.51 to ‐0.81, 163 women, very low‐certainty evidence), assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupuncture compared to sterile water injection: We are uncertain if acupuncture has any effect on use of pharmacological analgesia, assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupressure compared to a sham control: We are uncertain if acupressure reduces pain intensity in labour (MD ‐1.93, 95% CI ‐3.31 to ‐0.55, 6 trials, 472 women) or assisted vaginal birth because the evidence was found to be very low certainty. Acupressure may have little to no effect on use of pharmacological analgesia (low‐certainty evidence). Acupressure probably reduces the caesarean section rate (RR 0.44, 95% CI 0.27 to 0.71, 4 trials, 313 women, moderate‐certainty evidence). Acupressure compared to usual care: We are uncertain if acupressure reduces pain intensity in labour (SMD ‐1.07, 95% CI ‐1.45 to ‐0.69, 8 trials, 620 women) or increases satisfaction with pain relief (MD 1.05, 95% CI 0.75 to 1.35, 1 trial, 105 women) because the evidence was found to be very low certainty. Acupressure may have little to no effect on caesarean section (low‐certainty evidence). Acupressure compared to a combined control: Acupressure probably slightly reduces the intensity of pain during labour compared with the combined control (measured on a scale of 0 to 10 with low scores indicating less pain) (SMD ‐0.42, 95% CI ‐0.65 to ‐0.18, 2 trials, 322 women, moderate‐certainty evidence). We are uncertain if acupressure has any effect on the use of pharmacological analgesia (RR 0.94, 95% CI 0.71 to 1.25, 1 trial, 212 women), satisfaction with childbirth, assisted vaginal birth or caesarean section because the certainty of the evidence was all very low. No studies were found that reported on sense of control in labour and only one reported on satisfaction with the childbirth experience. Authors’ conclusions: Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low‐certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need for further high‐quality research that include sham controls and comparisons to usual care and report on the outcomes of sense of control in labour, satisfaction with the childbirth experience or satisfaction with pain relief

Comparison of Saffron and Fluvoxamine in the Treatment of Mild to Moderate Obsessive- Compulsive Disorder: A Double Blind, Randomized Clinical Trial

Objective: There are different pathophysiological mechanisms for obsessive- compulsive disorder (OCD) as suggested by the serotonergic, dopaminergic, and glutamatergic hypotheses. The present study aimed at comparing the efficacy and safety of saffron (stigma of Crocus sativus) and fluvoxamine in the treatment of mild to moderate obsessive- compulsive disorder. Method: In this study, 50 males and females, aged 18 to 60 years, with mild to moderate OCD, participated. The patients were randomly assigned to receive either saffron (30 mg/day, 15 mg twice a day) or fluvoxamine (100 mg/day) for 10 weeks. Using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Adverse Event Checklist, we assessed the patients at baseline, and at the second, fourth, sixth, eighth, and tenth week. Finally, the data were analyzed using general linear repeated measures. Results: In this study, 46 patients completed the trial. General linear repeated measures demonstrated no significant effect for time-treatment interaction on the Y-BOCS total scores [F (2.42, 106.87) = 0.70, P = 0.52], obsession Y-BOCS subscale scores [F (2.47, 108.87) = 0.77, p = 0.49], and compulsion Y-BOCS subscale scores [F (2.18, 96.06) = 0.25, P = 0.79]. Frequency of adverse events was not significantly different between the 2 groups. Conclusion: Our findings suggest that saffron is as effective as fluvoxamine in the treatment of patients with mild to moderate OCD