Nutritional Risk Screening Tools in Hospitalised Children

In clinical practice, the assessment of nutritional status in children can be problematic. More than one indicator is often required and may include a combination of anthropometric measurements, body compartment analysis and biochemical markers. The nutritional status of children at the time of admission to hospital can impact adversely on their hospital stay. Furthermore, children's medical conditions may also impact upon their nutrition during a hospital stay. In recent years a number of Nutrition Risk Screening (NRS) tools have been developed and validated, with the goals of providing rapid assessment of children's risk of nutritional change during a hospitalisation. This article reviews the current NRS tools, considers their benefits and shortcomings and evaluates the potential roles of these tools

Impact of Inflammatory Bowel Disease upon Growth in Children and Adolescents

The inflammatory bowel diseases (IBDs) are chronic inflammatory processes affecting the gastrointestinal tract. When diagnosed in childhood and adolescence, IBD almost always impacts adversely upon the nutritional state of the patient. Weight loss and impaired linear growth may be present at diagnosis or subsequently. Further potential nutritional consequences in childhood IBD include malnutrition, anaemia, osteopaenia, and delayed puberty. Understanding the nutritional aspects of IBD is paramount in growing children, especially those entering and advancing through puberty. This paper focuses upon the nutritional impacts of IBD in children and adolescents

A Retrospective Comparison between the PNST and other Paediatric Nutritional Screening Tools

Background: Although it is widely acknowledged that hospitalized children are at greater risk of malnutrition, the available paediatric Nutritional Risk Screening (NRS) tools have not yet become universally used to identify those children at greater risk. Furthermore, the utility of one NRS tool over another remains unclear.Materials and Methods: The utility of a recently developed tool, the Paediatric Nutritional Screening Tool (PNST), was evaluated using data previously collected in the assessment of three other NRS tools in 281 children from Iran and New Zealand. The sensitivity and specificity of each tool was then assessed based on the WHO criteria for malnutrition.Results: The PNST recognized about half of the malnourished patients while the other three tools identified at least 85% of these children. The sensitivity of PNST for moderate (BMI-z < 2) and severe malnutrition (BMI-z <-3) was 37% and 46% respectively, while the sensitivity for other three NRS tools ranged from 82-100%.Conclusion: In this data set, the PNST tool did not perform as well as the three more established NRS tools. Further work is required to provide optimal tools for the identification of hospitalized children at risk of malnutrition

Predictors of time to relapse in amphetamine-type substance users in the matrix treatment program in Iran : a Cox proportional hazard model application

Background: The aim of this study was to determine which predictors influence the risk of relapse among a cohort of amphetamine-type substance (ATS) users in Iran. Methods: A Cox proportional hazards model was conducted to determine factors associated with the relapse time in the Matrix treatment program provided by the Iranian National Center of Addiction Studies (INCAS) between March 2010 and October 2011. Results: Participating in more treatment sessions was associated with a lower probability of relapse. On the other hand, patients with less family support, longer dependence on ATS, and those with an experience of casual sex and a history of criminal offenses were more likely to relapse. Conclusion: This study broadens our understanding of factors influencing the risk of relapse in ATS use among an Iranian sample. The findings can guide practitioners during the treatment program

Comparing Web-Based Content Delivery and Instructor-Led Learning in a Telecommunications Course

This study compares the achievement of students enrolled in two sections of an undergraduate telecommunications course. One class was conducted in an instructor-led classroom and the other utilized a web-based content delivery method. Students were unaware of the difference in delivery methods at the time of registration. Identical pre- and post-tests were administered to the students and a statistical analysis was performed. While in a practical sense, the instructor-led classroom generated much higher average performance, the difference between the two methods was not statistically significant

The Prospective Assessment of Nutrition in Children with Cystic Fibrosis

Aims: Patients with Cystic Fibrosis (CF) have increased risk of malnutrition. Early detection of nutritional deterioration enables prompt intervention and correction. The aims of this project were to define the nutritional status of CF patients in Iran and New Zealand, compare and contrast the McDonald Nutritional Risk Screening (NRS) tool with the Australasian Guidelines for Nutrition in Cystic Fibrosis, and validate these results with each patient’s evaluation by their CF clinical team. Methods:Children with CF (2 - 18 years) were assessed during routine outpatient visits over one year. Anthropometric measurements were obtained. Both tools were applied and the results compared to their clinical evaluation (as gold standard) with calculation of specificity and sensitivity. Results:Under-nutrition was seen more frequent in the 33 Iranian children than in the 36 New Zealand (NZ) patients (39% versus 0%, p=0.0001), whereas over-nutrition was more prevalent in NZ children (9% versus 17%, p=0.05). At the first visit, both guidelines were able to recognize 77% and 61% of under-nourished Iranian patients, respectively. The mean sensitivity and specificity for all visits for the McDonald tool were 83% & 73% (Iran) and 65% & 86% (NZ). Sensitivity and specificity for the Australasian guidelines were 79% & 79% (Iran) and 70% & 90% (NZ). Conclusions: Both tools successfully recognised patients at risk of malnutrition. The McDonald tool had comparable sensitivity and specificity to that described previously, especially in Iranian patients. This tool may be helpful in recognizing at risk CF patients, particularlyin developing countries with fewer resources

Perceived barriers to methadone maintenance treatment among Iranian opioid users

Abstract Background Opioid use is a severe problem in Iran. Despite methadone maintenance treatment (MMT) programs being one of the most important treatment strategies for reducing individual and public harms associated with opioid use, a large proportion of Iranian patients refuse to participate in such treatment programs. Methods The present study aims to explore the beliefs and attitudes toward MMT programs of opioid-dependent patients who were participating or had participated in methadone therapy. In-depth interviews were conducted with 23 opioid users between 27 and 58 years of age from Kurdistan provinces. Results Overall, six themes were discovered to be key barriers relating to methadone treatment, including financial barriers related to methadone treatment, lack of awareness about methadone treatment, negative attitudes regarding using methadone, worries about methadone’s side effects, social stigma ascribed to methadone therapy, and systemic barriers to methadone treatment. Conclusion Our study revealed that the cost of treatment is a major obstacle to attending and continuing at MMT programs and that addicts and their families are not always accurately informed about the duration of MMT programs and the side effects of methadone treatment

Economic Efficiency of Intensive Care Units Department of Hospitals Affiliated With Yazd University of Medical Sciences: A DEA Approach

Introduction:Hospitals as the most expensive health care system is an operational unit, considering the cost efficiency of this unit is very important. The aim of this study was to evaluate the performance of the intensive care units of hospitals affiliated with Yazd University of Medical Sciences. Methods:This is a descriptive - analytic study performed in 2014. Intensive care units of 8 hospitals affiliated with Yazd University of Medical Sciences were included in this study. Data envelopment analysis (DEA) was used to evaluate the economic efficiency of intensive care units. Input variables included the number of physicians, nurses, and active beds, as well as the number of equipment (ventilator), and output variables included bed occupancy rate and the number of patients discharged healthy. Input prices contained the doctors and nurses income, bed price, and depreciation cost of equipment (ventilator). Results:The findings show that among 8 studied hospitals, the efficiency of 5 hospitals were 1 and the efficiencies of the other hospitals were 0.174, 0.645, and 0.855. The mean economic efficiency of intensive care units of all hospitals was 834.0 in 2014. Conclusion:By ameliorating the allocation of resources allocated for hospitals including human resources and equipment, the efficiency level of hospitals can be improved. Key¬words:Economic Efficiency, Educational Hospital, Data Envelope Analysis (DEA). Citation: Abedi M, Bahrami MA, Yusefzadeh H, Kiani MM, Moeeni M.Economic Efficiency of Intensive Care Units Department of Hospitals Affiliated With Yazd University of Medical Sciences: A DEA Approach.Journal of Health Based Research 2016; 2(1): 29-38

How Preferences of General Medicine Students for Specialty Choice Are Affected? a qualitative study

Background & Objectives: Equal distribution of human resources in health sectors was one of the main aspects of Alma-Ata Declaration (2000). Since physicians are among the skillful human resources in health sector, optimal allocation of medical specialties has been always a challenge for policy makers. Distribution of general medicine physicians and specialties is related to medical students’ preferences for speciality choice. This study aimed to identify the factors affecting preferences in choosing medical specialty. Methods: This was a qualitative study based on the grounded theory. Through apllying snowball sampling, participants were selected from senior medical students of Isfahan University of Medical Sciences in the academic year 2016/2017and 28 interviews were conducted. Data analysis was done based on thematic analysis and applying MAXQDA18 software. Results: We extracted 4 main themes and 10 subthemes. Main themes included students’ perception of the medical specialties, students’ characteristics, medical specialties’ characteristics, and social conditions. Conclusion: In order to attract medical students to more needed medical specialities and optimal distribution of specialities, policy makers should consider both individual and social determinants of medical specialty choice. Key­words: Preferences, Specialty careers, Primary care specialties, Medical students ­Citation: Heidari M, Keivanara M, Moeeni M. How Preferences of General Medicine Students for Specialty Choice Are Affected? a qualitative study. Journal of Health Based Research 2019; 5(3): 303-18. [In Persian

Regional Energy Supply Planning: Chance Constraint Programming

Regional energy planning under uncertainty is an important concept in energy-economy models which makes the planning outcomes closer to reality and enables the decision maker to select the best decision. Reliability of local energy supply and the possibility of long-term access to resources and emissions reduction is an essential step.   In this study, an urban energy demand which is supplied by electricity network is investigated with an optimal combination of alternative energy resources such as solar, wind and natural gas during the next 10 years. The optimal combination of fossil energy as well as renewable energies are determined by goal stochastic programming model.  Isfahan province in Iran has been selected as a case study. Empirical results indicate that due to the importance of investment and operation costs, the dominant share of energy supply will belong to natural gas, while the shares of solar and wind energies remain constant in the next decade. In sum, the share of solar and wind energies increases by 8% in 10 years and therefore, it is not necessary to increase electricity supply by the network in order to meet annual increasing demand. CO2 and NOx emissions will decrease significantly. Keywords: Stochastic programming, Goal programming, Local energy planning, Iran. JEL Classifications: Q43, Q47 DOI: https://doi.org/10.32479/ijeep.787