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

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

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

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

Equality in safe delivery and its determinants in Iran

Background/objective: To determine the equality in safe delivery indices, i.e., appropriate place of delivery, type of delivery and skilled attendant for delivery, and their determinants in Iran. Methods: This study was performed using the data of Iran demographic and health survey, performed in 2000. Our sample was nationally representative and included 17,991 Iranian married women aged 10-49 years who had delivered during two years before the survey. The equality status was assessed by concentration index. The relationship between different factors and safe delivery was investigated by logistic regression. These factors included age, occupation, resident place (urban vs. rural), mother's educational level and household economic status (weighted asset index). Results: Concentration index (95 CI) for appropriate place of delivery, normal vaginal delivery and skilled attendant for delivery, were 0.111 (0.107 to 0.115), -0.100 (-0.105 to -0.095) and 0.095 (0.091 to 0.099), respectively. In other words, the opportunity of delivery in appropriate place and by skilled attendant were more common in those with higher economic levels; while normal vaginal delivery was less common. Also, mother's age and educational level had significant correlation with safe delivery indices; in all cases mother's education was the most important factor. Conclusion: in spite of the improvement in delivery care in Iran during the past decades, there are significant differences between the current situations of safe delivery in people with different socioeconomic states

Multiple sclerosis epidemiology in Middle East and North Africa: A systematic review and meta-analysis

Background: Multiple sclerosis (MS) is one of the most common neurological disorders and a leading cause of nontraumatic disability in young adults in many countries. Recent reports from the Middle East and North Africa have suggested a moderate to high risk of MS in these countries. Methods: A literature search was performed in August 2014 in MEDLINE, EMBASE, and IMEMR to retrieve original population-based studies on MS epidemiology in the Middle East and North African countries published between 1st January 1985 and 1st August 2014. We designed search strategies using the key words: MS, prevalence, incidence, and epidemiology. According to the inclusion criteria, 52 studies were included in this systematic review. Results: McDonald's criteria were the most widely used diagnostic criteria in the studies. Most studies were conducted in single hospitalbased centers with a defined catchment area. The female/male ratio ranged from 0.8 in Oman to 4.3 in Saudi Arabia. MS prevalence ranged from 14.77/100,000 population in Kuwait (2000) to 101.4/100,000 in Turkey (2006). The overall MS prevalence in the region was 51.52/100,000. The mean age at disease onset ranged from 25.2 years in Kuwait to 32.5 years in Northeastern Iran, with an overall estimate of 28.54 years. Conclusions: Recent advances in MS registries will allow nation-wide studies and temporal comparisons between countries, provided that age- and sex-standardized estimates are available. © 2015 S. Karger AG, Basel

Morphine Suppository versus Indomethacin Suppository in the Management of Renal Colic: Randomized Clinical Trial

Background. Renal colic is a medical emergency due to the rapid onset and devastating nature of its pain. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are both used as first-line choices in its management. Aim. This study aimed to compare the efficacy and safety of opioids and NSAIDs in the management of acute renal colic. Methods. One hundred and fifty-eight patients were divided into two groups (n=79) and received either 10 mg morphine or 100 mg indomethacin suppositories. The severity of pain was measured using verbal numeric rating scale at baseline and 20, 40, 60, and 90 minutes after the administration of analgesics. Drug side effects as well as patients' vital signs were also recorded. Results. The mean decrease in the pain score during the first 20 minutes was significantly higher among those who received morphine suppository. However, no significant difference was observed between the two groups regarding the mean decrease in pain score during the first 40, 60, and 90 minutes after the admission. Prevalence of drug side effects or changes in the vital signs was not significantly different between the two groups. Conclusions. Morphine suppositories seem to be more efficient in achieving rapid pain relief comparing to indomethacin. © 2016 Forough Zamanian et al

High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990�2015: Findings from the Global Burden of Disease Study 2015

Background and purpose � Osteoarthritis (OA) imposes a substantial burden on individuals and societies. We report on the burden of knee and hip OA in the Nordic region. Patients and methods � We used the findings from the 2015 Global Burden of Diseases Study to explore prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of OA in the 6 Nordic countries during 1990�2015 (population of about 27 million in 2015). Results � During 1990�2015, the number of prevalent OA cases increased by 43 to 1,507,587 (95 uncertainty interval UI 1,454,338�1,564,778) in the region. OA accounted for 1.3% (UI 1.0�1.7) of YLDs in 1990, increasing to 1.6% (UI 1.2�2.0) in 2015. Of 315 causes studied, OA was the 15th leading cause of YLDs, causing 52,661 (UI 34,056�77,499) YLDs in 2015; of these 23% were attributable to high body mass index. The highest relative importance of OA was reported for women aged 65�74 years (8th leading cause of YLDs in 2015). Among the top 30 leading causes of YLDs in the region, OA had the 5th greatest relative increase in total YLDs during 1990�2015. From 1990 to 2015, increase in age-standardized YLDs from OA in the region was slightly lower than increase at the global level (7.5% vs. 10.5%). OA was, however, responsible for a higher proportional burden of DALYs in the region compared with the global level. Interpretation � The OA burden is high and rising in the Nordic region. With population growth, aging, and the obesity epidemic, a substantial rise in the burden of OA is expected and should be addressed in health policies. © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation

Saharan sand and dust storms and neonatal mortality: Evidence from Burkina Faso

West African populations are exposed to the longest and harshest dust storms on the planet, the Saharan sand and dust storms (SDS). Nonetheless, little is known about the effects of the severe storms on early-life health in West Africa. This study investigated the association of the risk of neonatal mortality, an indicator of the population's early-life health, with potential prenatal and neonatal exposure to the Saharan SDS. Data on 30,552 under-five children from Burkina Faso's 1993, 2003, and 2010 demographic and health surveys were matched to the particulate matters (PM) and terrestrial air temperature and precipitation forecasts. Exposure to dust events was measured by the number of days with average PM10 and PM2.5 concentrations above a series of threshold. Intensity-dependent patterns of associations between neonatal mortality and both prenatal and birth month exposure to dust events were identified. There was no association if average daily PM10 and PM2.5 levels were &lt;60 and 30 μg/m3, respectively. However, strong associations, which increase almost linearly with the intensity of exposure, were identified when daily PM10 and PM2.5 levels ranged from 70 to 150 and from 40 to 70 μg/m3, respectively. At the higher PM levels, the association for the gestation period decreased, but that for the birth month remained mostly unresponsive to changes in the PM levels. Larger associations were identified when siblings were compared. © 2020 Elsevier B.V