Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study

BACKGROUND: The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians. METHODS: Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner\u27s Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported. RESULTS: Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h. CONCLUSIONS: Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time)

Design and implementation of pay-for-quality in primary healthcare

BackgroundThe common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q) programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria.AimsThis study describes the design and implementation of a P4Q program in the primary healthcare (PHc) in East Azerbaijan Province, Iran.Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD), final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program.Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. 'Improvement' and 'absolute level of measures' were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences.ConclusionDesigning and implementing the P4Q program led to a shift in paying the incentives to healthcare providers from passiveness and subjective judgment to rational and quality based payment. Linking the incentive payment to individual, team, and organizational performance, the P4Q program will lead to an increased capacity of staff morale to improve teamwork and integrated health care

Diagnostic stability among patients readmitted with serious mental illnesses in a referral psychiatric university hospital in Tabriz, Iran,in 2016

Introduction: Regarding mental disorders, one of the important factors in the validity of clinical diagnosis is its consistency in consecutive evaluations. This varies from 29% in personality disorders to 70% in schizophrenia. This survey was conducted to study clinical diagnosis stability among readmitted patients in referral psychiatric university hospital. Methods: In this study, 1000 records were evaluated retrospectively. Data were gathered by educated clinical psychologist with a prepared checklist. The checklist consisted of demographic data, clinical interview data, primary and final diagnosis, and process of care. The collected data were analyzed using SPSS software and presented as descriptive and proportion measures. Results: The mean age of patients in the first hospitalization was 31.23 years. Since the first admission, 26.6% of patients’ life time was spent in hospitals. The clinical diagnosis of cases at discharge was bipolar mood disorder I (BMD I) and schizophrenia in 49.5 and 40.4 percent of cases, respectively. Generally, concordance between admission and discharge diagnosis was 94.9 and 84.4 percent among the women and men, respectively. 66.0% of patients with BMD I and 71.4% of patients schizophrenia received the same diagnosis in at least 75% of their next hospital admissions. Furthermore, the prospective consistency was 80 and 60 percent in schizophrenia and BMD I, respectively. Conclusion: The findings of the present study showed that in psychiatric studies, clinical diagnosis can be challenging especially in short term evaluations

Context-aware multi-user offloading in mobile edge computing: A federated learning-based approach

Mobile edge computing (MEC) provides aneffective solution to help the Internet of Things (IoT)devices with delay-sensitive and computation-intensivetasks by offering computing capabilities in the proximityof mobile device users. Most of the existing studies ignorecontext information of the application, requests, sensors,resources, and network. However, in practice, contextinformation has a significant impact on offloading decisions.In this paper, we consider context-aware offloadingin MEC with multi-user. The contexts are collected usingautonomous management as the MAPE loop in alloffloading processes. Also, federated learning (FL)-basedoffloading is presented. Our learning method in mobiledevices (MDs) is deep reinforcement learning (DRL). FLhelps us to use distributed capabilities of MEC with updatedweights between MDs and edge devices (Eds). Thesimulation results indicate our method is superior to localcomputing, offload, and FL without considering contextawarealgorithms in terms of energy consumption, executioncost, network usage, delay, and fairness

Job Satisfaction Differences between Primary Health Care and Treatment Sectors: An Experience from Iran

Background: The aim of this study was to compare the levels of job satis¬faction and its predictors among primary health care and treatment sectors' staff in East Azerbaijan Province, Iran.Methods: This comparative study was conducted in East Azerbaijan Province, Iran in 2011. A questionnaire survey was performed on 420 staff from health care and treatment sectors using multi-stage proportional cluster sampling method. Job satisfaction was measured in five aspects namely: structural and managerial; individual; social; work-itself; environ¬mental and welfare job satisfaction factors. The job satisfaction measure¬ment score was normalized to fall into a range of zero to 100. Statistical analyses were performed using Friedman and independent sample t-tests.Results: Overall satisfaction in health and treatment sectors was moderate with a mean score above 50. Hospital General Practitioners reported sig¬nifi¬cantly higher job satisfaction score (mean ± SD=57.34 ± 17.02) com¬pared to health care center General Practitioners (mean ± SD= 31.74±14.99). The highest satisfaction scores belonged to individual factors both in health care sector staff (64.83±18.50) and treatment sector staff (63.55±17.44). The lowest job satisfaction was observed with environmental and welfare factors (38.47±19.86 and 36.83±19.86, respectively).Conclusion: The job satisfaction significantly differs between primary health care and treatment sectors. Based on the results, environmental and welfare factors may be targeted to improve the job satisfaction in public health care system

Translation and Psychometric Validation of Women Health Questionnaire (WHQ) in Persian Language

Menopause is not a disease; however the somatic and psychological symptoms that accompany it affect the life of women. Women health questionnaire (WHQ) is a self-administered questionnaire that measures the physical and mental health of women ages 40 to 65 years. The purpose of this study is to provide psychometric documentation details of the translation of WHQ into the Persian language. A total of 350 peri and postmenopausal women were recruited from urban health centers in the city of Tabriz, between March and October 2015. The validity of WHQ was assessed using construct and discriminate validity. The reliability of questionnaire was assessed by test retest reliability and measuring internal consistency. The KMO was 0.791, and the Bartlett’s test of Sphericity was significant. Principle component analysis (PCA) resulted in 9 factors which explained up to 55.4% of the total variance. Cronbach's coefficient was 0.799 and the Intraclass correlation coefficient (ICC) of the Persian translation scale was 0.712. Evaluation of the psychometric properties showed that the Persian language translation of the 36-item version of the WHQ was appropriate when applied to middle aged wome

Evaluating knowledge and attitude of physicians regarding medicinal drugs and driving: a descriptive-analytical cross-sectional study

Background. Drugged driving is a growing traffic safety issue in many countries. Adequate knowledge of physicians concerning the effects of different medicines on driving can help them prescribe safer medications. This study aimed to assess the knowledge and attitudes of family physicians regarding the effect of medicines on driving. Methods. This cross-sectional study was conducted on 91 family physicians in East Azerbaijan Province. A researcher-made questionnaire was used for data collection. This study considered knowledge and attitude as dependent variables and demographic characteristics as independent variables. To investigate the relationship between independent and dependent variables, independent t-test, one-way analysis of variance (ANOVA), chi-square, and multiple linear regression were used. Data were analyzed using Stata version 17. Results. According to the results, almost 65 (71.43%) of the participants were women and 26 (28.57%) were men with an average age of 31.54 years. The average score of physicians’ attitude about the effect of medicines on driving was 71.70 ± 14.94, and the average score of their knowledge was 37.52 ± 10.23. Therefore, 44 (48.35%) of the physicians had a good level of attitude, whereas 46 (52.87%) of them had a low level of knowledge regarding medications and driving. Receiving education regarding medications and driving was significantly correlated with the level of knowledge and the attitude of physicians (P<0.05). However, no significant relationship was observed between the attitude and knowledge of physicians and other demographic variables. Conclusion. Considering physicians’ inadequate knowledge regarding the effect of medicines on driving, it is essential to hold training and retraining courses in the field of medicines and driving for physicians and develop a classification system for the drugs affecting driving in Iran. Practical Implications. The findings of this study can be presented to the policy-makers of the Ministry of Health in order to provide an opportunity to boost the knowledge and attitude of physicians regarding medicines and driving with the support of universities of medical sciences. As a result, an important step can be taken to reduce traffic accidents caused by prescription medicines

A Full Eulerian Wave-Body Interaction Solver for Incompressible Two-Phase Flows with High Density and Viscosity Ratios

A force-free immersed boundary method is developed based on a primitive variable formulation of the Navier-Stokes equations, using Chorin's projection method. In the proposed method, the predetermined motion of a rigid structure is considered, and the rigid domain velocity field is imposed on the formulation by patching the rigid-body motion onto the fluid domain velocity field in the predictor step of the formulation. The capability of the method in handing two-phasefluid interaction with a structure is examined. For a two-phase uid with large density and viscosity ratios, the Laplacian operator becomes discontinuous. The interface evolution under the effect of an oscillating heaving cylinder based on the setup presented in [1] is considered. Before examining the method's accuracy in solving fluid-structure interaction (FSI) problems comprising two uids with high density and viscosity ratio, the classical problem of an oscillating cylinder in a quiescent fluid is considered, and the results are compared with [2] and [3]

Investigation of the difference between the expression and presence of sexual symptoms and dysfunction in depressed women treated with fluoxetine

Introduction: The present study aimed at investigating the difference between the expression and presence of sexual symptoms and dysfunction in depressed women treated with fluoxetine, and the possibility of sexual dysfunction following consumption of fluoxetine. Methods: This cross-sectional analytic study was conducted on 44 women candidates for receiving fluoxetine after the diagnosis of depression. Patients’ complaints of sexual dysfunction were collected and compared using Arizona Sexual Experiences Scale (ASEX) questionnaire during their first visit and 2 months after receiving fluoxetine. Two-way data were analyzed using chi-square test, and Wilcoxon Signed Ranks test was used to study ordinal variables in SPSS software. Results: This study indicates that there is a significant difference between the final score of the ASEX questionnaire and that of each question before and after the consumption of fluoxetine. Using ASEX scale, it was indicated that 11 (25.0%) and 27 (61.4%) of participants suffered from sexual dysfunction at their first and second visit, respectively, and that there is a correlation between the expression of sexual dysfunction symptoms and sexual dysfunction disorder. Conclusion: Results indicate that consumption of fluoxetine causes sexual dysfunction, and there is a correlation between the expression of sexual dysfunction symptoms and sexual dysfunction disorder. Moreover the fewer participants complain about symptoms, the more the chance of sexual dysfunction