Which Solution is better for the prevention and even treatment of diabetes in Iran?

The present article was written under the pretext of World Health Day 2016 to attract the attention of society and health policy makers toward this issue. Due to the importance of this issue, WHO is marking World Health Day, April 7th, by calling for action on beating diabetes. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and, over time, leads to serious damage to many of the body's systems, especially the nerves and blood vessels (1). In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2012, diabetes was reported to be the direct cause of 1.5 million deaths and high blood glucose was the cause of another 2.2 million deaths (2)

Balancing Overuse and Underuse in the Iranian Healthcare System: A Force Field Theory Analysis

BACKGROUND: Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care.METHODS: This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908).RESULTS: The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians’ side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively.CONCLUSION: It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers

Health care seeking behaviors in type 2 diabetic patients in East Azerbaijan

Background. Timely and effective use of health care services is essential to delay or prevent complications and reduce the burden of diabetes. Positive health care seeking behaviors can improve diabetes control and, as a result, reduce the incidence of the complications. So, this study aimed to investigate the status of health care seeking behaviors and affecting factors in type 2 diabetic patients. Materials and methods. This was a cross-sectional study. There were 1139 patients with type 2 diabetes aged > 18 years selected who referred to educational hospitals, Endocrinologist office, primary health care centers, and Clinics. Data collected using a researchermade questionnaire and analyzed using SPSS software version 22. Results. 36.3% of diabetic patients initially referred to a physician in the event of illness symptoms, and 70.7% of patients referred to a physician in case of exacerbating of disease symptoms. 58.4% of patients preferred to consult a specialist directly. 78.85 of patients reported that they had referred to a physician on a regular basis and 59.9% of patients followed up their treatment process on a regular basis. The physician was the main source of information for the majority of patients. Income, education and health insurance status, disease severity, chronicity of DM, the history of hospitalization due to DM were the affecting factors on health care seeking behaviors (p < 0.05). Conclusion. Most of the diabetics often did not follow the official structure of health care providing to manage their illness, and despite the referral system and family practitioner program more than half of the patients went directly to the specialist physician’s office. Factors related to the patient (an income and education status), disease characteristics (disease severity, chronicity of DM and the history of hospitalization due to DM) and health care system factors (type of the basic insurance and supplementary insurance status) affect the health care seeking behaviors

Validity and Reliability of the Questionnaire for Assessing Women’s Reproductive History in Azar Cohort Study

This study was done to evaluate the validity and reliability of women’s reproductive history questionnaire which will be used in Azar Cohort study; a cohort that is conducted by Tabriz University of Medical Science in Shabestar county for identifying risk factors of no communicable diseases. Content and face validity were evaluated by ten experts in the field and quantified as content validity index (CVI) and content validity ratio (CVR). To assess the reliability, using test-retest approach, kappa statistic was calculated for categorical variables and intra-class correlation coefficient (ICC) was used for the quantitative items. The calculated CVI and CVR were 0.91and 0.94, respectively. Reliability for all items was high. The ICC was 0.99 and kappa statistic was equal to 1. The final version of questionnaire was redesigned in 26 items with 7 subscales

Depression and anxiety in sterilised women in Iran

Sterilisation is an effective and convenient means of contraception and has become increasingly popular as a birth control technique throughout the world during the past 40 years. However some women who choose sterilisation may suffer a neurotic syndrome, which is manifested in the form of pain, depression and loss of libido.1We undertook a study designed to investigate depression, anxiety and post-operation regret rate in sterilised women referred to health centres in Tabriz, Iran in 2006. The study design was descriptive-analytical. The study participants comprised 300 women in the age range 25–45 years, of whom 150 women were sterilized between 1 and 10 years ago and 150 were a control group of non-sterilised women who used condoms, withdrawal or safe period methods for contraception. The control group was selected by a cluster random sampling method. Fifteen health centres were selected as a cluster from 96 health centres located in Tabriz. Ten women were selected randomly from each health centre using health documents. Women were eligible for inclusion in the study if they were aged between 25 and 45 years at the time of sampling, and if they had no history of psychological disorders and no recent sorrowful events. There were no differences between the two groups as regards the number of children, income or demographic characteristics. The women were contacted by telephone at their last known address and were asked to complete questionnaires. Data collection was done using Zung’s self-rating depression and anxiety scale in addition to questions about post-sterilisation regret. Data were collected from the subjects anonymously and analysed using SPSS (v. 11.5) statistics software. Analysis employed t-test, Chi-square test and descriptive statistics. The comparison of the means for depression in the two groups was not significantly different (p = 0.96), however the mean of anxiety in the case group was remarkably greater than the control group (p = 0.03). Insufficient poststerilisation rest was a significant risk factor for depression and anxiety (p = 0.008 and p = 0.02, respectively). Requesting information about reversal after tubal sterilisation was 2.7% and the post-sterilisation regret rate was 6%, which was significantly related to women’s conflict with their husbands about the decision-making process prior to sterilisation (p<0.001). The study findings as regards psychological disorders of sterilisation suggested that women undergoing sterilisation should ensure that they have a good rest after their operation in order to reduce the extent of psychological disorders. Unlike studies undertaken in other countries,2–4 women’s age, parity, marriage duration and the timing of sterilisation was unrelated to the women’s regret in our study. The earlier the sterilisation is carried out, the longer the woman’s remaining period of fertile life and the greater the chances of changes in her marital status and/or the loss of a child, both circumstances that may lead to a change in the desired family size and expression of regret. In our study, probably one of the reasons why women’s regret did not appear to be significantly related to young age of sterilisation was the infrequency of divorce or remarriage in our study population. Consistent with our study, Jamieson et al. reported that women who had substantial conflict with their husbands or partners prior to sterilisation were more than three times as likely to regret their decision and more than five times more likely to request a reversal than women who did not report such conflict.5 In our study, pre-sterilisation counseling was reported by 29.3% of subjects. With respect to personality and adaptability differences in facing the changes, pre-sterilisation counseling and post-sterilisation follow-up systems have an important role to play in women’s psychological and psychosexual health promotion

Prevalence of Spinal Deformities among School Age Children in Iran: A Systematic Review and Meta-Analysis

Background: Postural disorders and spinal deformities are one of the common conditions in children and adolescents. The aim of this systematic review and meta-analysis was to study the prevalence of spinal deformities among school age children in Iran.Methods: The search strategy was developed using keywords relating to kyphosis, lordosis, scoliosis, child and Iran in the databases of Medline, Scopus, CINAHL, Psycinfo as well as Persian local databases up to January 2020. Articles were appraised by two reviewers using the checklist of Joanna Briggs Institute (JBI) and data was extracted in the designed tables and analyzed using R software with a random effects model. The heterogeneity and dispersion of data was presented in Forest plots.Results: Eighteen studies were included in the meta-analysis. The total population included 84195 students consisting of 39202 boys and 45947 girls. The mean age of the participants was 12.71±1.18 years. The total prevalence of kyphosis was 13.06% [95% CI 0.07; 0.22], the total prevalence of scoliosis was 2.61% [95% CI 0.014; 0.045] and the total prevalence of lordosis was 32.59% [95% CI 0.23; 0.43]. The prevalence of deformities was higher in girls. Kyphosis and scoliosis was more frequent in elementary school children but lordosis was more frequent in middle school students. Confirmation of diagnosis with radiology as well as clinical examination yielded a lower prevalence compared to diagnosis only made by clinical examination.Conclusion: The prevalence of spinal deformities in school age children in Iran is on the average level compared to the other countries and lordosis is more common in girls. Designing further studies to evaluate etiology and risk factors of this condition is recommende

Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran

<p>Abstract</p> <p>Background</p> <p>Adverse reactions induced by BCG vaccination are rare, disseminated mycobacterial BCG infection in particular, which is often fatal and results from impaired immunity. The aim of this study is to determine the nature of the immunodeficiences in patients with disseminated BCG infection in northwest region of Iran.</p> <p>Materials and methods</p> <p>Through 2 years all infants with BCG adenitis or other complications of this vaccine that had suspicious BCG infection were referred to children's hospital and health centers of Tabriz.</p> <p>Evaluation of immune system and in some cases genetic survey was performed in infants with evidence of histopathologic demonstration of acid-fast bacilli. Then frequency of infants who had disseminated BCG infection with immunodeficiency was defined.</p> <p>Results</p> <p>From 48 selected infants with complications of BCG vaccine in the range of 2 to 62 months, 28 infants (58.3%) were male and 20 infants (41.7%) were female. Disseminated BCG infection was diagnosed in 11 cases, almost all of whom had immunodeficiency as follows:</p> <p>Seven cases had severe combined immunodeficiency and one cases had chronic granulomatous disease. MSMD in two cases and IL12 R deficiency in another one was diagnosed.</p> <p>Overall, the mortality rate was 72.8% (8 cases) which 7 cases of them were SCID and another one CGD</p> <p>Consanguineous was found in more than half (7 cases) of patients and family history of disseminated BCG infection or immunodeficiency was found in nearly one third (3 cases) of patients.</p> <p>Discussion</p> <p>BCG vaccine is administered world wide to prevent tuberculosis and is considered to have excellent safety profile. However in some immunodeficient patients it can cause severe and fatal complications, like in our region, where all cases of disseminated BCG infection with severe immunodeficiency died.</p> <p>Conclusion</p> <p>BCG vaccination is necessary in some countries such as Iran, so it seems that development of a more safer vaccine and change of vaccine program in the families with history of inherited immunodeficiency can be identifies such high risk infants and prophylaxis of severe complications or dead in such patients.</p

Holistic View in Medicine

Modern medicine was born in modernism period around two centuries ago with materialistic view in general and pure biologic approach to health and disease. This new kind of approach was based on the wide spread philosophic view of that era especially the hypotheses of Claude Bernard. As our understanding of human biology has tremendously progressed, and the emergence of postmodernism era has occurred, deficiencies of pure biologic approach in solving human problems concerning health and disease are becoming more evident. Numerous scientific researches on one hand and return of societies to humanistic values on the other hand have opened new horizons in therapeutic endeavors. Alternative medicine has been growing continuously, and pure biologic approach has been replaced by the new holistic approach. In this philosophy, human being is regarded from its biologic, psychologic, social, mental and spiritual dimensions and his interaction with the world of creation as his living environment has been taken into consideration. In this review we tried to discuss concepts, history and principles of this view

Validity and Reliability of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Its Correlation With Urodynamic Findings

Purpose: To validate the Persian version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) as a standard questionnaire for assessment of urinary incontinence (UI).Materials and Methods: After translation and back translation of the questionnaire, the harmonized translation was pre-tested in a pilot study on 28 patients. The final Persian version of the ICIQ-UI SF was administered to 123 consecutive patients aged ≥ 16 years complaining of UI. The psychometric aspects of the questionnaire, such as reliability and construct validity, were assessed and compared with full urodynamics studys’ findings as the gold standard diagnostic test. Results: Mean age of the participants was 46.30 ± 13.14 years (range, 16 to 72 years). Based on ICIQ-UI SF, the prevalence of mixed urinary incontinence, stress urinary incontinence and urgency urinary incontinence was 35%, 34.1%, and 30.9%, respectively. Cronbach’s alpha coefficient was calculated 0.75, which indicates the high reliability of this questionnaire in determination of UI. The obtained Weighted Kappa Index in determining the value of the test-retest was 0.70, and Pearson Correlation Coefficient was calculated 0.93 and intra-class correlation coefficient was 0.84. Conclusion: Persian version of ICIQ-UI SF is a simple, valid, and reliable method for evaluation of patients with UI. Significant correlation exists between ICIQ-UI SF score and urodynamics parameters