Responsiveness of Physical Rehabilitation Centers in Capital of Iran: Disparities and Related Determinants in Public and Private Sectors

Background: Responsiveness as a non-medical, non-financial goal of the health system is of special importance to people with physical disability. The current study assessed the experiences of people with physical disabilities when they encounter rehabilitation centers in Tehran.Methods: This cross-sectional study was conducted in Tehran, the capital of Iran. The sample consisted of 610 people with physical disabilities referred to 10 comprehensive rehabilitation centers (CRCs) selected by Quota sampling. Data were collected by a standard responsiveness questionnaire proposed by the World Health Organization (WHO) and were analyzed by a standard protocol. Blinder-Oaxaca analysis was done to explain the inequality in performance of public and private sectors.Results: Study participants included 298 (48.7%) women and 312 (51.3%) men. The mean age of the respondents was 46.3 (SD = 14.3) for women and 45.6 (SD = 15.4) for men. Prompt attention (33.3%) and confidentiality (1.3%) were the most and least important reported domains, respectively. Overall poor responsiveness was reported by 20.9% of respondents. Private rehabilitation centers showed significantly better performance in communication, basic amenities and autonomy compared to public centers (P ≤ 0.05). Perceived social class explained 76% of the inequality in autonomy in the private and public sector (P ≤ 0.05).Conclusion: Improving overall responsiveness in domains that are of high importance from the respondents' viewpoint but are performing poorly—areas such as prompt attention and basic amenities—is essential. Additionally, interventions are needed to improve the performance of the public centers and providers in the areas of participation of service users in all social classes in their rehabilitation decisions and procedures, clear communication, and basic amenities

Exploring the Efficacy of Fractional Carbon Dioxide Laser as an Add-on Combination to Conventional Therapies for Treatment-Resistant Vitiligo (A Review Article): Enhancing vitiligo treatment with fractional CO2 laser: a promising approach

Introduction: Vitiligo, a dermatological disorder that leads to depigmented skin patches, presents a significant challenge, particularly in resistant areas such as acral regions. Fractional CO2 laser therapy holds promise as an adjunct to conventional treatment, enhancing repigmentation. This review comprehensively explores its efficacy and safety in resistant-to-treatment vitiligo.Methods: We conducted extensive database searches in PubMed, Embase, and Cochrane, focusing on English-language literature published between 2012 and 2023. We included comparative studies that met the following criteria: (1) Participants had non-segmental vitiligo, with resistant-to-treatment localization engagement; (2) The treatment involved the use of fractional CO2 laser in combination with conventional therapies; and (3) Outcomes were assessed based on the repigmentation ratio or significant difference. We excluded studies from which data from published results could not be extracted.Results: After extensive screening of 52 articles, we finally selected five studies. The results showed that fractional CO2 laser therapy, when combined with other treatments, often shows promise in vitiligo treatment in refractory cases. Although individual responses varied, overall efficacy and safety were promising, with minimal adverse effects and no severe complications.Conclusion: The fractional CO2 laser, when used in conjunction with conventional therapies, emerges as a promising option for treating refractory vitiligo. Large-scale randomized trials and a deeper understanding of the underlying mechanisms are vital for future progress in optimizing treatment protocols, case selection, and safety

Executive function deficits in mild cognitive impairment: evidence from saccade tasks

Objectives: Early detection of mild cognitive impairment (MCI) is necessary to prevent irreversible brain damage caused by incipient Alzheimers disease. It has been showing that amnestic MCI (a-MCI) subjects exhibit subtle deficits in executive function that can be tested using saccade eye movements. Eye-tracking technology is a sensitive method to measure cognitive impairments in dementia and MCI. Methods In this study, we used eye-tracking technology to explore saccade impairments to distinguish between a-MCI and the variants of reference controls. 21 patients with AD, 40 patients with a-MCI, and 59 normal participants were recruited in current study. We measured saccade reaction time, saccade errors, saccade omission, and uncorrected saccades using anti-saccade and pro-saccade tasks with gap and overlap procedures. These parameters were used as markers of executive function and visual attention deficits.Results: The findings revealed that more errors, more omissions, and fewer corrections characterized the saccade behavior of the a-MCI group compared to the reference group. These eye-tracking characteristics can be considered as inhibitory control and working memory deficits in a-MCI subjects. Our results thus demonstrate the applicability of the anti-saccade task as a cognitive marker in a-MCI. Conclusion The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of executive function in aging with cognitive impairments

Relationship Between Oral Health and Demographic Characteristics in Retired Elderly People in Iran

Objectives The current study aimed to determine the relationship between oral health and demographic characteristics of retired elderly people. Methods & Materials This cross-sectional study was conducted on 158 older adults aged ≥60 years. The subjects were selected using random sampling method and personnel codes. All the elderly participants were retired members of the Tehran Municipality Administration. The study data were collected by direct visit to the subjects’ place of residence and conducting interviews. The data collection tool was a questionnaire that included 2 sections. The first section consisted of demographic, socioeconomic, and health profiles, while the second section consisted of Geriatric Oral Health Assessment Index (GOHAI). Results We collected data from 158 participants (90 men, 68 women). The mean age of the participants was 68.78 years. The obtained data suggested that 38 (24.05%) participants had a poor state of oral health. About 50% of the participants mentioned high dental care costs as a reason for not referring to the dentist. According to the findings of this study, there is a direct relationship between educational level and oral health status in the elderly (P<0.05). Conclusion Oral and dental health increase the quality of life in the elderly and reduce the high prevalence of dental problems among them. Therefore, designing and implementing practical policies to reduce oral and dental infections in the elderly and promote their health is necessary

The Effects of Intensive Speech Therapy on Non-oral Cleft Speech Characteristics and Quality of Life in Children With Cleft Palate

Objectives: This study aimed at investigating the effects of speech intervention on Non-Oral Cleft Speech Characteristics (NCSCs), intelligibility, and Quality of Life (QoL), as well as the relationship between speech variables and QOL-related variables in intensive speech therapy among children with cleft palate. Methods: This single-group pre-test and post-test clinical trial study was performed on 12 Persian-speaking children with cleft palate and NCSCs aged 3-7 years. For this purpose, we used 30 sessions of speech therapy and the Persian version of the Pediatric Quality of Life Inventory (PPedsQL). The pre-test and post-test assessments included perceptual assessment using the CAPS-A and QoL assessment using the Parent Proxy of the Persian version of the PPedsQL. The Wilcoxon’s test was applied to analyze group differences in the NCSCs, the intelligibility of speech, the total score of PPedsQL, physical, emotional, social, and school functions before and after providing the speech therapy. Results: The obtained results indicated that the frequency of NCSCs, the intelligibility of speech, the total score of PPedsQL, and its subscales significantly improved after the intervention (P<0.001). However, physical function presented no significant change after intensive treatment (P= 0.15). Additionally, the frequency of NCSCs had a significant negative c with a total score of PPedsQL and subscales. The intelligibility of speech was significantly and positively related to the total score of PPedsQL and its subscales. Discussion: This study demonstrated that intensive speech therapy was an effective approach in improving the intelligibility of speech and QoL in children with cleft palates. moreover, this study revealed that speech variables were significantly related to QoL variables

The Relationship Between Gender and Disability in the Elderly People in Tehran Municipality Pension Organization

Objectives Because of increasing geriatric population in Iran, the present study aims to plan, prevent, and mitigate the complications among the retired elderly of the Tehran Municipality Pension Organization and then investigate its relation to gender. Methods & Materials The descriptive and analytic approach was adopted on 300 elderly subjects who were 60 years and older (Mean [SD]: 68.14[7.11] years). The subjects were selected using random sampling method. All the elderly subjects were retired members of the Tehran Municipality Administration. The data were collected by direct reference to the subjects&rsquo; home and conducting interviews. The data collection tool included questionnaires with two sections. The first section consisted of the demographic, socioeconomic, and health profiles, and the second section consisted of WHO Disability Assessment Schedule 2.0 questionnaire. The obtained data were analyzed by SPSS 18.&nbsp; Results Among the elderly subjects in this study, 175 (54%) had no disability, 125 (46%) were disabled, and 19.13% had mild disability. The average disability rate was 5.6% in females and 4.38% in males; these rates were high compared to the present rate in the society. However, the lowest rate of disability (0.72% in males and 1.07% in females) was related to self-caring and personal health. Conclusion In conclusion, the retired elderly of Tehran Municipality Administration showed a lower level of disability compared to those of other developed countries. However, there is an increasing need for setting up geriatric cares units as the population pattern of elderly people is rising in Iran. In addition, the rate of disability was found to be higher in females (58.14%) compared to males (53.31%), which shows a significant relation of disability status with gender and age (P<0.001)

Explanation of the Structural-functional Challenges of Comprehensive Health Centers in Babol City, Iran, Based on the Guidelines of the World Health Organization’s Elderly-friendly Centers

Objectives Primary care is the first main interface of health services for the elderly to maintain and improve their health. Therefore, it is essential to evaluate the appropriateness of the way to provide services for this population group, which is one of the most vulnerable classes of society. This study was conducted to explain the structural and functional challenges of comprehensive health centers in Babol City, based on the guidelines of the World Health Organization’s elderly-friendly centers to plan aging-friendly. Methods & Materials The current research was a descriptive qualitative study using the content analysis method with a conventional approach. This research was conducted on elderly people who were referred to comprehensive health centers and their families as well as service providers in the form of in-depth semi-structured interviews until reaching the level of data saturation. Each interview was implemented immediately after implementation, and the content analysis of the interviews was conducted by determining conceptual units, accurate coding, and continuous comparison method until the formation of subgroups and main classes. Results In this study, 23 elderly people with an average age of 71.47±7.88, 5 family members, and 14 service providers participated. A total of 72 codes were extracted from all the interviews, which were divided into five main categories of structural factors, behavioral issues, educational characteristics, social support, and functional challenges during the analysis process. A total of twelve subgroups emerged for the five main classes. Conclusion Several underlying factors exist in the path of making comprehensive health centers elderly-friendly, and which will be impossible to achieve this issue without providing the conditions and eliminating the existing challenges. Therefore, the obtained components may help in identifying, and prioritizing needs, and choosing the type of interventions to adapt comprehensive health centers to the needs of the elderly

Self-medication among the elderly in Iran: a content analysis study

Abstract Background Self-medication is described as the use of drugs without a physician’s prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon. Methods This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior. Results Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: “patient’s attitudes towards disease, treatment, and physicians”, “living with disease”, “unfriendly environments”, “enabling health system”, and “influential others”. Conclusions Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services

Psychometric Properties of the Persian Kessler Psychological Distress Scale Among Iranian Older Adults

Background and Purpose: We measured the psychometric properties i.e., validity, reliability, and stability of the Persian 10-item Kessler psychological distress scale (K10) among older adults in Iran. Materials and Methods: We recruited elderly (60+ years) subjects (20 per item of the questionnaire) from various sampling units in the general population of Gorgan district, Golestan, Iran. After the translation/back-translation process, the questionnaire underwent various forms of validity and reliability, including Cronbach alpha (overall, by items, and by group of yes to an item and no to an item). The intra-class correlation coefficient was measured at a two-week interval, and inter-rater agreement was also determined. Both exploratory and confirmatory factor analyses were also conducted, along with receiver-operator characteristics vis-à-vis hospital anxiety and depression scale.  Results: In total, 190 subjects (47.3% males, mean age: 70.3, 95% CI: 69.2-71.4) participated in the study. A total of 35.8% had psychological distress (PD) (i.e., score >20). The alpha coefficient was 0.88 with no item below 0.86. The alpha coefficients to report a yes to an item (α=0.85) or no to an item (α=0.90) were similar to each other. The intra-class coefficient for test-retest at a two-week interval was 0.90. Exploratory factor analysis showed a one-factor structure of the underlying construct, with a cumulative variance of 97.1%. Confirmatory factor analysis showed high fit indices for the questionnaire (0.91) and a low standardized residual of 0.05.  Conclusion: We measured psychometric parameters of the Persian version of the K10 scale for detecting PD among older adults, which was found to be adequately valid, reliable, and stable. Our questionnaire fills the prior gaps regarding the lack of validated tools for the timely detection and management of PD among older adults in the Persian-language cultural contexts. Our study emphasizes that the Kessler questionnaire is a unidimensional scale, and detects non-specific PD with all items indicating a single underlying construct of “distress”

An indirect estimation of the population size of students with high-risk behaviors in select universities of medical sciences: A network scale-up study

<div><p>Background</p><p>Network scale-up is one of the most important indirect methods of estimating the size of clandestine populations and people with high-risk behaviors. The present study is an indirect estimation of the population size of students with high-risk behaviors in select universities of medical sciences.</p><p>Methods</p><p>A total of 801 students from two University of Medical Sciences at Tehran and Alborz University of Medical Sciences were selected through convenience sampling. Six subgroups of high-risk behaviors were examined in the study, including Tramadol use, cannabis use, opium use, alcohol consumption, extramarital heterosexual intercourse, and heterosexual intercourse in return for money. To estimate the social network size in the study population, each participant was asked to name their close student friends from the two select universities. Data were collected using a checklist designed for this purpose.</p><p>Results</p><p>The participants’ mean number of close friends from the selected medical universities was C = 8.14 (CI: 7.54–8.75). Within these social networks, friends with extramarital heterosexual intercourse (5.53%) and friends who consumed alcohol (4.92%) had the highest frequency, and friends who used opium (0.33%) had the lowest frequency. The variables of age, gender, marital status, type of residence and academic degree were significantly related to the likelihood of having close friends with certain high-risk behaviors (P<0.001).</p><p>Conclusion</p><p>According to the results obtained, alcohol consumption and extramarital heterosexual intercourse are very common among students. Special HIV prevention programs are therefore necessary for this age group.</p></div