Factors predicting physical activity among children with special needs.

IntroductionObesity is especially prevalent among children with special needs. Both lack of physical activity and unhealthful eating are major contributing factors. The objective of our study was to investigate barriers to physical activity among these children.MethodsWe surveyed parents of the 171 children attending Vista Del Mar School in Los Angeles, a nonprofit school serving a socioeconomically diverse group of children with special needs from kindergarten through 12th grade. Parents were asked about their child's and their own physical activity habits, barriers to their child's exercise, and demographics. The response rate was 67%. Multivariate logistic regression was used to examine predictors of children being physically active at least 3 hours per week.ResultsParents reported that 45% of the children were diagnosed with attention deficit hyperactivity disorder, 38% with autism, and 34% with learning disabilities; 47% of children and 56% of parents were physically active less than 3 hours per week. The top barriers to physical activity were reported as child's lack of interest (43%), lack of developmentally appropriate programs (33%), too many behavioral problems (32%), and parents' lack of time (29%). However, child's lack of interest was the only parent-reported barrier independently associated with children's physical activity. Meanwhile, children whose parents were physically active at least 3 hours per week were 4.2 times as likely to be physically active as children whose parents were less physically active (P = .01).ConclusionIn this group of students with special needs, children's physical activity was strongly associated with parental physical activity; parent-reported barriers may have had less direct effect. Further studies should examine the importance of parental physical activity among children with special needs

Association of Anticardiolipin Antibodies and Extent of Coronary Artery Disease in Military Personnel and Non Military Population With Acute Coronary Syndrome

Introduction: Cardiac involvement is one of the chief complications considerably contributing to the morbidity and mortality of patients with systemic autoimmune diseases. Anticardiolipin antibody is a marker of elevated myocardial infarction risk and it also predicts post cardiac intervention risk. In the current study, we aimed to evaluate the association between anticardiolipin IgM and IgG levels and atherosclerotic involvement of coronary arteries.Methods: Patients with acute coronary syndrome admitted to a military hospital were included in the study. Patients were categorized to military personnel and non-military personnel. Laboratory data including lipid profile, blood sugar, anticardiolipin IgM and anticardiolipin IgG were verified. Existence and the extent of Coronary Artery Disease (CAD) were defined according to angiographic findings. The relationship between anticardiolipin antibody levels and the number of vessels were evaluated.Results: According to our sample population calculation, we performed the study on a total of 92 patients. Measurement of both anticardiolipin antibodies (IgM and IgG) in military personnel and non personnel patients showed no significant difference. In both military personnel and non personnel groups, there was a significant association between anticardiolipin IgM and IgG levels and number of coronary arteries with significant stenosis. The C Reactive Protein (CRP) level was significantly higher in military personnel.Conclusions: According to the study results, anticardiolipin antibody levels were the same in both military personnel and non personnel. Also systolic and diastolic blood pressures were not significantly different in both groups. Increased CRP level in military personnel may be a warning signal about the possibility of premature CAD in this population, hence aggressive risk factor modification is recommended. Paradoxically lipid profile and FBS levels were more favorable in military personnel, which indirectly reflects their higher state of physical activity

Explanation and clarification of the concept of value in medical education

For downloading the full-text of this article please click here.Background and Objective: Developing the education of medical sciences is one of the main objectives of the Ministry of Health and Medical Education. The first step toward creating value-based educational programs in the country is to clarify the concept of value in medical education, which is addressed in this study.Method: Through critical interpretive synthesis, document analysis was performed to clarify the concept of value in medical education; then, the related literature on ‘value’ was investigated. From among 800 articles, 70 articles were selected by purposive sampling. A well-reasoned synthesis of the contradictory findings in different studies was conducted. As the next step, critical analysis on the documents was carried out so that the concept of value along with new concepts and their relationships, the philosophy, and the place of values in medical education of Iran were recreated. All the ethical issues were observed. Moreover, the authors did not report conflict of interest.Results: Values are created as a system within each individual, forming the basis of judgment and decision making. Values shape attitudes and guide our behavior. Furthermore, beliefs affect our scientific approaches. Scientific evidence that has been provided is not devoid of the scholars and researchers’ values. In our Islamic society, the basic assumptions shape our beliefs and values; then, these values determine our direction and behavioral patterns so that we do not get out of the circle of morality.  Conclusion: In our country, in many areas including medical education, those programs that guarantee the achievement of values are needed. To foster the values in this field, the first step is paving the way for understanding and internalization of values along with the development of teaching procedures to gain value-based experiences.For downloading the full-text of this article please click here

Proposing a new methodology for prioritising the investment strategies in the private sector of Iran

This article proposes a systematic and organised approach for group decision-making in the presence of the uncertainty involved in expert judgments as used in multi-criteria decision-making (MCDM) issues. This procedure comprises the selection of the optimum alternative with respect to the evaluation criteria under consideration, in particular to select the strategy of investing. However, the selection of the investment strategy is difficult on account of considering the numerous quantitative and qualitative parameters like benefits, opportunities, costs, and risks. However, it is possible that these parameters have a significant influence on each other. A decision-making trial and evaluation laboratory (DEMATEL), used to define the influential network of elements, can be employed to construct a network relationship map (NRM). On the other hand, according to whether the information is incomplete or unavailable, uncertainty is an inseparable part of making decision for solving the MCDM problems. Therefore, this article proposes a new hybrid model based on analytic hierarchical process (AHP), DEMATEL, and echnique for Order of Preference by Similarity to Ideal Solution (TOPSIS) techniques under fuzzy environment to evaluate the problem of the selection of the investment strategy. To achieve the aim, a three-step process is presented to solve a sophisticated problem. First, the AHP method is employed to break down the investment problem into simple structure and calculate the importance weights of criteria by using a pairwise comparison process. Second, the DEMATEL technique is applied for considering interdependence and dependencies and computing the global weights of benefit, opportunities, cost, and risk (BOCR) factors. Finally, the fuzzy TOPSIS methodology is used for prioritising the possible alternatives. To demonstrate the potential application of the proposed model, a numerical example is illustrated and investigated. The results show that the proposed model has a high ability to prioritise the strategies of investing

Approaches and Components of Health Workforce Planning Models: A Systematic Review

Background: To date, there is still no uniformity in forecasting models for health workforce planning (HWFP). Different countries use various HWFP models, some of which are context-specific. The objective of this systematic review is to determine approaches and components of HWFP models.Methods: A systematic review of studies published in English and Persian between 2004 and 2021 was performed by searching PubMed Central, MEDLINE, Web of Science, Scopus, Eric, and Elmnet databases. Articles that assessed HWFP models, focused on health service delivery, used input-output models, and a clear formulation process were included. Articles that scored ≥20 points on the “strengthening the reporting of observational studies in epidemiology” checklist were considered of acceptable quality for inclusion.Results: Twenty articles were included for qualitative synthesis based on the inclusion and exclusion criteria. Most studies used the mixed method approach “supply and demand”, whereas target- and needs-based approaches were used less frequently. The number of components used to estimate supply, demand, needs, and targets were 42, 32, 11, and 6, respectively. In addition, several unique factors used in the various HWFP models were identified.Conclusion: Different approaches are used in HWFP models, which is indicative of the lack of consensus on this topic. High diversity in the identified factors is related to the approach used and the context in which the model is applied

Explanation of the professional development process of general surgery residents in the operating rooms: A situational analysis

Introduction: Numerous factors and elements are effective in the professional development of any field of study, including the educational structure, the individual characteristics of learners, and the educational atmosphere prevalent in the educational environment. Understanding each of these factors and elements and the relationships among them can guide educational system administrators in the direction of professional development. Surgical residents’ professional development is no exception to this rule. As a consequence, the present research sought to explain and suggest a model for surgical assistant professional growth in Iranian operating rooms.Methods: The present research was a grounded theory study based on a post-positivist approach, in which data analysis was performed using Clark’s situational analysis methodology by drawing three maps, situational map, social worlds/arenas map, and positional map.Results: In the presence of human and non-human factors, cultural, political, historical, and social components, the ordered situational map demonstrated the complexity of the operating room learning environment. The social worlds/arenas map confirmed the existence of several communities of practice wherein surgical residents were present with different power roles, and the positional map showed role of the educational level in the acquisition of thecompetence in the professional development pathway. Finally, the Triple Helix model of professional development was extracted, which has three components: psychological identity, social identity, and surgical competency.Conclusion: The surgical residents’ professional development in operating rooms occurs due to the acquisition of surgicalcompetency along with the growth of individuals and socialization. As a result, all factors and components impacting the residents’ competence development process in this learning environment must be identified and their linkages clarified

Development and application of a social accountability assessment tool at the Shahid Beheshti University of Medical Sciences

Background: One of the critical needs of governmental agencies and educational institutions is meeting community needs. Organizations and governmental systems that rely on social capital are considered inefficient and vulnerable if they are unable to meet the needs of society. Thus, accountability is a critical pillar of government management that leads to effective actions and better service delivery. Methods: Critical review methodology was used in the first phase to review texts and documents available in the field of social accountability and to collect items used to develop the social accountability assessment tool. The Delphi method was then used to finalize and approve the model and assessment tool. University processes were investigated and evaluated based on the social accountability tool in the second phase. Result: In all, 422 university processes were investigated and evaluated to determine their accountability in different fields. The mean score of the evaluated processes was 11.9 out of 100. Conclusion: The results show that social accountability is a relatively new topic that has received considerable attention in medical education in Iran. Given the relative newness of this topic, these results could be expected; social accountability should try and be expected to improve in the coming years

Health Technology Assessment of CEM Pulpotomy in Permanent Molars with Irreversible Pulpitis

Introduction: Teeth with irreversible pulpitis usually undergo root canal therapy (RCT). This treatment modality is often considered disadvantageous as it removes vital pulp tissue and weakens the tooth structure. A relatively new concept has risen which suggests vital pulp therapy (VPT) for irreversible pulpitis. VPT with calcium enriched mixture (VPT/CEM) has demonstrated favorable treatment outcomes when treating permanent molars with irreversible pulpitis. This study aims to compare patient related factors, safety and organizational consideration as parts of health technology assessment (HTA) of the new VPT/CEM biotechnology when compared with RCT. Materials and Methods: Patient related factors were assessed by looking at short- and long-term clinical success; safety related factors were evaluated by a specialist committee and discussion board involved in formulating healthcare policies. Organizational evaluation was performed and the social implications were assessed by estimating the costs, availability, accessibility and acceptability. The impact of VPT/CEM biotechnology was assessed by investigating the incidence of irreversible pulpitis and the effect of this treatment on reducing the burden of disease. Results: VPT/CEM biotechnology was deemed feasible and acceptable like RCT; however, it was more successful, accessible, affordable, available and also safer than RCT. Conclusion: When considering socioeconomic implications on oral health status and oral health-related quality of life of VPT/CEM, the novel biotechnology can be more effective and more efficient than RCT in mature permanent molars with irreversible pulpitis

Values in Health Policy – A Concept Analysis

Background: Despite the significant role “values” play in decision-making no definition or attributes regarding the concept have been provided in health policy-making. This study aimed to clarify the defining attributes of a concept of value and its irrelevant structures in health policy-making. We anticipate our findings will help reduce the semantic ambiguities associated with the use of “values” and other concepts such as principles, criteria, attitudes, and beliefs. Methods: An extensive search of literature was carried out using electronic data base and library. The overall search strategy yielded about 1540 articles and 450 additional records. Based on traditional qualitative research, studies were purposefully selected and the coding of articles continued until data saturation was reached. Accordingly, 31 articles, 2 books, and 5 other documents were selected for the review. We applied Walker and Avant’s method of concept analysis in studying the phenomenon. Definitions, applications, attributes, antecedents, and consequences of the concept of “value in health policy-making” were extracted. We also identified similarities and differences that exist between and within them. Results: We identified eight major attributes of “value in health policy-making”: ideological origin, affect one’s choices, more resistant to change over time, source of motivation, ability to sacrifice one’s interest, goal-oriented nature for community, trans-situational and subjectivity. Other features pinpointed include alternatives, antecedents, and consequences. Alternative, antecedents and consequences case may have more or fewer attributes or may lack one of these attributes and at the same time have other distinctive ones. Conclusion: Despite the use of the value framework, ambiguities still persist in providing definition of the concept value in health policy-making. Understanding the concept of value in health policy-making may provide extra theoretical support to decision-makers in their policy-making process, to help avoid poor policy formulation and wastage of limited resource