The Impact of Structure, Process and Output on the Establishment of an Accreditation System in Social Security Hospitals in Tehran

Background: The lack of an evaluation mechanism and effective accreditation for hospitals in addition to increasing healthcare costs jeopardizes the overall health of communities. This study was conducted to identify and prioritize factors affecting the establishment of an accreditation system in social security hospitals in Tehran in 2015.Methods: This is a cross-sectional study and participants consisted of academic experts, hospital chiefs, managers, head nurses and supervisors, and staff of quality improvement in departments of social security in hospitals in Tehran City, Iran. Study samples were of 170 participants. A 5-points Likert scale questionnaire, according to the Donabedian model (structure, process, and output), with 24 items, was used. For data analysis, SPSS software version 22 and Pearson correlation coefficient, one-sample t-test and linear regression were used.Results: Out of 170 participants, 49 (28.8%) were male and 121 (71.2%) were female. T-test results showed that all dimensions had a significant effect on the accreditation system (P<0.05). Also, pearson correlation coefficient results showed that all aspects had a significant correlation with each other (P<0.05). In the regression model, R2 showed that 89.6% of changes of the dependent variable could be predicted.Conclusions: The correct implementation of hospital accreditation requires the specific education for personnel so that they can easily understand the accreditation model and standardized processes that need to be established in the hospital

The Impact of Structure, Process and Output on the Establishment of an Accreditation System in Social Security Hospitals in Tehran

Background: The lack of an evaluation mechanism and effective accreditation for hospitals in addition to increasing healthcare costs jeopardizes the overall health of communities. This study was conducted to identify and prioritize factors affecting the establishment of an accreditation system in social security hospitals in Tehran in 2015.Methods: This is a cross-sectional study and participants consisted of academic experts, hospital chiefs, managers, head nurses and supervisors, and staff of quality improvement in departments of social security in hospitals in Tehran City, Iran. Study samples were of 170 participants. A 5-points Likert scale questionnaire, according to the Donabedian model (structure, process, and output), with 24 items, was used. For data analysis, SPSS software version 22 and Pearson correlation coefficient, one-sample t-test and linear regression were used.Results: Out of 170 participants, 49 (28.8%) were male and 121 (71.2%) were female. T-test results showed that all dimensions had a significant effect on the accreditation system (P<0.05). Also, pearson correlation coefficient results showed that all aspects had a significant correlation with each other (P<0.05). In the regression model, R2 showed that 89.6% of changes of the dependent variable could be predicted.Conclusions: The correct implementation of hospital accreditation requires the specific education for personnel so that they can easily understand the accreditation model and standardized processes that need to be established in the hospital

Effect of polyamines on thermal inactivation of hen egg white lysozyme

     Lysozyme is considered as part of the innate immune system. It has stimulated considerable interest as a natural food preservative. Lysozyme has been shown to be effective in preserving a variety of foods such as fresh fruits and vegetables, meats, seafood and wine, for which many Japanese patents have been granted. The relatively high thermal stability of lysozyme also makes it attractive for use in pasteurized and heat-sterilized food products, possibly allowing reduced thermal processes, and therefore, minimized nutritional and sensory quality loss. In this study, we investigated effect of polyamines on the thermal inactivation of lysozyme by kinetics curves. Our results showed that polyamines can decrease the thermal inactivation of lysozyme; the effect of spermine on the thermal inactivation of lysozyme was more than that of the spermidine.

Effect of Epigallocatechin-3-gallate (EGCG) on cell proliferation inhibition and apoptosis induction in lymphoblastic leukemia cell line

Introduction: Acute lymphoblastic leukemia (ALL) is one of the malignant proliferations of lymphoid cells in the early stages of differentiation and accounts for &frac34; of all cases of childhood leukemia. Available treatment cannot completely treat this disease. Epigallocatechin-3-gallate (EGCG) is a polyphenolic compounds in the green tea that has demonstrated to have anticancer and antimitotic properties. The purpose of the present study was the evaluation of the effect of EGCG on the proliferation inhibition and apoptosis induction in a lymphoblastic leukemia cell line. Methods: Jurkat cell line was cultured in standard condition and in different concentrations of EGCG (0-100 micromolar) for 24, 48 and 72 hours. Cell viability was measured by MTS assay. Apoptosis induction was assessed by annexin V-FITC and flow cytometry analysis. Results: The MTS assay revealed that EGCG has decreased cell viability with a time and dose dependent manner. The level of cell apoptosis in all used concentrations of EGCG (50, 70 and 100 &mu;m) was higher than control group (71, 40 and 31 respectively vs. 8) and reached to significant level at 100 &mu;m concentration. Conclusion: The study indicated that EGCG is effective on proliferation inhibition and apoptotic induction in Jurkat lymphoblastic cell line. Therefore, the study of the mechanism of apoptosis induction could be a step of progress toward target therapy which might be considered in the future studies.</p

Recent advances in nanocarriers containing Bromelain: In vitro and in vivo studies

Medicinal products of plant origin have long been considered the most affordable and accessible sources to treat different health problems. Bromelain (Br) is a mixture of enzymes derived from pineapple (Ananas comosus L.) with a wide field of applications including medicine, health, food, and cosmetics. Br has various therapeutic effects, such as antimicrobial, antioxidant, anticancer, wound healing, burn treatment, pain relief, anti-inflammatory, inhibition of platelet aggregation, and fibrinolytic activity. On the other hand, most proteins are susceptible to denaturation and structural changes that may reduce their activities. Encapsulation of drug molecules into nanoparticles (NPs) could increase their stability, bioavailability, and overcome other challenges in drug delivery and therapy. This review aimed to highlight various Br nano-formulations approaches, toward the improvement of Br therapeutic efficiency

The effects of Valerian on sleep spindles in a model of neuropathic pain

Introduction: Valeriana officinalis is known to be one of the most famous herbal supplements for the treatment of anxiety and insomnia. Despite its widespread use in most countries all around the world, there is little scientific information and research on how this medication affects sleep patterns, and there are almost no studies on its effects on the characteristics of sleep spindles. Material and Methods: The present study was conducted to investigate the effects of Valerian extract (VAL) on sleep spindles and induced anxiety in chronic neuropathic pain model in rats. 24 male rats were divided into three groups: neuropathic group (n=9) in which the rats underwent chronic constriction injury (CCI), sham group (n=7) in which the sciatic nerves of the animals were exposed without any constriction and also fed with the vehicle, and the third group was under CCI condition and treated with Valerian (n=8). All the rats underwent electrode implant surgery so that we could record electroencephalogram and electromyography waves. In all the three groups, EEG and EMG recordings were recorded three times (150min each time). The initial recording was just prior to the CCI surgery and the rest were 3 and 6 days following CCI surgery. Moreover, cold allodynia and elevated plus maze tests were performed 3 and 6 days following the CCI surgery. Results: Valerian treatment could repair the allodynia induced by neuropathy. On the other hand, by Valerian treatment (400mg/kg) during neuropathy, the REM sleep, decreased and the non-REM sleep increased. Moreover, there was an increment in sleep spindle density and spindle frequency even in neuropathic condition. Discussion: This herbal supplement improves the quality of sleep in neuropathy conditions

Tangeretin protects renal tubular epithelial cells against experimental cisplatin toxicity

Objective(s): Cisplatin is an effective antineoplastic agent; its clinical utility, however, is limited by a few salient toxic side effects like nephrotoxicity. This study aimed to determine the potential protective effects of tangeretin, a citrus-derived flavonoid, against renal tubular cell injury in cisplatin-induced renal toxicity of rats.Materials and Methods: Tangeretin was injected intraperitoneally at 2.5 and 5 mg/kg doses for 10 days, and a single dose of cisplatin (8 mg/kg) was injected on the 7th day. Tests of kidney function and tubular injury in renal tissues and urine together with oxidative stress and inflammation markers were examined.Results: Tangeretin ameliorated cisplatin-induced elevations in serum creatinine, BUN, and histopathologic changes. It also attenuated kidney oxidative stress elicited by cisplatin as demonstrated by reduced MDA and increased GSH, CAT, and SOD activities, elevated Nrf2 expression and protein levels of its downstream effectors, HO-1 and NQO-1. Tangeretin further alleviated inflammation evoked by cisplatin as indicated by reduced NF-κB p65 subunit phosphorylation with a simultaneous decrement in its downstream effectors IL-1β and TNF-α expression and protein levels. Moreover, it declined caspase-3 protein levels and TUNEL positive cells in the kidneys, the markers of apoptosis and DNA fragmentation, thus improving renal endurance. Additionally, tangeretin mitigated renal levels of KIM-1 and NGAL, as well as urinary cystatin C and β2-microglobulin concentrations, the markers of renal tubular injury.Conclusion: Collectively, these data signify the binary profit of tangeretin: enhancement of renal protective mechanisms against cisplatin and attenuation of renal tubular cell injuries induced by the agent

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Funding Bill & Melinda Gates Foundation

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017:a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd