Comparative Efficacy of Bispectral Index Monitoring and Clinical Assessment in The Recovery of Patients Undergoing Open Renal Surgery: A Randomized, Double-Blind Study

Background and Aims: Maintaining the sufficient depth of anesthesia with an adequate anesthetic drug dosage in patients undergoingsurgery is one of the most significant issues. Inadequate depth of anesthesia can cause significant disturbances in hemodynamicparameters. In this study, clinical assessment and bispectral (BIS) index monitoring compare the depth of general anesthesiaand recovery time in patients undergoing open renal surgery.Method: In this double-blind, randomized, controlled trial, all patients undergoingopenrenal surgery were enrolledandrandomlydivided into a BIS group and clinical assessment group (control). In the BIS group, the electrodes of BIS monitoring system wereplaced on frontal and temporal lobes of the patient. The time of eye opening, verbal response to verbal stimulation, extubation time,the duration of stay in the recovery unit, the first-time of narcotic usage, and total dosage of intravenous narcotics were assessed in2 groups.Results: A total of 96 patients were enrolled. Sex, age, BMI, duration of surgery, length of stay in the recovery room and first-timenarcotic drug usage were not significantly different in the two groups. However, the length of time from the anesthetic drug discontinuationto eye opening, verbal responses to verbal stimulation and extubation was significantly lower in the BIS group thanthe control group, respectively (P = 0.002, P = 0.007, P = 0.019).Conclusions: The evaluation of the aneasthesia status of patients based on the BIS index would be more efficient in decreasing theemergence anaesthesia including eye opening, verbal response, extubation after anesthesi

Analysis of Economic Determinants of Fertility in Iran: A Multilevel Approach

Background: During the last three decades, the Total Fertility Rate (TFR) in Iran has fallen considerably; from 6.5 per woman in 1983 to 1.89 in 2010. This paper analyzes the extent to which economic determinants at the micro and macro levels are associated with the number of children in Iranian households. Methods:Household data from the 2010 Household Expenditure and Income Survey (HEIS) is linked to provincial data from the 2010 Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS), the National Census of Population and Housing conducted in 1986, 1996, 2006 and 2011, and the 1985–2010 Iran statistical year books. Fertility is measured as the number of children in each household. A random intercept multilevel Poisson regression function is specified based on a collective model of intra-household bargaining power to investigate potential determinants of the number of children in Iranian households. Results:Ceteris paribus (other things being equal), probability of having more children drops significantly as either real per capita educational expenditure or real total expenditure of each household increase. Both the low- and the high-income households show probabilities of having more children compared to the middleincome households. Living in provinces with either higher average amount of value added of manufacturing establishments or lower average rate of house rent is associated to higher probability of having larger number of children. Higher levels of gender gap indices, resulting in household’s wife’s limited power over household decision-making, positively affect the probability of having more children. Conclusion:Economic determinants at the micro and macro levels, distribution of intra-household bargaining power between spouses and demographic covariates determined fertility behavior of Iranian households

Therapeutic Effect of Comedy Films on Decreasing of Depression in the Schizophrenic Patients

Objective: This research is an evaluation of the theraputic efficacy of comedy films in improving the mood of the long – stay schizophrenic inpatients. Materials & Methods: 50 schizophrenic patients in 2 rehabilitation wards of Razi Psychiatric – Center were selected on the basis of available sampling. They were divided into 2 groups (Experimental and Control), each group consisted of 25 patients. Before any therapeutic procedure, the magnitudes of their depression were measured by Beck Depressive Inventory. Afterwards, the experimental group was exposed to silent comedies of Charles Chaplin and Mr. Bean (Roan Atkinson) for 30 minutes every other day for two weeks. Meanwhile, the control group were shown a documentary film about the formation of planet Earth. At the end of the second week, the magnitude of depression of all cases were again measured by B.D.I. Furthermore, in order to investigate the statistical significance of differences between depression magnitude among both groups before and after the experiment, Mann Withney – U test, was utilized. Also for defining and explaining the data and drawing the scales, SPSS and Excel softwares were employed as well. Results: According to the findings of this research, the difference between depression magnitude in both groups before and after the exposure to comedy films was significant at P=0.05. Conclusion:  This result shows that comedy films can improve the depressed mood in the long–stay schizophrenic people

Determinants and causes of maternal mortality in Iran based on ICD-MM: a systematic review

Abstract Background No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization. Methods A systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables. Results Amongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran. Conclusions This study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities

Analysis of economic determinants of fertility in Iran: a multilevel approach

Background: During the last three decades, the Total Fertility Rate (TFR) in Iran has fallen considerably; from 6.5 per woman in 1983 to 1.89 in 2010. This paper analyzes the extent to which economic determinants at the micro and macro levels are associated with the number of children in Iranian households. Methods: Household data from the 2010 Household Expenditure and Income Survey (HEIS) is linked to provincial data from the 2010 Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS), the National Census of Population and Housing conducted in 1986, 1996, 2006 and 2011, and the 1985–2010 Iran statistical year books. Fertility is measured as the number of children in each household. A random intercept multilevel Poisson regression function is specified based on a collective model of intra-household bargaining power to investigate potential determinants of the number of children in Iranian households. Results: Ceteris paribus (other things being equal), probability of having more children drops significantly as either real per capita educational expenditure or real total expenditure of each household increase. Both the low- and the high-income households show probabilities of having more children compared to the middle- income households. Living in provinces with either higher average amount of value added of manufacturing establishments or lower average rate of house rent is associated to higher probability of having larger number of children. Higher levels of gender gap indices, resulting in household’s wife’s limited power over household decision-making, positively affect the probability of having more children. Conclusion: Economic determinants at the micro and macro levels, distribution of intra-household bargaining power between spouses and demographic covariates determined fertility behavior of Iranian household

Private and social time preference for health outcomes:A general population survey in Iran

Despite the recent increase in economic evaluations of health care programs in low and middle income countries, there is still a surprising gap in evidence on the appropriate discount rate and the discounting of health outcomes such as quality adjusted life years (QALYs). Our study aimed to calculate the implied time preference rate for health outcomes in Iran and its key determinants. Data were gathered from one family member from each of the 650 households randomly selected in Tehran. The respondents' private and social preferences for health outcomes were calculated using the time trade-off (TTO) technique based on the discounted utility model. We investigated the main assumptions of the discounted utility model through equality of mean comparison, and the association between private time preference and key socio-economic determinants using multilevel regression analysis. The mean and median implied rates were 5.8% and 4.9% for private time preference and 25.6% and 20% for social time preference respectively. Our study confirmed that magnitude, framing and time effects have a significant impact on implied discount rates, which means that the conventional discounted utility model's main assumptions are violated in the Iranian general population. Other models of discounting which apply lower rates for far health outcomes might provide a more sensible solution to discounting health interventions with long-term impacts.</p

Private and social time preference for health outcomes: A general population survey in Iran

Despite the recent increase in economic evaluations of health care programs in low and middle income countries, there is still a surprising gap in evidence on the appropriate discount rate and the discounting of health outcomes such as quality adjusted life years (QALYs). Our study aimed to calculate the implied time preference rate for health outcomes in Iran and its key determinants. Data were gathered from one family member from each of the 650 households randomly selected in Tehran. The respondents' private and social preferences for health outcomes were calculated using the time trade-off (TTO) technique based on the discounted utility model. We investigated the main assumptions of the discounted utility model through equality of mean comparison, and the association between private time preference and key socio-economic determinants using multilevel regression analysis. The mean and median implied rates were 5.8% and 4.9% for private time preference and 25.6% and 20% for social time preference respectively. Our study confirmed that magnitude, framing and time effects have a significant impact on implied discount rates, which means that the conventional discounted utility model's main assumptions are violated in the Iranian general population. Other models of discounting which apply lower rates for far health outcomes might provide a more sensible solution to discounting health interventions with long-term impacts