Medical Journal of the Islamic Republic of Iran最新文献

Background: Cardiovascular diseases (CVD) represent a leading cause of global mortality, necessitating proactive identification of risk factors for preventive strategies. This study aimed to uncover prognostic factors influencing cardiovascular patient survival.

Methods: This study, which used a sample size of 410, showed how to analyze data using simple random sampling. It was conducted at the Tikur Anbessa Specialist Hospital in Addis Ababa, Ethiopia, between September 2012 and April 2016. The Cox PH and stratified Cox regression models were used for the analysis.

Results: Findings disclosed a patient cohort where 200 patients (48.8%) persisted through subsequent evaluation, while 210 patients (51.2%) succumbed. Blood pressure (BP), specific CVD, and education levels (EL) exhibited nonproportionalities in scaled Schoenfeld residuals (P < 0.001), prompting necessary stratification. Inadequacies in the Cox proportional hazards model led to favoring the stratified Cox model. Notably, EL, BP, cholesterol level (CL), alcohol use (AU), smoking use (SU), and pulse rate (PR) exhibited statistical significance (P < 0.001). Acceptability of the absence of interaction in the model, with disease types as strata, was established. Different cardiovascular conditions served as distinct groups, where EL, AU, BP, PR, CL, and SU emerged as variables with statistically substantiated significance associated with the mortality of patients with CVD.

Conclusion: Implications stress the imperative of widespread awareness among policymakers and the public concerning cardiovascular disease incidence. Such awareness is pivotal in mitigating identified risk factors, guiding more effective healthcare interventions tailored to the multifaceted challenges posed by cardiovascular health.

Background: Hyperglycemia is common in the early acute stroke phase especially in patients with diabetes. To the best of our knowledge, no study has evaluated the course of hyperglycemia in patients with diabetes during the post-stroke recovery phase.

Methods: It was an observational study conducted in Tabassom Rehabilitation Center for Stroke Patients, Tehran, Iran, 2018-2021. Forty-seven consecutive patients with diabetes and stroke were enrolled and included if at least 3 months had passed from their stroke . Any change in glycemic control before and after stroke was controlled by monitoring drugs used for diabetes treatment and laboratory results. To assess categorical variables, the Pearson chi-squared test was used. Quantitative variables before and after the stroke were analyzed by the paired sample t-test.

Results: The mean age was 63.6 ± 6.9 years, and 22 patients were women. The median time from occurrence of stroke to the first visit was 5 months and 6 days. Glycemic control improved among patients with diabetes during the post-stroke recovery phase. There was a significant decrease of 0.7 ± 1.3 % in HbA1c (P = 0.001). The number and the dose of drugs needed for diabetes treatment decreased. No significant correlation could be found between changes in HbA1c and weight.

Conclusion: Despite the initial increase in glycemia in patients with diabetes in the acute phase of stroke, glycemic control improves after stroke, and often, it is necessary to decrease diabetes drugs to prevent hypoglycemia. This topic is important and should be addressed by guidelines and institutions involved in the care of patients with diabetes and stroke.

Background: Lengthy hospitalization may lead to an increased hospital-acquired patient complication, including infections, as well as increased costs for both healthcare systems and patients. A few studies evaluated the impact of various clinical and demographic variables on patients' length of stay (LOS). Hence, in this study, we aimed to investigate the impact of various variables on traumatic patients' LOS.

Methods: This is a retrospective single-center, registry-based study of traumatic patients admitted to Taleqani, a major trauma center in Kermanshah, Iran. A Minimal Dataset (MDS) was developed to retrieve traumatic data on demographic and clinical aspects. We used univariable and multiple quantile regression models to evaluate the association between independent variables, including ISS, GCS, and SBP, with LOS. LOS is practically defined as the time interval between hospital admission and discharge. The LOS durations have been presented as median (Q1 to Q3) hours. A p-value of <0.05 was considered statistically significant.

Results: A total of 2708 cases were included in this study, with 1989 (73.4%) of them being male. The median LOS was 87.00 (48.00 to 144.00) hours. When adjusted for systolic blood pressure (SBP), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and cause of injury, the two characteristics of spine/back and multiple trauma were significantly associated with the higher LOS, with 43 (20.5 to 65.48) and 24 (10.39 to 37.60) hours more than extremities (P < 0.001 and P = 0.005). Besides, the patients admitted due to road traffic injuries (RTI) were discharged 16 and 41 hours later than falling and cutting/stabbing (P = 0.008 and < 0.001, respectively). Moreover, the patients with ISS≥16 and 9≤ISS≤15 had a median of 51 (21 to 80) and 34 (22 to 45) LOS hours more, compared to 1≤ISS≤8, respectively (P < 0.001). The trauma cases experiencing SBP ≤ 90 mmhg on admission had a median of 41 (20 to 62) hours more hospitalization period than those with SBP> 90 mmhg (P < 0.001). At last, the patients with GCS of 9 to 12 and GCS of 3 to 8 were hospitalized for 39 and 266 hours more than GCS of 13 to 15 (P < 0.001).

Conclusion: Determining independent determinants of prolonged LOS may lead to better identifying at-risk patients on admission. Trauma care providers should consider the following risk factors for increased LOS: higher ISS, Lower GCS, and SBP, multiple trauma or spine injury, and trauma resulting from falling or cutting/stabbing. As a result, the impact of extended LOS might be reduced by intervening in the related influencing factors.

Background: One of the approaches to health workforce planning is supply-based. It has been emphasized that countries should model health workforce based on evidence and their context. The objective of this study is to "design a supply health workforce planning model for specialty and subspecialty in Iran."

Methods: This is a study using Walker and Avant's (2018) theory synthesis framework to construct the model. This method has three steps. According to the viewpoint of the research team and the needs of the country, the focal concept is determined. Then, a literature review was done to determine related factors and their relationships. In the third step, according to the review, the viewpoint of the research team, the rationale of the connection between components, and the graphic model were presented.

Results: "Supply" was selected as the focal concept. In the literature review, 42 components were obtained from the systematic review, 43 components obtained from the study of other texts were combined with the opinion of the research team about the field of Iran, and the connections between them were determined. In the third step, the supply model was designed using the Stock and Flow method. Finally, by applying the "functional full-time coefficient", the number of full-time equivalent physicians was calculated.

Conclusion: The presented model is an evidence-based model that follows stock and flow design. Stock is the number of specialties or subspecialties that exist in the labor market. Flow includes inflow and outflow according to the educational pathway in the context of Iran.

Background: Stress is an overwhelming feeling in patients with breast cancer (BC). However, The effect of virtual education has not been fully regulated. Hence, this study intends to compare the impact of 2 virtual education methods on perceived stress and stress coping in women with BC.

Methods: A 3-armed randomized clinical trial was conducted among 315 women with BC who were referred to the Cancer Institute in Tehran. They were randomly assigned to 3 groups: (a) Family-based, receiving family-based training package; (b) peer-support, receiving peer-support educational package; and (c) control, receiving routine hospital care. Data were collected through demographic and disease characteristics, the Perceived Stress Scale (PSS-14), and Coping Inventory for Stressful Situations (CISS-21) questionnaires before and 3 months after the intervention.

Results: The effect of the group factor after controlling the before-intervention scores in perceived stress, problem-oriented, emotion-oriented, and avoidance-oriented strategies were P < 0.0001, P = 0.015, P < 0.0001, and P = 0.111, respectively. Also, the effect of the confounding factor of BC disease stage in the dependent variables was P = 0.527, P = 0.275, P = 0.358, and P = 0.609, respectively. The effect size test showed that before the intervention, the mean scores of perceived stress, problem-oriented, emotion-oriented, and avoidance-oriented strategies were 32.00 ± 7.03, 19.36 ± 4.68, 25.10 ± 5.90, and 17.65 ± 6.64 respectively, but after the intervention showed a decrease in mean scores of perceived stress, emotion-oriented, and avoidance strategies.

Conclusion: What is vibrant in virtual family-based education is far more effective than peer support when problem-oriented coping increases. Conversely, reducing perceived stress in women with BC receiving enough information and family support should be considered.

Background: Due to the changing conditions of education, research, and treatment in the world, especially the recent pandemic, and more use of virtual space, there is a need for evaluation of digital professionalism in faculty members as the most influential people who have a direct and deep impact on the next generation.

Methods: In this analytical cross-sectional study that was conducted in 2023 on 149 faculty members of Iran University of Medical Sciences, they were invited to participate in the study through various methods (SMS, E-mail, and media messages). The link to the Persian standardized questionnaire was made available for participants. If a person received less than 70% of the score in each area, he/she would receive solutions to improve his/her situation in that area at the end of answering the questions. The self-administered questionnaire has 5 fields and 33 questions. Maximum scores were 10 points. Spearman and Pearson correlation coefficients and statistical tests consisting of chi-square, t-test, Mann-Whitney U, one-way ANOVA, and Kruskal-Wallis H were used in the analysis.

Results: The mean overall score of people in principles of digital professionalism was 0.8. Women and basic sciences faculties had a significantly better status than men and clinical faculties in the principles of digital professionalism as a whole (P = 0.001 and P = 0.049, respectively). The domain of "knowledge management and information literacy" had significantly lower scores in professors in comparison with other degree (instructors, assistant professors, and associate professors (P = 0.039).

Conclusion: The mean score of the principles of digital professionalism is acceptable at 80%. Coherent, timely, and up-to-date training to ensure the effective, safe and appropriate use of digital technology, especially for men, professors and clinical faculty members who had a lower score than others, should be done.

Background: Online reporting systems can establish and maintain the community-authority connection for safety promotion initiatives and their sustainability. The aim of this study was to report the development, implementation, and evaluation of an online community safety reporting system in safe communities in Iran.

Methods: In the first place, the life cycle approach and software systems development were used for design and implementation, which included 7 steps. In the following, an online Community Safety Reporting System (CSRS) was developed with two main interfaces, including a web-based and phone application. The software was developed using suitable programming languages for the web and as a mobile application for Android and iOS systems.

Results: During the six months of implementation, we received 80 reports in different safety areas, which were managed by the administrators and provided feedback for reporters. System user-friendliness and easy to use were the main strengths declared by users. The CSRS program is implemented at two levels of usage: public users to report safety issues and city admin functional evaluation of the system through a short interview with users. Moreover, city authorities believed that the system facilitates community participation in decision-making processes. The address of the web page is www.payamiran.ir.

Conclusion: CSRS provides a way for community voices to be heard and facilitates mutual interaction between the community and authorities. CSRS could be used as a community participation tool to ensure safety promotion initiatives sustainability.

Background: Obesity and Helicobacter pylori (H. pylori) infection are public health problems in the world and Iran. This study aimed to indicate the anatomical place with the most accurate results for H. pylori. According to gastric mapping, this study will be able to evaluate the prevalence of H. pylori based on the pathology of gastric mapping and the accuracy of the antral rapid urease test (RUT) based on endoscopic findings.

Methods: In this cross-sectional study, upper digestive endoscopy and gastric pathology were studied in 196 obese patients candidates for bariatric surgery. Statistical analyses were performed using a t-test and Chi-square/fisher's exact test to compare the groups. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and odds ratio (OR) were used to compare RUT and pathological H. pylori test of each of the six areas of the stomach. We set a positive test of the pathology of 6 regions of the stomach as our gold standard (in this study).

Results: The most common area of the stomach for pathological findings of H. pylori were incisura (116, 59.2%), greater curvature of the antrum (115, 58.3%), lesser curvature of the antrum (113, 57.7%), lesser curvature of the corpus (112, 57.1%), greater curvature of the corpus (111, 56.6%) and cardia (103, 52.6%). The prevalence of H. pylori was 58.2% (114 cases) and 61.2% (120 cases) with RUT and gastric pathology, respectively. Mild, moderate, and severe infection of H. pylori in cardia (58, 29.6%), greater and lesser curvature of the antrum (61, 31.1%), and greater curvature of the antrum (37, 18.9%) had the highest percentages of incidence comparing to other sites of the stomach, respectively. The most sensitive area for pathologic biopsy was incisura (96.6%, 95% confidence interval: 91.7, 98.7).

Conclusion: According to the highest sensitivity, PLR, NPV, and pathological findings of H. pylori in accordance with the lowest NLR in the incisura compared with other parts of the stomach, it is highly recommended to take the biopsy from the incisura instead of other anatomical places of stomach for detecting H. pylori specifically if our strategy is taking only one biopsy.

Background: The likelihood of poor health outcomes for refugees is increased due to a variety of complicated causes. Lack of access to high-quality care during resettlement is frequently cited by migrants. Therefore, this study was carried out to assess the quality of primary care services from the perspective of refugees and migrants.

Methods: This cross-sectional study was conducted in three health networks affiliated with Iran University of Medical Sciences in 2021. Data were collected by using a self-administrative questionnaire, the validity and reliability of which were checked and confirmed. The questionnaires were randomly completed by 280 migrants and refugees. Data were analyzed by using Kruskal-Wallis, Mann-Whitney U, Spearman correlation, exploratory factor analysis, and Cronbach's α with SPSS 22.

Results: According to the results, the overall service quality was 3.86 out of 5. The highest and lowest mean scores were related to efficiency (4.12 ±0.64) and tangibility (3.28 ±0.39). Furthermore, there was a significant relationship between the perception of service quality and gender, education, residence area, and the rate of center visits (P < 0.05).

Conclusion: The quality of services was generally rated favorably by the refugees. Managers and decision-makers are recommended to allocate enough funds to equip and upgrade the amenities at health centers to increase the quality of services.

Background: The prevalence of dental caries among the elderly is high worldwide, and dental caries cause the major burden of oral diseases. This meta-analysis aimed to determine the dental caries experience among the elderly in Iran.

Methods: A systematic review of the published and grey literature on Iranians aged 65 years or older was performed. Six international and local databases provided the most comprehensive population-based studies. National oral health surveys and national disease and health surveys were considered other primary data sources. The quality of remained studies was assessed by a modified tool designed based on the STROBE statement checklist to evaluate the cross-sectional studies. R Version 3.6.0 was used for statistical analysis. Heterogeneity was assessed using Cochran's Q and F statistics. Subgroup analysis was performed to detect the source of heterogeneity. Funnel plots and Egger's regression intercept test were used to assess publication bias and selective reporting.

Results: Overall, 3099 sources were found. After excluding ineligible studies, 46 data points with 10411 people ≥65 years were included in the meta-analysis. The mean pooled decayed, missing, and filled teeth (DMFT) among older people was 26.84 (range, 26.41-27.28). The DMFT was 26.78 (range, 26.12-27.43) in women and 26.91 (range, 26.32-27.50) in men. The mean number of decayed teeth was 1.48 (range, 1.32-1.65). The mean pooled missing teeth was 24.83 (range, 24.20-25.46), and the mean pooled filled teeth was 0.14 (range, 0.12-0.17). The majority (92%) of the DMFT was related to missing teeth.

Conclusion: Iranian elderly have almost 5 sound teeth in their mouth on average. The Iranian oral health policymakers should address this considerable burden of dental caries in designing and implementing better oral health policies for the population, especially older Iranian adults.