Medical Journal of the Islamic Republic of Iran最新文献

Background: Spinal cord injury (SCI) is a life-long neurological disease. This study reviews the literature on the vocational rehabilitation (VR) of people who experience SCI.

Methods: MEDLINE (via PubMed), Web of Science, EMBASE, Google Scholar, ProQuest, and Science Direct databases were searched. The inclusion criteria of the articles included the following: describing adults with SCI only, the English or Persian language, and involving people of workforce age. Conference abstracts, case studies, and editorials were excluded.

Results: The eligibility of 186 full-text articles was assessed, and 124 studies met the inclusion criteria. Most studies focused on barriers and facilitators for work in people with SCI.

Conclusion: There are no current services and programs in Iran that support post-injury employment of people with SCI, and therefore, there remains a need for studies addressing employment in this population.

Background: The term Ponticulus Posticus (PP) refers to a complete or partial bony bridge on the vertebral artery that passes through the superior-lateral surface of the posterior arch of the atlas. This study was conducted with the aim of investigating the prevalence of ponticulus posticus in orthodontic patients referred to Mashhad Dental School.

Methods: In this cross-sectional study, one thousand cephalograms were selected from the patients referred to the orthodontics department of Mashhad Dental School between 2017 and 2021. In lateral cephalogram images with appropriate quality, the type of malocclusion was determined using the AudaxCeph software (Audax d.o.o., Ljubljana, Slovenia). Then, the images were evaluated for the presence or absence of PP. For the statistical analysis, chi-square and t-test were used.

Results: In this study, 861 lateral digital cephalograms were analyzed. The overall prevalence of PP in the studied population was 17.5%. The prevalence of PP was higher in males than in females (P < 0.001). The variables "presence of PP" (P = 0.056) and "type of PP" (P = 0.522) were found to be independent of age groups. Although class II subjects showed a higher prevalence of PP, skeletal malocclusion classes were not found to be correlated with the presence of PP (P = 0.104) nor with its types (P = 0.958).

Conclusion: The current study is considered the primary study that provides data concerning the prevalence of PP in the East of Iran. Our study showed that PP was not rare in this region. More studies with 3D radiological examination are needed to increase the accuracy of diagnosing PP and its prevalence in Iran.

Background: Acid-base disturbances are frequently found in intensive care unit (ICU) patients. Base excess (BE) is commonly used to quantify the degree of metabolic impairment. We aimed to compare the predictive value of BE and Sequential Organ Failure Assessment (SOFA) score for mortality in ICU patients.

Methods: This prospective and observational investigation was performed on 87 ICU patients who underwent mechanical ventilation. SOFA score and acid-base variables at 6 hours of ICU admission were analyzed and compared between survivors and non-survivors. Receiver-operating characteristic (ROC) curve was applied to analyze the predictive value of BE and SOFA for mortality.

Results: Mean age of patients was 63.91±5.03 years, and 60 (69%) were male. The non-survived patients had significantly higher SOFA (P = 0.001) and APACHE II scores (P = 0.001). The non-survived patients had a lower bicarbonate (P = 0.002), PO₂ (P = 0.001), pH (P = 0.0021), and a higher PCO₂ (P = 0.001) compared with survivors, and most patients who died (80%) had a low BE value (< -2) (P = 0.002). The estimated AUC of SOFA and BE was 0.83 (95% CI, 0.73 - 0.92) and 0.71 (95% CI, 0.57 - 0.85), respectively.

Conclusion: BE is, to some extent capable of predicting mortality in ICU patients. However, the SOFA score is a more accurate and reliable parameter in comparison to BE for prediction.

Background: Pulmonary compliance is an important lung factor and is affected by tidal volume. In this study, static and dynamic compliance with tidal volumes of 6 and 10 ml/kg have been evaluated in patients undergoing abdominal cancer surgery.

Methods: This randomized clinical trial was conducted on 50 patients who were candidate for abdominal cancer surgery. This study was done in patients aged 20-65 years without chronic diseases. After induction of anesthesia, the first group was ventilated with a tidal volume of 10 ml/kg and 8 breaths/minute, and also the second group was ventilated with a tidal volume of 6 mL/kg and 14 breaths/minute. From the beginning and every 15 minutes, expiratory tidal volume, peak and plateau airway pressure, heart rate and blood pressure were measured for two hours. The data was analyzed with SPSS v.20 and P < 0.05 was meaningful.

Results: There was no significant difference between the two groups for demographic characteristics. There was no significant difference between the two groups in the dynamic and static compliance of the patients during the study. However, the static compliance decreased in the 6 ml/kg group and increased in the 10 ml/kg group, but the difference was not statistically significant (P = 0.32). The peak, plateau pressure and hemodynamic parameters were the same in the two groups.

Conclusion: In general, the static and dynamic compliance was not significantly different in the two groups despite a slight decrease in the 6 ml/kg group and a slight increase in the 10 ml/kg group.

Background: Many children with autism spectrum disorder (ASD) are unable to benefit from timely interventions. This research aimed to indirectly enhance play and communication skills in ASD children by providing a video educational package and distance education for their parents.

Methods: In this clinical trial study, 32 parents and their children with ASD were randomly assigned to either the intervention or waitlist control groups. The intervention group received an educational video package along with 24 one-hour online sessions. The frequency of communication, engagement in functional games, and the use of conventional and unconventional gestures were assessed before, immediately after, and 3 months following the completion of the intervention in the participating children. The variables were analyzed within and between the two groups using a mixed between-within-subjects analysis of variance (ANOVA).

Results: The intervention group achieved significantly higher scores than the control group in the frequency of communication (P = 0.003), functional play (P < 0.001), and conventional gestures (P < 0.001). Conversely, the intervention group had significantly lower scores than the control group in unconventional gestures (P < 0.001).

Conclusion: The observed improvements in both parents and children within the intervention group provide compelling support for the effectiveness of telepractice in speech therapy. This suggests that incorporating remote training methods into speech therapy sessions could enhance access for children with ASD to these interventions.

Background: It is now confirmed that mental health promotion policies need innovations beyond the scope of the health sector. In this study, an attempt was made to identify the most effective stakeholders of the public sector in the field of mental health promotion in Iran to help the policy-makers and to encourage inter-sectoral collaboration and further involvement of these effective sectors in mental health promotion plans.

Methods: This was a mixed-methods study. From the first step (literature review and a survey), the names of public agencies affected by mental health promotion were extracted. In the next step, a checklist for identifying the main stakeholders was developed. The data of this step were analyzed by the simple additive weighting method. Ultimately, a table was plotted in the form of institutional mapping in order to summarize the organizations affecting each risk factor of mental health promotion.

Results: The Islamic Consultative Assembly, the Ministry of Interior, the Islamic Republic of Iran Broadcasting, the Ministry of Cooperatives, Labor, and Social Welfare, and the Ministry of Education were identified as the five institutions with the greatest impacts on the social determinants of mental health in Iran.

Conclusion: Significant impacts can be exerted by institutions such as the Islamic Consultative Assembly (as the legislator), the Ministry of Interior, and its subsidiary entities such as municipalities and governors (as the administrators of homeland security and support for safe and appropriate urban and local facilities), the Islamic Republic of Iran Broadcasting (as the national media), the Ministry of Cooperatives, Labor, and Social Welfare (as the institution in charge of employment, job security, and social welfare), and the Ministry of Education (as the educational institution of the country).

Background: Neonatal mortality is a significant public health issue that can often be prevented. The present study was designed and conducted to determine the causes of neonatal mortality and the status of their mothers in Kurdistan Province in 2019.

Methods: In this matched case-control study, the case group comprised 171 deceased neonates, while the control group consisted of 171 healthy neonates, along with their mothers' status in Kurdistan Province in 2019. for each case in each city, one control from the same city within the same week of the case's birth was randomly selected. Data were collected using a checklist containing information on the neonates and their mothers. The analysis was performed using STATA 17 software, which involved descriptive tests and analytical tests. These included frequency calculation, chi-square test, conditional logistic regression, and a stepwise backward elimination method for multivariate analysis with (P = 0.1). A significance level of P < 0.05 was considered.

Results: The results, after matching the odds ratio with a CI 95% using the backward method, showed a significant association between prematurity (OR:15.99, 95%CI:4.38-58.31), complications during pregnancy (OR:8.64, 95% CI:2.80-26.66), weight gain during pregnancy (OR:3.04, 95% CI:1.06-8.70).

Conclusion: The findings of our study suggest a positive association between neonatal mortality and specific maternal and neonatal factors, namely neonatal prematurity, complications during pregnancy, and inappropriate weight gain during pregnancy. Therefore, there is a compelling need to implement effective measures to control these identified risk factors, with the goal of reducing neonatal mortality.

Background: Evidence-informed policymaking is a complex process that requires adapting to diverse contexts characterized by varying degrees of certainty and agreement. Existing models and frameworks often lack clear guidance for dealing with such contexts. This study aimed to develop a novel contingency model to guide the context-specific use of evidence in health policymaking.

Methods: The study conducted a meta-ethnographic synthesis of 15 existing models and frameworks on evidence-informed policymaking, integrating key factors and concepts influencing the use of evidence in policy decisions. The study also adapted the Stacey Matrix, a tool for understanding the complexity of decision-making, into a quantitative scoring system to assess the levels of certainty and agreement in a given policy context.

Results: The study proposed a contingency model that delineates seven modes of decision-making based on the dimensions of certainty and agreement, ranging from rational to molasses-slow collective. For each mode, the model suggests configuring four aspects: team composition, policy idea generation, problem analysis, and consensus building. The model also highlights the multifaceted influences of evidence, interests, values, and beliefs on policy decisions.

Conclusion: The contingency model offers researchers and policymakers a flexible framework for aligning policymaking processes with available evidence. The model also underscores the importance of context-specific approaches to evidence-informed policymaking. The model could enhance evidence-informed policymaking capacity, improving health outcomes and system performance. Further research should validate and extend the model empirically across diverse contexts.

Background: Developmental dysplasia of the hip (DDH) is used to describe a spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment are critical to providing the best possible functional outcome. This study aimed to evaluate the prevalence of DDH in neonates with and without risk factors and determine the role of ultrasound screening on the initial diagnosis.

Methods: This prospective cross-sectional study was conducted on 399 infants at the Pediatric Treatment Center, Tehran University of Medical Sciences, between December 2015 and June 2016. Infants with suspected DDH who underwent hip ultrasonography were included, and the presence or absence of each risk factor was documented according to the checklist. The ultrasound findings were also registered in the checklists. The odds ratio (OR) of each risk factor for DDH was calculated. The collected data were analyzed by SPSS software version 18 at a 0.05 significance level.

Results: In 16 months of study, 174 (43.6%) male and 225 (56.4%) female infants under the age of 18 months were studied. Risk factors were detected in the medical history of 329 infants. Out of them, 230(57.6%) were firstborn children, 7 (1.75%) had a positive family history of DDH, and 26 (6.5%) had limb anomalies. There was also a history of breech presentation in 16 (4.01%) and a history of oligohydramnios in 21 (5.1%) of infants. The prevalence of DDH was 25.8% in infants with risk factors and 2.8% in those without risk factors. (OR = 11.84, P < 0.05).

Conclusion: In this study, the frequency of DDH was significantly higher in infants with risk factors. The female gender and limb anomalies were stronger risk factors for DDH. Overall, ultrasound showed great potential for DDH screening.

Background: Diagnosing factitious disorder (FD) poses significant medical challenges; delays impact patient care and costs. Cultural factors of each country also affect illness and behavior disorders. This study examines the prevalence, demographics, and clinical features of factitious disorder patients in Iranian psychiatric hospitals.

Methods: This cross-sectional study reviewed patient data from three psychiatric hospitals in Tehran from 2017 to 2022, confirming FD diagnoses by psychiatry faculty. Inclusion criteria were the diagnosis of FD according to ICD-10 in the last five years. We recorded demographic data, main stressors, symptoms and diagnoses and analyzed them with SPSS-25. Data are presented as numbers and percentages and compared between groups by chi-square test.

Results: A total of 17 cases with the diagnosis of factitious disorder were investigated in 5 years (4.315 per 10,000 patients). The highest frequency age range was between 20-30 years, and most of them were male. Our results showed that in only 7 cases, there was initial suspicion of factitious disorder or factitious disorder imposed on another (factitious disorder by proxy). Most of the patients had psychiatric comorbidities, among which the most common comorbidity was substance use disorder and cluster B personality disorder. Among the evidence of suspicion for the diagnosis of factitious disorder in 65% of cases was a history of multiple previous hospitalization and more than 40% of the cases were based on the pattern of repeated symptoms.

Conclusion: This study showed that FD is underdiagnosed, and more attention is needed to the signs of this diagnosis in the assessments. Also, the clinical features showed that treatment should account for comorbid disorders.