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Per the definition of the World Health Organization, rehabilitation is a set of interventions designed to optimize performance and reduce disability in people with a varying range of health-related disorders in interacting with their environment. Like many other fields of the health-care realm, the application and integration of valid and reliable research are perceivably highly primitive. It is not possible to accurately measure or predict the need for rehabilitation services in general, and it is certainly difficult to do so for specific demographic or geographic classes. Service providers lack the tools to make objective policy and financial decision-making at the systemic level without accurate and reliable information management practices. To gain the capacity to transform the current guidelines of the ministry and make financial changes in the entire rehabilitation process, the rehabilitation sector needs a strong voice and a solid political base to guide the rehabilitation process therefrom. The current narrative review focuses on our knowledge of rehabilitation information systems and what we know and what we want.

Background: Trauma severity indices are commonly used to describe the severity of sustained injuries in a quantitative manner perceivable by healthcare providers in different settings. In this study, we aimed to assess the predictive utility of the Glasgow Coma Scale (GCS) and the 2015 revision of the head Abbreviated Injury Scale (head AIS) as two of the most widely used severity indices for traumatic brain injury (TBI). Methods: In this cross-sectional study, we used data from the National Trauma Registry of Iran. The area under the receiver operating characteristic curve (AUROC) was calculated to assess the utility of GCS and head AIS scores in predicting patients’ outcomes. Results: A total of 321 patients, predominantly males (81.9%) with an average age of 41.9 (±19.5) years were enrolled in the study. The most common cause of injury was road traffic accidents (73.5%) followed by falls (20.2%). The mean admission GCS and head AIS scores were 13.5 (±3.2) and 2.5 (±1.0), respectively. AUROC of the GCS was significantly higher than the head AIS for all outcome variables (P

Objective Lumbar spinal stenosis (LSS) patients suffer from significant pain and disability. To assess long-term safety and efficacy of laminectomy in LSS patients, a systematic review and meta-analysis study was conducted. Methods Literature review in MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library databases was performed using a predefined search strategy. Articles were included if they met the following characteristics: human studies, LSS, and at least 5 years of follow-up. Outcome measures included patient satisfaction, pain, disability, claudication, reoperation rates, and complications. Results Twelve articles met the eligibility criteria for our study. Overall, there was low-quality evidence that patients undergoing laminectomy, with at least 5 years of follow-up, have significantly more satisfaction, and less pain and disability, compared with the preoperative baseline. Assessment of neurogenic intermittent claudication showed significant improvement in walking abilities. We also reviewed the postoperative complication and adverse events in the included studies. After meta-analysis was performed, the reoperation rate was found to be 14% (95% confidence interval: 13–16%). Conclusion Our study provides low-quality evidence suggesting that patients undergoing laminectomy for LSS have less disability and pain and can be more physically active postoperatively.

This study aimed to investigate the use of digital games for educational purposes among medical and paramedical sciences students at Mashhad University of Medical Sciences (Northeast of Iran). This cross-sectional study was conducted from July 2018 to January 2019. The research population was all students of the school of medicine and school of paramedical sciences at Mashhad University of Medical Sciences (n = 496). The research tool was a researcher-made questionnaire based on a literature review. The validity of the questionnaire was confirmed by its content validity, and the reliability of the questionnaire was evaluated based on the test-retest method (r = 0.82). In this examination of medical and paramedical sciences students’ attitudes and perspectives, some novel preliminary insights into the applications, advantages, disadvantages, and features of digital games in education emerge. Overall, the findings showed that the use of interactive digital games can increase students’ motivation for learning and make the learning process more attractive for students. This study was approved by the ethical committee of MUMS (approval number IR.MUMS.REC.1397.151).

Background Trauma care is one of the most expensive medical procedures that is significantly affected by factors like insurance status. Providing medical care to injured patients has a significant impact on patients’ prognosis. This study examined whether insurance status was associated with different outcomes, including hospital length of stay (HLOS), mortality, and Intensive Care Unit (ICU) admission. Methods This prospective study analyzed the data of traumatized patients who had been registered in the National Trauma Registry of Iran (NTRI), and hospitalized at Sina Hospital, Tehran, Iran, from March 22, 2016, to February 8, 2021. Given the type of insurance, the insured patients were classified as basic, road traffic, and foreign nationality. The outcomes of in-hospital death, ICU admission, and HLOS between insured and uninsured patients, and then different insurance statuses, were compared using regression models. Result A total of 5014 patients were included in the study. 49% of patients (n = 2458) had road traffic insurance, 35.2% (n = 1766) basic insurance, 10.5% (n = 528) were uninsured, and 5.2% (n = 262) had foreign nationality insurance. The mean age of patients with basic, road traffic insurance, foreign nationality, and uninsured patients was 45.2 (SD = 22.3), 37.8 (SD = 15.8), 27.8 (SD = 13.3), and 32.4 (SD = 11.9) years, respectively. There was a statistically significant association between insurance status and mean age. Based on these results, the mean age of patients with basic insurance was higher than other groups (p Conclusion This study shows that having insurance can change the ICU admission, death, and HLOS in traumatized patients. The results of this study can provide essential data for national health policy for minimizing the disparities among different insurance statuses and proper use of medical resources.

Migraine is commonly linked to a range of psychiatric comorbidities, primarily anxiety and depression. The present study compared the frequency of anxiety and depression disorders in migraine and non-migraine adolescents and evaluated the relation of depression and anxiety to migraine characteristics.In this case-control study, 234 adolescents (112 migraineurs and 122 non-migraine adolescents) aged 13-18 years were evaluated. A headache questionnaire as well as the Beck Anxiety Inventory and Children's Depression Inventory were completed to investigate the prevalence of headache, anxiety, and depression.The average age of participants was 15.77±2 years in the case group and 15.39±1.79 years in the control group. We found significantly higher levels of mild, moderate, and severe anxiety (38.4%, 23.2%and 23.2% respectively) in the migraine group compared to the control group (24.2%, 5.8%and 10.0% respectively) (p0.001). Significantly more children in the control group (29.6%) than in the case group (10.1%) had a non-depressive CDI score (p=0.005). There was a significant difference between patients with moderate and severe anxiety in terms of attack frequency and duration. Depressed migraineurs recorded higher attack severities and frequencies than migraineurs without depression.Anxiety and depression are common in adolescents with migraine and can be associated with more burdensome attacks.

Introduction: Injury from animal attacks is an important public health problem with high morbidity and mortality. As we cannot neglect or underestimate these hazardous conditions, we aimed to assess animal-related injuries in Iranian patients and compare the results.Methods: In this cross-sectional study conducted on data from the National Trauma Registry of Iran, trauma patients admitted to the hospital due to animal attacks from January 15, 2018, to November 1, 2021, were assessed. A checklist gathered data consisting of baseline characteristics such as sex, age, activity, place at the time of the attack, and injury site. In addition, we extracted the clinical features of these patients, including injury severity score, Glasgow coma scale, intensive care unit (ICU) admission, hospital length of stay, surgery, and discharge status.Results: One hundred thirty-one patients were registered in the study. Most of the patients were male (80.9%), aged 16 to 44 years (59.5%), and encountered animal attacks when they were in agricultural areas (45%). Ninety-six patients (73.3%) underwent surgery, and three were hospitalized in ICUs. We recorded 172 injuries, consisting of 92 (53.5%) injuries in the upper extremities as the most common region of the body. The males were aged 16-44 years (66%), and the females were aged 45-65 (52%) (P=0.005). Fifty percent of males and 24% of females were injured in the agricultural areas. Moreover, 24% of females and 6.6% of males were injured at home.Conclusion: This study showed a high incidence animal attacks in Iran. Most injuries were in middle aged males and in the agricultural area.

Supplemental material, sj-docx-1-opp-10.1177_10781552231180876 for Atezolizumab-associated myositis in a patient with unresectable hepatocellular carcinoma by Tania Baigi, Erika N Brown, Rodrigo M De La Torre and Fadi I Abu-Shahin in Journal of Oncology Pharmacy Practice

Self-confidence is an attribute of the individual that enables one to have a positive or realistic view of themselves or the situations in which they exist. Investigations have shown that people wi...

This systematic review investigates various evaluation tools for digital educational games and answers the question of which evaluation tools could be used to evaluate digital educational games. A systematic review of studies, by searching for related keywords in the title, abstract, and keywords of studies in the scientific databases EMBASE, Web of Science, Scopus, and PubMed, was launched without time-limited on November 2, 2021. The same checklist was used to extract data such as reference, first author's name, year of publication, tool name, type of tool, instructional strategy, and evaluation factors. A total of 3516 articles were extracted and finally, an analysis of the included studies gave us 22 different approaches to the systematic evaluation of educational games. The same study developed some proprietary evaluation tools exclusively for game evaluation. However, some tools evaluated games in different dimensions, most of which did not consider the tool's validity. In the same sense, we have five prominent evaluation guidelines, including E-GESS, MEEGA+, EGameFlow, HEP, and Kato evaluation guideline, all of which have been developed by explicitly decomposing the evaluation objectives into criteria and using a questionnaire assessed through a collection of case studies. Our systematic review showed the need to identify more consistent and uniform patterns in different dimensions for the systematic evaluation of digital educational games to achieve valid results that can be used as a basis for deciding on the use of digital educational games.

Background: The B vitamins can potentially help prevent migraine. This study was designed to examine the effects of supplementation with thiamine (B1), pyridoxine (B6), cobalamin (B12), folic acid (B9), and a combination of these vitamins on women with episodic migraine (EM). Methods: This study was a double-blind, placebo-controlled, randomized, clinical trial conducted on 120 women with EM. The participants were divided into the 6 groups of B1 (n = 20), B6 (n = 20), B12 (n = 20), B9 (n = 20), vitamin B complex (n = 20), and placebo (n = 20). Subjects received 1 capsule daily for 12 weeks. As part of the baseline and post-intervention phases, paper-based headache diaries were used to record the number of abortive drugs consumed and the frequency of headache attacks, and the Migraine Disability Assessment Questionnaire (MIDAS) was used to assess migraine disability. Results: A 16-week study on women with EM revealed that the mean changes in the frequency of headache attacks decreased significantly in all vitamin groups in comparison with the placebo group (P < 0.001). In contrast to the placebo, there was also a significant improvement in the migraine disability score in each vitamin group (P < 0.001). The 12-week supplementation with vitamins B9, B1, B6, B12, and B complex also brought on a significant decrease in the use of abortive drugs compared to the placebo group (P = 0.032). Conclusion: The results of this study showed that B1, B6, B12, and B9, and a combination of these vitamins could be effective as an adjuvant in treatment and prophylaxis of EM. Further large trials with long-term follow-ups will be required to confirm our results.

Study Design: Systematic review. Objective: Providing a comprehensive review of spinal cord injury cost of illness studies to assist health-service planning. Methods: We conducted a systematic review of the literature published from Jan. 1990 to Nov. 2020 via Pubmed, EMBASE, and NHS Economic Evaluation Database. Our primary outcomes were overall direct health care costs of SCI during acute care, inpatient rehabilitation, within the first year post-injury, and in the ensuing years. Results: Through a 2-phase screening process by independent reviewers, 30 articles out of 6177 identified citations were included. Cost of care varied widely with the mean cost of acute care ranging from $290 to $612,590; inpatient rehabilitation from $19,360 to $443,040; the first year after injury from $32,240 to $1,156,400; and the ensuing years from $4,490 to $251,450. Variations in reported costs were primarily due to neurological level of injury, study location, methodological heterogeneities, cost definitions, study populations, and timeframes. A cervical level of the injury, ASIA grade A and B, concomitant injuries, and in-hospital complications were associated with the greatest incremental effect in cost burden. Conclusion: The economic burden of SCI is generally high and cost figures are broadly higher for developed countries. As studies were only available in few countries, the generalizability of the cost estimates to a regional or global level is only limited to countries with similar economic status and health systems. Further investigations with standardized methodologies are required to fill the knowledge gaps in the healthcare economics of SCI.

PURPOSE: Second-hand smoke is recognized as a major indoor pollutant. Evidences indicated that Second-hand smoke exposure can influence on not only physical health, but also mental well-being. As the correlation of secondhand smoke exposure with sleep quality and quality of life has not yet been clarified sufficiently, the purpose of this study was to evaluate the association between Second-hand smoke exposure, with sleep quality and quality of life after adjusting for active smoking and other relevant confounders. METHODS: The participants of this study were 1790 staff in Tehran University of Medical Sciences with different jobs employed in various academic departments (clinical, research, services, educational and technical ones). They participated voluntarily in this research project and completed the informed consent form between 2018 and 2019. A translated questionnaire of Global Adult Tobacco Survey was used to gather information about smoke exposure. When to evaluate the quality of life, the WHOQOL-BREF tool was applied. All statistical analyses were executed using STATA V14 software. RESULTS: High rate of smoking and also exposure to second-hand smoke significantly increased sleep disorder and reduced the quality of life. In other words, smokers or those who are exposed to second-hand smoke suffer from sleep disturbances and had a poorer physical, psychological, and environmental quality of life. Additionally, the results of multivariate regression analysis demonstrated that the secondhand-smoke group had 1.38 times higher rate of sleep disorder in comparison with non-smokers, that was statistically significant. The women had 2.68 times higher odds of having sleep disorder compared to men. (95 % CI: 2.20 to 3.27). On the other hand, mean score of psychological domain of quality of life in secondhand-smoke group was lower with the size of difference as 0.66 than that in non-smokers, and the difference was statistically significant (p = 0.001). CONCLUSIONS: Both active smoking and exposure to second hand smoke have a negative impact on sleep quality and quality of life.

INTRODUCTION Montgomery-Asberg Depression Rating Scale (MADRS) is a validated tool for rating the depth of depression. The structured interview guide for the MADRS (SIGMA) is an interview guide that has been developed in order to increase the inter-rater reliability. Patients often meet more than one psychiatrists during their hospitalization for depression. A divergent rating of depression between psychiatrists could affect both the treatment and the outcome. This makes knowledge of the inter-rater reliability among psychiatrists important. AIM The primary aim of this study was to measure the inter-rater reliability between psychiatrists when rating depression using the MADRS. METHODS Ten in-patients, who were diagnosed with depression, were filmed while being interviewed using the SIGMA. The patients were after that instructed to rate themselves using the self-rating version of the MADRS. Ten psychiatrists rated the pre-recorded interviews according to the MADRS. The inter-rater reliability was measured using intra-class correlation (ICC). RESULTS The mean ICC for the total MADRS score was 0.952 (95% CI 0.891-0.986; p

To review the role of N-methyl-D-aspartate receptor (NMDAR) antagonists in managing post-TBI cognitive deficits.A search of PubMed, Embase, and Cochrane was conducted on Jan 12, 2021 without publication date or language restriction.Forty-seven studies were included, involving 20 (42.6%) randomized controlled trials. Four (8.5%) studies had a low risk of bias (RoB), while 34 (72.3%) had unclear and nine (19.2%) had high RoB. Six NMDAR antagonists had been investigated: amantadine (n = 32), memantine (n = 4), magnesium (n = 4), traxoprodil (n = 3), selfotel (n = 2), and dextromethorphan (n = 2).Although some benefits were observed, there are still some concerns regarding the efficacy and safety of NMDAR antagonists in improving post-TBI cognitive deficits. Further research is required to examine whether (i) these agents, notably amantadine, could accelerate cognitive improvement and shorten the hospital stay, (ii) these agents affect different cognitive domains/subdomains in the same direction, (iii) an optimal therapeutic time window exists, (iv) a member of this drug class can be proved to be effective without interfering in non-excitotoxic actions of glutamate, (v) they can be more effective as part of combination therapies or in particular subgroups of patients with TBI.

This study aims to identify the type and number of errors in the Iranian Electronic Health Record System (SEPAS) in hospitals affiliated with Mashhad University of Medical Sciences (MUMS). A cross-sectional analytical study was conducted to specify the errors done by SEPAS in the first half of 2019, based on the type and number of errors in 26 hospitals affiliated with MUMS that were connected to the SEPAS system. SEPAS system errors were classified into four categories: identity errors, clinical errors, administrative-financial and technical errors. The most important errors that occurred in the SEPAS system included non-authentication errors in Hospital Information System (HIS), non-service records, and invalid national code, respectively. Therefore, hospital administrators and information system developers must make an effort to prevent such errors.

This is a study protocol to evaluate the Impact of digital games on learning medical terminology of paramedical students. An unblinded randomized controlled trial (RCT) 2-arm, with 1:1 allocation ratio was randomized by 60 students at the faculty of paramedical science at Mashhad University of Medical Science(MUMS), Iran, who had their medical terminology course at the time of this study, would enter the study. To evaluate the game, Participants in both groups attended typical teaching in traditional instructional activities for two months; however, the intervention group played the smartphone-based digital game during the course. The knowledge level of students in the control and intervention group were measured before and immediately after the intervention using the pre-designed questionnaire. This study was approved by the ethical committee of MUMS (approval number IR.MUMS.REC.1400.336).

This study aims to identify the type and number of errors in the Iranian Electronic Health Record System (SEPAS) in hospitals affiliated with Mashhad University of Medical Sciences (MUMS). A cross-sectional analytical study was conducted to specify the errors done by SEPAS in the first half of 2019, based on the type and number of errors in 26 hospitals affiliated with MUMS that were connected to the SEPAS system. SEPAS system errors were classified into four categories: identity errors, clinical errors, administrative-financial and technical errors. The most important errors that occurred in the SEPAS system included non-authentication errors in Hospital Information System (HIS), non-service records, and invalid national code, respectively. Therefore, hospital administrators and information system developers must make an effort to prevent such errors.

This is a study protocol to evaluate the Impact of digital games on learning medical terminology of paramedical students. An unblinded randomized controlled trial (RCT) 2-arm, with 1:1 allocation ratio was randomized by 60 students at the faculty of paramedical science at Mashhad University of Medical Science(MUMS), Iran, who had their medical terminology course at the time of this study, would enter the study. To evaluate the game, Participants in both groups attended typical teaching in traditional instructional activities for two months; however, the intervention group played the smartphone-based digital game during the course. The knowledge level of students in the control and intervention group were measured before and immediately after the intervention using the pre-designed questionnaire. This study was approved by the ethical committee of MUMS (approval number IR.MUMS.REC.1400.336).

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p

Study Design Systematic Reviews. Objectives To investigate predictors of surgical outcomes for mild Degenerative Cervical Myelopathy (DCM) by reviewing all related studies conducted at this point. Methods An electronic search was carried out in PubMed, EMBASE, Scopus, and Web of Science until June 23, 2021. Full-text articles reporting surgical outcome predictors of mild DCM cases were eligible. We included studies with mild DCM which was defined as a modified Japanese Orthopaedic Association score of 15 to 17 or a Japanese Orthopaedic Association score of 13 to 16. Independent reviewers screened all the records, and discrepancies between the reviewers were solved in a session with the senior author. For risk of bias assessment, RoB 2 tool was used for randomized clinical trials and ROBINS-I for non-randomized studies. Results After screening 6 087 manuscripts, only 8 studies met the inclusion criteria. Lower pre-operative mJOA scores and quality-of-life measurement scores were reported by multiple studies to predict better surgical outcomes compared to other groups. High-intensity pre-operative T2 magnetic resonance imaging (MRI) was also reported to predict poor outcomes. Neck pain before intervention resulted in improved patient-reported outcomes. Two studies also reported motor symptoms prior to surgery as outcome predictors. Conclusion Lower quality of life before surgery, neck pain, lower pre-operative mJOA scores, motor symptoms before surgery, female gender, gastrointestinal comorbidities, surgical procedure and surgeon’s experience with specific techniques, and high signal intensity of cord in T2 MRI were the surgical outcome predictors reported in the literature. Lower Quality of Life (QoL) score and neck prior to surgery were reported as predictors of the more improved outcome, but high cord signal intensity in T2 MRI was reported as an unfavorable outcome predictor.

Background Socioeconomic status, especially during childhood, is known as one of the key factors affecting health. This study’s objective was to investigate the association between childhood socioeconomic and mental health status in adulthood. Methods This cross-sectional study was conducted on 2062 employees of Tehran University of Medical Sciences. Depression, stress and anxiety were measured using the validated DASS-42 questionnaire. A self-rated question was used to assess childhood socioeconomic status. Other variables including age, sex, marital status, and also wealth index, were measured. Linear regression models were used to analyze the data. Results 24.6% of men and 33.8% of women had degrees of depression (mild, moderate, severe or very severe). 32.9% of men and 29.4% of women had mild, moderate, severe or very severe anxiety. 36.3% of men and 45.2% of women also exhibited mild, moderate, severe or very severe stress. Results showed after adjusting for the current socioeconomic status, childhood socioeconomic status has a relationship with the mental health of individuals. Conclusion People with a suboptimal childhood socioeconomic status seem to be a high-risk group for depression, stress and anxiety in adulthood. Strategies need to put into practice to improve the mental health of these people.

Håkan Bergh,1,2 Margit Albrektson,3 Clovis Kastberg,4 Amir Baigi,1,2 Lennart Hedström3 1School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; 2Department of Research & Development Unit, Hospital Varberg, Region Halland, Sweden; 3Public Dental Services, Västra Vall, Varberg, Sweden; 4Tre Tandläkare, Varberg, SwedenCorrespondence: Håkan Bergh, School of Public Health and Community Medicine, Institute of Medicine, P.O. Box 463, Gothenburg, 405 30, Sweden, Email hakan.e.bergh@gmail.com Lennart Hedström, Public Dental Service, Västra Vallgatan 14, Varberg, S-43244, Region Halland, Sweden, Email h.lennart.hedstrom@gmail.comObjective: To study the association between sublingual varices (SV) and cardiovascular (CVD) risk factors.Methods: A total of 989 consecutive dental patients aged 55– 84 years participated in the study, which applied a survey about risk factors, diseases and medications. Digital photos of the lateral borders of the tongue, height, weight, waist, hip and blood pressure were registered, and blood samples were analyzed. Those with SV were compared with those without SV (nSV).Results: Those with SV had more hypertension 41.8% vs 27.0% (p< 0.0001), a higher systolic blood pressure (BP) 139.5 (SD 18.6) mmHg vs 134.3 (SD 18.8) mmHg (95% CI − 7.73 &boxh; − 2.72), more diabetes type 2 (DM-2) 7.4% vs 3.8% (p=0.014), a higher fasting plasma glucose 5.9 (SD 1.5) mmol/L vs 5.7 (SD 1.0) mmol/L (95% CI − 0.42 &boxh; − 0.05), more dyslipidemia 24.1% vs 17.7% (p=0.018), lower HDL 1.6 vs 1.7 (p=0.003), a greater waist circumference 97.0 cm vs 93.9 cm (95% CI − 4.66 &boxh; − 1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI − 0.03 &boxh; − 0.01), and a higher BMI 26.6 kg/m2 vs 26.0 kg/m2 (95% CI − 1.11 &boxh; − 0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 &boxh;2.13), a high systolic BP OR =1.5 (95% CI 1.11 &boxh;2.13), a high fP-glucose OR= 1.8 (95% CI 1.03 &boxh;3.21), a low HDL OR= 1.8 (95% CI 1.15 &boxh;2.92), a greater waist circumference OR= 1.68 (95% CI 1.10 &boxh;2.58), a greater waist/hip ratio OR=2.21 (95% CI 1.36 &boxh;3.58), and a higher BMI OR=1.05 (95% CI 1.02 &boxh;1.09).Conclusion: This study shows an association between SV and a high BP, a high fP-glucose, hypertension, diabetes mellitus type 2, dyslipidemia, abdominal obesity, older age and smoking.Keywords: sublingual varices, cardiovascular riskfactors

Background: The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. Methods: A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. Results: In total 89,503 patient attendances were included in the final analysis. Of those, 29.1% resulted in admission within 24 h. The mean hospital bed occupancy by the hour of the two hospitals was 87.1% (SD 7.6). In both the univariate and multivariate analysis, odds ratio for admission within 24 h from the ED did not decrease significantly with an increasing hospital bed occupancy. Conclusions: A negative association between admission to hospital and occupancy level, as reported elsewhere, was not replicated. This suggests that the previously shown association might not be universal but may vary across sites due to setting specific circumstances. (Less)

Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities. Design: Prospective two-armed randomised intervention. Setting: Three PHC centres in south west of Sweden. Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails. Main outcome measures: Weight, quality of life, risks and health factors. Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012). Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key pointsBoth groups had a consisting weight- reduction after two years.High intensity did not lead to a significant difference in weight reduction between the groups.The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle

We consider disease mapping of early- and late-stage cancer, in order to identify and monitor inequalities in early detection. Our method is demonstrated by mapping cancer incidence at high geographical resolution using data on 10,302 cutaneous malignant melanoma (CMM) cases within the 3.7 million population of South-West Sweden. The cases were geocoded into small-areas, each with a population size between 600 and 2600 and accessible socio-demographic data. Using the disease mapping application Rapid Inquiry Facility (RIF) 4.0, we produced regional maps to visualise spatial variations in stage I, II and III–IV CMM incidences, complemented by local maps to explore the variations within two urban areas. Pronounced spatial disparities in stage I CMM incidence were revealed by the regional and local maps. Stage I CMM incidence was markedly higher in wealthier small-areas, in particular within each urban area. A twofold higher stage I incidence was observed, on average, in the wealthiest small-areas (upper quintile) than in the poorest small-areas (lower quintile). We identified in the regional map of stage III–IV CMM two clusters of higher or lower than expected late-stage incidences which were quite distinct from those identified for stage I. In conclusion, our analysis of CMM incidences supported the use of this method of cancer stage incidence mapping for revealing geographical and socio-demographic disparities in cancer detection. Electronic supplementary material The online version of this article (10.1007/s10654-020-00637-0) contains supplementary material, which is available to authorized users.

In this paper, a new model for distribution network rearrangement (DNR) with regard to plug-in electric vehicles (PEVs) is presented. The proposed model is a random model (random programming) in which scenarios corresponding to vehicle uncertainty are simulated by the Monte Carlo method. The distribution system was also mathematically modeled by an approximate linear model. This way of modeling helps us to derive a new design based on linear integer programming. The electricity market is considered to be the day-ahead electricity market. Uncertainties regarding the price of electricity as well as the load of the distribution network are also considered. The simulation results on a 24-bus distribution system showed that the proposed model has the required efficiency. Uncertainties related to PEVs are modeled by random programming using Monte Carlo Simulation (MCS). The DNR problem is formulated as a MILP problem. This problem is then solved by the Banders decomposition (BD) algorithm. Numerical results also showed that if the PEV is charged intelligently in the DNR issue, then the cost of purchasing electricity from above will be lower than in the case where the PEV is not controlled in a controlled way. We also see a different switching strategy in these two cases, which indicates that considering the electric vehicle in the DNR problem is inevitable. In addition, a method for rearranging distribution networks to transfer load from one feeder to another was presented. It has been observed that this reduces the load of high-capacity feeders well and causes the construction of new feeders to be delayed. It was also observed that rearrangement of the distribution network leads to a reduction in network losses. Also, with the help of rearrangement, the amount of interrupted load can be significantly reduced.

The article's abstract is not available.

To prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.This retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX).Totally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p 0.001). In the ≤15 years and ≥65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p 0.02. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p 0.001).The pandemic affected the epidemiology of traumatic patients in terms of gender, age groups, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.

Introduction: Covid-19 pandemic is spreading rapidly around the world. Given the high risk of transmission of the disease in order to curb the effects of the epidemic, governments and health care organizations must maximize the capacity of medical care, protective equipment and preventive measures. Therefore, in this study, the challenges and recommendations for the use and development of telemedicine technologies during the Covid-19 epidemic were examined.Material and Methods: A systematic review of English-language studies was conducted by searching for keywords in the authoritative scientific databases. Studies related to the challenges and recommendations of telemedicine at the time of the Covid-19 epidemic were considered as inclusion criteria. Titles and abstracts were screened independently based on eligibility criteria. Complete texts were then retrieved and screened independently based on eligibility criteria. The checklist was used to extract data such as study title, first author name, year of publication, country, challenges and telemedicine recommendations during the Covid-19 epidemic.Results: In this study, the existing challenges and recommendations for the use and development of telemedicine technologies were examined. Challenges studied in the studies were included three categories of human, managerial and technical challenges. Human factors, management factors and technical factorsConclusion: The results showed that today human and managerial challenges play a more fundamental and important role than technical challenges. In addition, Covid-19 emergencies are effective in addressing telemedicine challenges, and efforts are underway to expand telemedicine more rapidly as a response to managing and controlling the outbreak of Covid-19 epidemics.

BackgroundThe vast availability of and demand for evidence in modern primary healthcare force clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary healthcare managers play a key role in implementing these governing documents. Thus, the aim of this article is to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary healthcare managers.MethodsThe study is based on a national survey of primary healthcare managers, consisting of 186 respondents, recruited nationally from Sweden. The data was analysed using empirically constructed concepts and validated using factor analysis. A chi-square test was utilized to determine the statistical significance of comparisons. Associations between variables were calculated using Spearman’s correlation coefficients. All tests were two-sided, and the significance level was set to 0.05.ResultsA majority (97 %) of managers stated that guidelines and policy documents impacted primary healthcare; 84 % of managers observed a direct effect on daily practices. Most of the managers (70 %) stated that some adaptation was needed when new evidence was introduced. The managers emphasized the importance of keeping themselves updated and open to new information about work routines (96 %).ConclusionsThe study illustrates a nearly unanimous response about the influence of clinical evidence on daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date is viewed as a direct result of this effect on daily practice. An information-dense organization such as a primary healthcare organization would have much to gain from increased cooperation with regional information resources such as clinical libraries.

Study Design: Development and psychometrics study Objective: To evaluate the reliability and validity of a new version of cognitive appraisals of health situation scale in Traumatic Spinal Cord Injury (CAHSSTSCI) in the Persian language for persons with spinal cord injury (SCI).Setting: The persons were selected from National Spinal Cord Injury Registry of Iran (NSCIR-IR) and Brain and Spinal Cord Injury Research center (BASIR).Method: This was a mixed sequential exploratory study that performed in two phases. In the qualitative phase, a systematic scoping review and 12 interviews with the participants were done. Finally, items were generated. In the quantitative phase, to evaluate the validity; face, content, construct and convergent validity were assessed. To evaluate construct validity, a cross-sectional study was conducted on 305 persons with TSCI, and also the reliability was examined by internal consistency and stability assessment. All quantitative data analyses were conducted using SPSS 20 software.Results: The content validity and reliability were indicated by Scale’s Content Validity Ratio (S-CVR) = 0.73 and Scale’s Content Validity Index (S-CVI) = 0.86, Cronbach’s α = 0.9 and the Test re-test reliability using intra-class correlations were (ICC) = 0.97 to 0.98. Exploratory factor analysis determined eight factors which showed more than 52% of the variance. CAHSSTSCI had a significant and strong correlation with Appraisals of DisAbility Primary and Secondary Scale (ADAPSS) (r=0.475, P < 0.001).Conclusion: Results showed the 36 items CAHSSTSCI tool had an acceptable validity and reliability in Iran and it can help health care providers or even administrators to improve the quality of the rehabilitation services and quality of life through design training programs for SCI people due to traumatic incidents.

Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) is known to be endemic in the population of northeastern Iran. This study was conducted with the aim of investigating the knowledge and attitude of medical students of Mashhad University of Medical Sciences about the HTLV-1 virus.Material and Methods: The present study was a descriptive-analytical study that was conducted in Mashhad Medical School from April to June 2014. The research population included all medical students studying at the time of the study (307 people). The tool of data collection was a questionnaire including 4 parts of demographic characteristics, the amount of information resources used, the level of awareness about HTLV-1 infection and measuring the attitude of students towards HTLV-1 infection. The data was analyzed in the form of descriptive statistics using SPSS 16.0 software.Results: A total of 271 people responded to the questionnaire (response rate: 88/27). Among the participants, 130 were male and 141 were female. The majority of students, 161 people got their information from the classroom and 157 people were natives of Mashhad. The information obtained from the description of the questions and the percentage of correct answers to the questions showed that the level of students' knowledge about this infection was average with an average score of 16.66 out of 40 points, and the average score of the students' attitude was reported as 68.11 with an average level.Conclusion: The obtained results reported the level of knowledge of the target group as medium-low, and the level of attitude of this group as medium-high. Also, there was a direct relationship between the amount of information and the level of attitude with the year of entering the university and studying in the university, which reports the slope of this change as low.

Introduction: In recent decades, following the upward trend of aging, one out of three people in the world need rehabilitation services during the period of illness or injury. Considering the long-term complications and high costs of treatment, the need to follow up and review the evidence to find the best care programs and extensive planning in this field seems mandatory. Registry systems (registration) in this area can provide the necessary evidence for strategic decisions in this field. Of course, launching and developing these systems comes with challenges. Therefore, the purpose of this comprehensive literature review is to examine the challenges and benefits of developing a rehabilitation registration system.Materials and Method: A systematic review, in studies published in English, without time limit and by searching for keywords in the keywords, title and abstract of reliable scientific databases Web of Science, Scopus, PubMed and Science Direct, as well as searching the title of studies in the database Cochrane data was accessed on March 31, 2021. Studies that were a possible answer to the researched question based on the title and content were examined. A total of 1924 related studies were identified; And finally, 32 qualified articles were included in this review.Results: One of the most important challenges investigated was the limitation of rehabilitation comprehensive registration systems. Other challenges include the lack of support for ensuring the quality of registration data, insufficient funds for investment, privacy and data security, the unclear purpose of registration system development, access to hardware infrastructure, lack of binding laws and regulations related to registration systems, lack of access to sufficient information. To implement information registration systems, continuous monitoring and holding training courses.Conclusion: The most important challenge investigated was that currently the health care and rehabilitation registration systems around the world are focused on single diseases (single discipline rehabilitation), which does not meet the needs of patients due to the multifactorial nature of rehabilitation services and chronic diseases. Therefore, it seems that the connection between the data registration systems with the help of a comprehensive guideline or model or the creation of a national integrated central database in the form of integration with other health information systems and based on electronic health records will be very efficient.

Aims: The aims of this study were to construct a small-area index of multiple deprivation (IMD) from single deprivation indicators (SDIs) and to compare the explanatory power of the IMD and SDIs with regard to mortality. We considered a small-area division of Sweden consisting of 5985 DeSO ( Demografiska statistikområden), each with a population size between 653 and 4243 at the end of 2018. Methods: Four SDIs were provided by open-source data: (a) the proportion of inhabitants with a low economic standard; (b) the proportion of inhabitants aged 25–64 years with ⩽12 years of schooling; (c) the proportion of inhabitants aged 16–64 years who were not in paid employment; and (d) the proportion of inhabitants who lived in a rented apartment/house. A four-indicator IMD was constructed using factor analysis. As a validation, the IMD and SDIs were compared by exploring their DeSO-level associations with spatially smoothed death rates, with robustness checks of associations across different small-area contexts defined by degree of urbanisation and distribution of immigrants from non-Western countries. Results: The constructed IMD and SDI1 performed essentially equally and outperformed SDI2, SDI3 and SDI4. Associations between IMD/SDI1 and the spatially smoothed death rates were most pronounced within the age range 60–79 years, showing 5–8% lowered rates among those categorised in the least deprived quintiles of IMD and SDI1, respectively, and 7–9% elevated rates among those categorised in the most deprived quintiles. These associations were consistent within each small-area context. Conclusions: We suggest prioritisation of SDI1, that is, a DeSO-level deprivation indicator based on open-access data on economic standard, for public-health surveillance in Sweden.

Background: Firefighting is a high-risk occupation. The firefighters can be involved in acute and chronic diseases. The study was conducted to investigate the acute symptoms of pulmonary problems, chest radiography, and pulmonary function testing among the professional firefighters of Tehran Firefighting Stations in active firefighting of the Plasco trade center disaster.Methods: A call was announced by the national Fars news agency to examine the firefighters in the Plasco trade center disaster.Results: A total of 56 firefighters completed the study design. They were male, commonly at a young age, and less than their 3rd decade. Upper respiratory tract symptoms were at a higher frequency than a lower airway tract; 98% of the subjects complained of respiratory symptoms. Chest abnormality was 24% and normal acute short-term spirometry was 87%. Acute occupational bronchitis was a prominent respiratory disease.Conclusion: Acute toxic inhalation respiratory diseases, including acute bronchitis, asthma-like disease, and laryngitis were found in our study. Medical monitoring is necessary for the detection of adverse health effects in the exposure, post-exposure, and long lifetime.

Introduction A recent survey showed that 27% of rheumatoid arthritis (RA) patients had inadequately controlled disease activity. Hence, there is a need for new strategies aiming at improving patient outcomes. The aim of the present study was to evaluate the effect of a nurse‐led clinic with frequent visits, treat‐to‐target and person‐centred care of patients with established RA and moderate‐to‐high disease activity compared with patients receiving regular care. Methods The study was a randomized, controlled trial over 26 weeks, with a nonrandomized extension to week 50. Patients were randomized to an intervention group (IG; nurse‐led clinic) based on person‐centred care, frequent visits and “treat to target”, or to a control group (CG) which visited the clinic according to care as usual. The primary outcome was the difference in the DAS28 change between the IG and the CG groups. Results A total of 332 patients were screened for eligibility, of which 70 were randomly assigned to either the IG (n = 36) or the CG (n = 34) group. The primary outcome was not met, although patients in the IG group tended to improve more than those in the CG group (difference: 0.43 (95% confidence interval [CI] –0.27, 1.13). In both the IG and CG groups, delta‐DAS28 improved significantly. The European League Against Rheumatology moderate or good response was achieved by 76% (95% CI 58, 89) in the IG and 49% (95% CI 32, 65) in the CG group. Conclusions Disease activity tended to improve more with the nurse‐led intervention compared with regular care, although the difference was not significant, probably partly due to the lack of statistical power.

This article intends to investigate the presence of coherence tools in one tenth of Harriri's Maghamat by comparing the original text with its translation based on Halliday's systematic functional grammar theory. In this theory, language is the main instrument to convey culture and every element of it is introduced by the certain role in whole language system. In this system, different tools which indicate coherence in the text are applied. By utilizing Halliday's functional grammar, this survey makes an effort to specify the degree of coherence tools exist in certain statistical group, that is Five Maghameh from Harriri's quintet Maghamat: Maghamat like Dinariyeh, Borghaidiyeh, Marviyeh, Shiraziyeh, and Tenisiyeh which represent the whole Maghmat not only from the content point of view (justifying poverty and beggary) but also from thoroughness coherence of language and text point of view. By investigating original text and its translation based on the theory, these results were achieved. Firstly, in the main text and its translation because of the dual approach of the translator (free and literal translation), as well as the difference in the semantic terms of the word and the structure of the grammatical and original language, the degree of cohesion is not quantitatively the same in tools such as elimination, synonymy, collocation, and hyponymy.Secondly, Despite Harriri's extraordinary attention to rhetoric and negligence of writing techniques, at first the text seems to be a little aimless and unclear. Both the book and its translation contain the capacity of reflecting the degree of coherence tools. The book also enjoys triple features of linguistic, narrative storytelling, social enlightenment and coherence elements.