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Abstract Background Multiple sclerosis (MS) is a chronic and progressive neurological autoimmune disease that affects the central nervous system. There are two types of drugs used to treat this disease: injectable and oral drugs. The present study aimed at systematically reviewing the cost effectiveness of oral versus injectable drugs. Methods The researchers searched the PubMed, Scopus, and Web of Science databases to find relevant studies. After removing the duplicates, two authors independently assessed the records. The studies that had conducted full economic evaluations of oral versus injectable drugs in MS patients were included. The Quality of Health Economic Studies (QHES) tool was also used to assess the quality of the studies. Results Thirty studies that had conducted the economic analysis of oral versus injectable therapies in MS patients were included in this review. The QHES scores for all records were generally high (≥ 77) and they were of good quality. The lowest and highest levels of incremental net monetary benefit were respectively obtained through the comparison of Fingolimod and Alemtuzumab (-1,419,333) and the comparison of Teriflunomide and Interferon β-1a (1,792,810). The amount of INMB (incremental net monetary benefit) in the comparisons between oral and injectable drugs showed that the highest and lowest amount of INMB calculated between) Fingolimod and injectable drugs, respectively, compared to (interferon β-1a) 98,253 and (Ocrelizumab) -212,417, the highest amount in dimethyl fumarate is also against (peginterferon β-1a) 191,470 and the lowest against (alemtuzumab) -124,333, Teriflunomide against injectable drugs is the highest against (peginterferon β-1a) 89,956 and the lowest (Ocrelizumab) − 194,169, as well as Cladribine compared to injectable drugs, the highest was compared to (interferon β-1a) 236,430 and the lowest (Ocrelizumab) was 23,965. Conclusion A large number of health economic evaluations of disease-modifying therapies (DMTs) in MS were available at the international level, the comparison of which was difficult and sometimes contradictory. However, despite the difference in the results, Cladribine tablets were cost-effective in all studies compared with injectable drugs. In addition, the present study could be of great importance for policymakers and other beneficiaries regarding the cost-effectiveness of the aforementioned drugs.

Background: This study explored the concept of ‘life balance’ during physical isolation due to COVID-19 in Iran in 2020. Methods: In a cross-sectional design, 403 participants completed the internet-based "Life Balance Inventory (LBI)”, which includes five subscales: health, relationship, identity, challenging/interesting activity, and daily activities. The data were analyzed using SPSS 21, and a significant level of less than 0.05 was considered. Descriptive statistics, t-tests, and one-way ANOVA were utilized in the analysis. Results: The total mean score of LBI was 1.51+_0.38(unbalanced). The scores were distributed among the participants as follows: 52.6% of participants scored between 0.6 and 1.5 (very unbalanced); 37.7% of participants scored between 1 and 1.5 (unbalanced); 8% of participants scored between 2 and 2.5 (moderately balanced); and finally, 1.7% of participants scored between 2.5 and 3 ( very balanced). Significant relationships were found between LBI and gender (P=0.001), chronic comorbidity (P-value =0.029), and Job (P-value=0.044). The health subscale showed no statistical difference according to the demographic factors. Males demonstrated more life balance in their daily activities, including driving and social transportation (p=0/001). Married participants and those older than 40 exhibited more balance in the relationship subscale (p-value=0/001). Teachers and faculty members showed more balance in identity (p=0.014) and relationship (p=0.001). Higher-income participants revealed more life balance in the challenge/interesting subscale (p=0.033). Conclusion: The results suggested that participants experienced an unbalanced lifestyle during the early phase of COVID-19 isolation.

Abstract Background During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. Method This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. Results During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25–0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97–2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13–1.40]) and mortality rate (OR 1.05, [1.04–1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17–0.31]) and second years (IRR 0.35, [0.26–0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21–0.42]), influenza (IRR 0.04, [0.03–0.06]) and COPD (IRR 0.39, [0.23–0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42–3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65–2.78]) and musculoskeletal (OR 1.48, [1.20–1.82), nervous system (OR 1.42, [1.26–1.60]), metabolic (OR 1.99, [1.80–2.19]) and circulatory diseases (OR 1.35, [1.31–1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19–1.49]), heart failure (OR 1.59, [1.35–1.87]) and stroke (OR 1.35, [1.24–1.47]) showed an increase in mortality rates without changes in hospitalization. Conclusions In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.

Background: The hospital autonomy plan, the biggest decentralization plan to reform the administration structure of public hospitals, has been implemented for about three decades in Iran. In this study, we aimed to examine the effects of the plan on the financial indicators of autonomous public hospitals. Materials and Methods: This descriptive cross-sectional study used revenue and cost data associated with all public hospitals affiliated to Bushehr University of Medical Sciences in 2021. The relevant data was extracted from two big databases including health information system (HIS) and accounting system, and after the data quality control, specific financial self-sufficiency balance (the ratio of specific income to the specific cost of the same hospital) and total financial balance (the ratio of specific income to the total cost of the same hospital) were calculated using Excel software. Results: Results demonstrated that the specific financial self-sufficiency balance and the total financial balance were 61% and 27%, respectively. The highest and the lowest values of the specific financial self- sufficiency index pertained to the Heart Hospital (the only single specialty heart hospital in the province) and Imam Hossein Hospital (a hospital with 29 active beds in Tangestan county with a population of 82502) as 74% and 45%, respectively. The gap index between the specific cost and revenue of each ac-tive bed showed that on average, the cost of each bed was nearly 215 million Tomans higher than its own income in 2021. Conclusion: The hospital autonomy plan had different effects on the financial indices of public hospitals studied in this research, denoting it is not possible to cover all hospital-specific expenses through its own earned revenues. Accordingly, government subsidies to autonomous hospitals are necessary.

Background : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion: The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

BackgroundDifferent populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients.MethodsIn this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models.ResultsA total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75-26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34-1.37]) and among ICU admitted patients (1.12 [1.09-1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91-2.22]) and in ICU (aOR = 1.71 [1.51-1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51-1.54]) and at ICU (median ratio = 1.17 [1.16-1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32-1.48]), Alborz (aOR = 1.28 [1.22-1.35]), and Khorasan Razavi (aOR = 1.24 [1.20-1.28]) were the provinces with the highest risk of mortality in hospitalized patients.ConclusionHospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.

IntroductionWater is one of the most important needs of plants and drought stress is one of the most important stresses for plant growth. Given the global water shortage, provide solutions to save water consumption in agriculture, such as choosing the appropriate irrigation method, irrigation time management, providing methods to reduce and control the negative effects of water shortage on plants and the use of more resistant varieties to water shortage and The use of different techniques to reduce the effects of water scarcity is important and should be a priority for research. Paclobutrazole is a group of plant growth regulators of triazole that prevents the production of a wide range of gibberellic acid and has many applications in agriculture. Paclobutrazole reduces the negative effects of abiotic stress on plant growth by regulating the levels of hormones, enzymatic and non-enzymatic antioxidants and osmolytes. A group of beneficial soil bacteria that increase plant growth are called plant growth promoting bacteria and are among the most important types of biofertilizers. PGPRs by lat out of volatile organic compounds (VOC) increase biomass, plant tolerance to abiotic stresses and disease resistance.Materials and MethodsThis research was conducted as a factorial split plot in the form of a randomized complete block design with three replications in Qom and Hamedan regions (Hamedan is a cold and mountainous region with mild summer and Qom is a dry and desert region with hot and dry summers). Experimental factors include irrigation regime with three levels 1- (irrigation at 40% of available plant moisture discharge during the growing season (optimal irrigation), 2- optimal irrigation up to pollination stage and irrigation at 60% of available plant moisture discharge until the end of the growing season 3- Irrigation in 40% of available plant moisture discharge up to pollination stage and cessation of irrigation until the end of growing season), foliar application of paclobutrazole at three levels (zero, 50 and 100 ppm in two stages of stem and spike) and invoice The third included five levels of growth-promoting bacteria (non-consumption, Mycobacterium, Azotobacter, Azospirillium, and a combination of three bacteria). Irrigation regimen factors and paclobutrazol in the main plots and growth-promoting bacteria in the subplots. The traits evaluated in this experiment included parameters related to leaf chlorophyll fluorescence and Rubisco activity. Results and DiscussionThe results showed that the interaction effect of irrigation regime on paclobutrazol was significant for biological yield and grain yield, so that at the third irrigation level, the use of paclobutrazol at a concentration of 100 ppm increased grain yield and biological yield. Also, according to the analysis of variance table, the interaction effect of irrigation regime in bacteria for biological yield and grain yield was significant, so that in the third level of irrigation regime, two levels of combination of three bacteria and Azotobacter with 19.05 and 17.95 tons, respectively. Hectares had the highest biological yield.ConclusionsIn general, the results showed that in more difficult conditions of irrigation regime, the use of paclobutrazol can cause less decline and improve grain yield and biological yield. It can also be inferred that the use of growth-promoting bacteria increases grain yield and biological yield and improves morphological traits, and the combination treatment of Mycobacterium, Azotobacter and Azospirillium had the highest yield.

Background and Aims Exercise training is an important intervention in the pulmonary rehabilitation of adults with chronic respiratory diseases. High-intensity exercise is challenging for these patients. Thus, interval exercise has received much attention as a suitable option for optimizing a tolerable load during exercise. This study aimed to investigate the effects of high-intensity interval training (HIIT) on peak power, peak oxygen uptake, functional capacity, and health-related quality of life in people with chronic respiratory diseases.Methods In this study, the related studies were collected and examined from Google Scholar, PubMed, and Science Direct databases.Results A total of 14 randomized controlled trials were selected based on the study subject. The results demonstrated that HIIT and continuous training in adults with chronic obstructive pulmonary disease (COPD) led to significant improvement in peak power, peak oxygen uptake, and 6-minute walk test (6MWT) or 12-minute walk test (12MWT) distance and health-related quality of life and there was no significant difference between the two groups. And HIIT, compared to no exercise training, showed greater significant changes. Few studies have examined HIIT in patients with cystic fibrosis, with different results. We found no studies investigating the effect of HIIT on non-cystic fibrosis bronchiectasis and interstitial lung diseases.Conclusion studies confirm the positive effect of HIIT on cardiorespiratory fitness, exercise capacity, functional capacity, and health-related quality of life in people with COPD. In other respiratory diseases, more studies are needed to investigate the effects of HIIT.

Abstract Background Nurses have been at the center of managing the COVID-19 outbreak through direct bedside care in respiratory, emergency and intensive care environments, managing hospital units, providing Covid-19 testing, vaccination and contact tracing. Thus, the present study aimed to analysis the strategies used by Iranian nurses for management of Provided Care for patients with COVID- 19. Methods The present study was conducted based on the conventional content analysis method and Graneheim & Lundman approach. The participants included the nurses working in the COVID-19 wards and were recruited by purposeful sampling and based on inclusion criteria. The data were collected by conducting semi-structured, in-depth, one-to-one interviews until reaching data saturation. Results In-depth interviews with 10 nurses represented four main categories and fifteen subcategories. Four main categories emerged in this study i.e. “justice in human resources management”, “The art and science of comprehensive nursing care”, “managers as agents of change in crisis” and “challenges and its management”. Conclusion The nurses’ experiences of management strategies showed that paying attention to the financial, psychological, educational, equipment needs of nurses and maintaining their safety make the suitable environment for providing high quality care for patients with covid-19.

Background and Aims: The presence of a blind child in the family puts a lot of pressure on the caregivers, especially the mother. Therefore, the mother’s mental and emotional condition is affected and disturbs her ability to balance time. By knowing the pattern of time use in mothers of blind children, it is possible to help improve the health and quality of life of these mothers. This study aims to evaluate the time use in mothers of children with blindness compared to the mothers of healthy children.Methods: This is a descriptive and cross-sectional study. Ninety mothers of blind and healthy children aged 6-14 years participated in this study. Mothers were selected from among those whose children were in exceptional schools of Shahid Mohebi, Narjes, and Khazaeili and normal schools in West of Tehran, Iran using a convenience sampling method. Mothers’ time use for different activities was evaluated by the Persian version of the Mothers’ time Use questionnaire. The collected data were analyzed in SPSS software versio 21 using independent t-test and Mann-Whitney U test.Results: Mothers of children with blindness spent more time on household chores and childcare and less time on sleeping/resting compared to the mothers of healthy children (50.0≥P).Conclusion: The presence of a blind child in the family affects the ability of mothers in balancing the time and the quality of the time spent by them on daily activities. Therefore, there is a need to pay attention to balance of time as a variable of health and quality of life.

Introduction: Appropriate information about the ability of patients with Parkinson disease (PD) to perform cognitive instrumental activities of daily living (IADL) is necessary. The present study aimed to assess the psychometric properties of the Persian version of the Penn Parkinson daily activities questionnaire-15 (PDAQ-15). Methods: A total of 165 knowledgeable informants of PD patients completed the PDAQ-15. The clinical dementia rating scale, Hoehn and Yahr staging, hospital anxiety and depression scale (HADS), and Lawton IADL scale were used in the study. Internal consistency and test-retest reliability were evaluated by the Cronbach α coefficient and intraclass correlation coefficient (ICC), respectively. To examine the dimensionality of the questionnaire, exploratory factor analysis was used. The construct validity was assessed using the Spearman rank correlation test. To assess the discriminative validity, PDAQ-15 scores were compared across cognitive stages. Results: The PDAQ-15 showed strong internal consistency (the Cronbach α=0.99) and test-retest reliability (ICC= 0.99). Only one dimension was identified for the PDAQ-15 in the factor analysis. There was a strong correlation between PDAQ-15 with the depression domain of the HADS scale and the Lawton IADL scale (rs=|0.71–0.95|). The correlation of PDAQ-15 with the anxiety domain of the HADS scale was moderate (rs=0.66). Discriminative validity analysis showed that the PDAQ-15 has significant power to discriminate between PD patients across cognitive stages. Conclusion: These results suggest that the PDAQ-15 is a valid and reliable PD-specific instrument and can be useful in clinical and research settings.

Abstract Background Depression disorders are a leading cause of disability in the world which imposes a significant economic burden on patients and societies The present study aimed to determine the economic burden of Major Depressive Disorder (MDD) on the patients referred to the reference psychiatric single-specialty hospitals in southern Iran in 2020. Methods This cross-sectional research is a partial economic evaluation and a cost-of-illness study conducted in southern Iran in 2020. A total of 563 patients were enrolled through the census method, and a researcher-made data collection form was used to gather the required information. The prevalence-based and the bottom-up approaches were also used to collect the cost information and calculate the costs, respectively. The data on direct medical, direct non-medical, and indirect costs were obtained using the information in the patients’ medical records and insurance bills as well as their self-reports or those of their companions. To calculate the indirect costs, the human capital approach was used as well. Results The results showed that the annual cost of MDD was $ 2717.41 Purchasing Power Parity (PPP) (USD 2026.13) per patient in 2020. Direct medical costs accounted for the largest share of the costs (73.68%), of which hoteling and regular beds expenses were the highest (57.70% of the total direct medical costs). The shares of direct non-medical and indirect costs were 7.52 and 18.80%, respectively, and the economic burden of the disease in the country was estimated at $7,120,456,596 PPP (USD 5,309,088,699). Conclusion In general, due to the high prevalence of MDD and the chronicity of the disease, the costs of its treatment can impose a heavy economic burden on the society, healthcare system, insurance system, and the patients themselves. Therefore, it is suggested that health policymakers and managers should take appropriate measures to increase the basic and supplemental insurance coverage of these patients. In addition, in order to reduce the costs, proper and equitable distribution of psychiatrists and psychiatric beds, expansion of home care services, and use of Internet-based technologies and the cyberspace to follow up the treatment of these patients are recommended.

Abstract Background Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz. Methods This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data. Results The hearing screening data obtained during 6 years (2015–2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results. Conclusions According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.

Abstract Background Multiple Sclerosis (MS) is a chronic debilitating disease that imposes a heavy socioeconomic burden on societies. This study aimed to determine the economic burden of MS on patients using the first (CinnoVex and ReciGen) and second (Fingolimod and Natalizumab) drug therapy lines. Methods This cost of illness study was an economic evaluation carried out as cross-sectional research in 2019 in southern Iran. A total of 259 patients were enrolled in two lines of drug therapy (178 patients in the first line and 81 ones in the second). The prevalence-based approach and the bottom-up approach were used to collect cost information and to calculate the costs from the societal perspective, respectively. The human capital approach was applied to calculate indirect costs. To collect the required data a researcher-made data collection form was utilized. The data were obtained using the information available in the patients’ medical records and insurance invoices as well as their self-reports or that of their companions. Results The results showed that the annual costs of MS in the first and second lines of drug therapy per patient were $ 1919 and $ 4082 purchasing power parity (PPP), respectively, and in total, $ 2721 PPP in 2019. The highest mean costs in both lines were those of direct medical costs, of which purchasing the main medicines in both lines accounted for the highest. Conclusion Considering the findings of this study and in order to reduce the burden of the disease, the following suggestions are presented: providing necessary facilities for the production of MS drugs in the country; proper and equitable distribution of neurologists; expanding the provision of home care services; and using the technologies related to the Internet, including WhatsApp, to follow up the MS patients’ treatment.

Abstract Introduction Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. According to studies, anti-CD20 monoclonal antibodies have significant results in the treatment of this disease. Thus, the aim of the present study was to determine the cost-effectiveness of rituximab against natalizumab in the patients with RRMS in southern Iran in 2020. Methods This is an economic evaluation including cost-effectiveness analysis in which the Markov model with a lifetime horizon was used. The study sample consisted of 120 patients randomly selected from among those referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences. In this study, the costs were collected from a societal perspective, and the outcomes were obtained in the form of Quality Adjusted Life Years (QALY) and the mean relapse rate. The TreeAge pro 2020 and Excel 2016 software were used for data analysis. Results The comparative study of rituximab and natalizumab showed that the patients receiving rituximab had lower costs ($ 58,307.93 vs. $ 354,174.85) and more QALYs (7.77 vs. 7.65). In addition, the incidence of relapse by rituximab was lower compared to natalizumab (1.15 vs. 2.57). The probabilistic one-way sensitivity analysis showed the robustness of the results. The scatter plots also showed that rituximab was more cost-effective for the patients in 100% of the simulations for the threshold of < $ 37,641. Discussion and conclusion According to the results of this study, rituximab had higher cost-effectiveness than natalizumab. Therefore, it could be a priority for RRMS patients compared to natalizumab because it reduced treatment costs and increased effectiveness.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

Background: Surgery wards account for a significant portion of hospital costs, followed by patient costs. Improving surgery wards' performance plays a major role in enhancing the accountability and efficiency of the hospital. This study aimed to evaluate the performance of inpatient surgical wards at the hospitals affiliated with Tehran University of Medical Sciences(TUMS). Methods: A descriptive, cross-sectional, retrospective study was performed at all hospitals affiliated with TUMS in 2018. To measure the efficiency of these wards, three indicators have been considered; bed occupancy rate, the average length of stay, and bed turnover. Data have been analyzed using Excel software based on the Pabon Lasso model . Results: Among the 15 active surgical departments, 5 (33.31 %) were categorized in quadrant three, including ophthalmology, obstetrics and gynecology, vascular and trauma surgery, plastic surgery, and infertility department. The oral and maxillofacial surgery and general surgery departments were the poorest in their performance and located in quadrant one. Ten surgical wards out of 38 (26.33 %) have reported a satisfactory performance. Conclusion: Understanding and comparing the performance of clinical departments is also useful in making decisions for standardizing the patterns of health services delivery, evidence-based management in health care centers, and enhancing accountability in the health system. It is suggested that managers revise the departments in the inefficient area to reduce the number of inefficient departments or attract more patients by marketing, diversifying services, and increasing the quality of services.

Myocardial infarction (MI) is one of the leading causes of deaths globally. The early diagnosis of MI lowers the rate of subsequent complications and maximizes the benefits of cardiovascular interventions. Many efforts have been made to explore new therapeutic targets for MI, and the therapeutic potential of non-coding RNAs (ncRNAs) is one good example. NcRNAs are a group of RNAs with many different subgroups, but they are not translated into proteins. MicroRNAs (miRNAs) are the most studied type of ncRNAs, and have been found to regulate several pathological processes in MI, including cardiomyocyte inflammation, apoptosis, angiogenesis, and fibrosis. These processes can also be modulated by circular RNAs and long ncRNAs via different mechanisms. However, the regulatory role of ncRNAs and their underlying mechanisms in MI are underexplored. Exosomes play a crucial role in communication between cells, and can affect both homeostasis and disease conditions. Exosomal ncRNAs have been shown to affect many biological functions. Tissue-specific changes in exosomal ncRNAs contribute to aging, tissue dysfunction, and human diseases. Here we provide a comprehensive review of recent findings on epigenetic changes in cardiovascular diseases as well as the role of ncRNAs and exosomal ncRNAs in MI, focusing on their function, diagnostic and prognostic significance.

Objective: Family-centered services are collections for children with special needs and their families. These services consider families as expert about children's needs. The essence of this approach is involvement of family in decision making, cooperation, and mutual communication (family and therapist), mutual respect, acceptance of family choice, family support, flexibility of service, and effort to empower families. These services have become a basic foundation of many early intervention programs and are especially useful in rehabilitation services. MPOC-20 is one of the questionnaires used to evaluate these services. This questionnaire consists 20 questions divided into 5 areas, the areas include the following: 1) enabling and partnership, 2) providing general information, 3) providing specific information about the child, 4) coordinated and comprehensive care for child and family, and 5) respectful and supportive care. This tool has been translated and validated in several countries and specifically in several diseases. In this study, the validity and reliability of this tool have been investigated. Materials & Methods: This study was a descriptive-analytical and in order to measure the validity and reliability of MPOC-20, content validity, correlation coefficient and reliability of the test-retest were done. To determine the content validity, 14 occupational therapists were asked and the result was calculated by measuring the content validity index and content validity Ratio. Then, an MPOC-20 questionnaire along with a form of demographic information and a consent form were given to 340 parents of children (children under 18 years and with different diagnosis) in clinics of Tehran. The articipants consisted of 142 girls patients (42%) and 198 boys (58%) randomly selected from public and private rehabilitation centers in different regions of Tehran. A large percentage of respondents were mothers (314 people were 92.4%). After 2 weeks, the questionnaire was again distributed among 30 of them, and the ICC coefficients were calculated. In order to determine the internal consistency, Cronbach's alpha was calculated. Results: The content validity index and content validity Ratio for all items were acceptable and no items were deleted. Cronbach's alpha was 0.81 which indicates a high correlation between items in the questionnaire. The highest Cronbach's alpha coefficient is related to the field of providing general information about the child (α=0.77). Also, in this section, the p-value was significant for all fields at the level of 0.001. In the reliability of the test-retest, the scores of the Intra-class correlation coefficient of all domains were higher than 0/6 which indicates a medium to good reliability of the questionnaire. Reliability in the field of supportive care had a high coefficient and good reliability. In other areas, the reliability was moderate. Conclusion: Considering the importance of evaluation in improvement of family-centered services provision, a strong tool is needed and MPOC-20 is well known in this regard. The results of this study showed that the Persian version of "MPOC-20" questionnaire has a good validity and reliability in children under the age of 18, and it can be used to assess family-centered services in both research studies and as clinical tool.

Background: Outsourcing as an effective strategy in public management has attracted policy-makers. Awareness of quantity and quality of implementing this strategy can help policy-makers and managers to remove barriers to this policy. This study aimed to investigate outsourced services and the applied models in Bushehr University of Medical Sciences. Materials and Methods: This descriptive cross-sectional study was carried out in Bushehr University of Medical Sciences in 2019 in four separate steps of literature review, shortlisting outsourceable services, data quality assurance and categorization of outsourced services into clinical and non-clinical services. Finally, the collected data were entered into Excel® version 8 to calculate and report descriptive indicators. Results: Result showed that totally 24 types of services have been outsourced. Half of them were clinical and the other haf were non-clinical. Among the outsourcing models, service purchasing model and management outsourcing model were the most and the least applied models, respectively. Conclusion: Although various outsourcing models are available, the type and the number of outsourced services are still limited. Given the diversity of services in health sector especially clinical services, it is possible to use the capacity of outsourcing strategy more effectively.

Objectives: To investigate whether Iranian children and adolescents with Cerebral Palsy (CP) participate in their preferred leisure activities. Methods: A group of children and adolescents (n=152; 59.2% male; aged 7-17 years; Mean±SD of age was 10.93±3.46 years old) diagnosed with CP (39.5% hemiplegic; 28.9% quadriplegic; 31.6% diplegic) were selected to complete the children’s assessment of participation and the enjoyment (CAPE) and Preference for Activities of Children (PAC) questionnaires. Results: Recreational and social activities were the most preferred (PAC mean score=2.13±0.40; 2.08±0.40, respectively), and active-physical activities were the least preferred (PAC mean score=1.60±0.46). Preferences were strongly correlated with leisure participation (P

Background: Non-viral Nano carriers such as liposomes and cationic polymers based on engineered properties are regarded in gene delivery field. Although these carriers do not have weaknesses of viral vectors, but they are less efficient than viruses and they still need to be improved as favorable gene delivery carriers. Amongst non-viral carriers, cationic liposomes have been proposed for clinical applications, but limitations such as low nucleic acid transfer and endosome escape and conduction of plasmid to the nucleus have challenged their use in clinical trials. Therefore, the combination of liposomes and cationic polymers for nucleic acid transfer has been considered because this approach makes it possible to use the desirable properties of liposomes and polymers so that it is even suggested for the gene treatment of some diseases such as Parkinsonchr('39')s. In this study, a combination of liposomes and cationic polymers were used for the preparation of lipopolyplexes. This approach allows simultaneous utilizing of the desirable properties of liposomes and polymers. Methods: This interventional-experimental study was conducted in the medical faculty of Mashhad University of Medical Sciences from April 2017 to February 2018. In this study, PEI-based lipopolyplex with a molecular weight of 25 and 10 kDa and a liposome-to-polymer ratio of 1:1 were combined with plasmid containing the GFP (Green Fluorescent Protein) marker. The physicochemical properties of the synthesized carriers such as size, cytotoxicity and gene transferability in human prostate cancer (PC3) cells were evaluated. Results: The prepared lipopolyplex were 104 nm in size and all the lipopolyplexes were able to enhance transfection in the C/P=0.4 compared with its basic carriers (PEI and liposomes) alone, while showing less cytotoxicity than not manipulated liposomes. The results of this study suggest synthesized nanoparticles as nanocomposites for gene delivery purposes to different cells and in in-body studies. Conclusion: The results of this study show that the lipopolyplex constructed from combination of PEI and liposomes can efficiently transfer the gene to the cell, while showing low cytotoxicity and appropriate size at the nano-scale. Therefore, this lipopolymer can be suggested for gene delivery purposes to different cells and in vivo targets.

Objectives: To determine the role of child factors in the prediction of parental attitudes toward children and adolescents with CP in Iran. Methods: The cross-sectional study design was used. A total of 152 children and adolescents with CP aged 7-17 years (Mean±SD = 10.93±3.46) with a mother aged at least 25 years were selected, using a systematic random sampling method. The Mother-Child Relationship Evaluation questionnaire was used to assess the parental attitude. Simple and multiple linear regression analyses were performed to determine the predictive role of child factors (eg, age, gender, type of CP, dependency in gross and fine motor functions, and IQ) in parental attitudes. Results: Overindulgence and overprotection attitudes were the most common attitudes among mothers. The acceptance attitude was best predicted by the type of CP (r2=0.151). Diplegia, being fully dependent in gross motor functions, and adolescence predicted greater overprotection attitude (r2=0.101). Girls were predicted to be treated more overindulgent (r2=0.045). Femininity predicted lesser rejection attitude while being fully dependent in fine motor functions predicted greater rejection attitude (r2=0.006). Discussion: Child factors influence only a small proportion of parental attitudes toward children and adolescents with CP. Contrary to expectation, child factors, including the child’s disability status, are not the most prominent determinants of the parental attitudes toward children and adolescents with CP in Iran.

Objective: The purpose of the present study was to establish the item analysis and internal consistency of the Persian version of the Child Sensory Profile 2 in 2 groups of typical and atypical children (autism spectrum disorder and learning disabilities) aged 3 to 14 years. Method: The sample of this study included 120 typical and atypical children aged 3 to 14 years who referred to schools and rehabilitation centers in Tehran were selected using multistage sampling method. To collect data, the Child Sensory Profile 2 questionnaire was used, which is a set of questionnaires of the Sensory Profile 2. To analyze the data, the discrimination index was used to determine the discriminant validity of the Child Sensory Profile 2, and the Cronbach's alpha coefficient was used to determine the reliability in terms of internal consistency. Results: Discrimination index was satisfactory for all the items of the Child Sensory Profile 2. The values of Cronbach's alpha ranged from 0.795-0.919 in typical children and 0.617-0.901 in autistic children, and 0.792-0.920 in children with learning disabilities. Conclusion: The Persian version of the child sensory profile 2 is a valid (discrimination with vulnerable populations) and reliable (internal consistency) tool for assessing sensory processing.

Abstract Background A 32-base pair deletion (∆32) in the open reading frame (ORF) of C-C motif chemokine receptor 5 (CCR5) seems to be a protective variant against immune system diseases, especially human immunodeficiency virus type 1 (HIV-1). We aimed to assess the frequency of CCR5∆32 in the healthy Iranian population. Methods In this study, 400 normal samples from Khorasan, northeastern Iran, were randomly selected. The frequency of CCR5∆32 carriers was investigated using PCR analysis. Allele prevalence and the fit to the Hardy-Weinberg equilibrium were analyzed. Results The prevalence of CCR5∆32 in the northeastern population of Iran was 0.016. Four hundred samples were studied, among which one with CCR5 ∆32/∆32 and 11 with CCR5 Wild/∆32 genotype were detected. Conclusion This study was the first investigation for an assessment of the prevalence of CCR5∆32 in northeastern Iran. The low prevalence of CCR5∆32 allele in the Iranian population may result in the increased susceptibility to HIV-1. In addition, this prevalence is the same as that of reported in East Asia, while is lower than that in the Europeans.

Background and Objectives: Furosemide is one of the elements of drug therapy for cardiogenic pulmonary edema, but its systemic administration is associated with complications, such as hypotension, renal damage, and decreased serum potassium. Inhalation administration is a new route, which does not have the side effects of systemic administration, but its effectiveness is still unclear. The aim of this study was to determine the effectiveness of treatment with the nebulized furosemide in patients with acute cardiogenic pulmonary edema Methodes: This clinical trial study was conducted on 125 patients with acute cardiogenic pulmonary edema reffering to the Department of Emergency Medicine of Rasoul Akram and Firouzgar hospitals in 2017. The samples were randomly assigned to two groups of experimental (62 individuals receiving furosemide with nebulizer) and control (63 individuals receiving normal saline with nebulizer). After the vital Signs intervention, the data relating to the lung were compared using t-test and Chi square test. Results: There was no difference between the two studied groups in terms of the mean changes in systolic (intervention 129, plasebo 128.9) and diastolic blood pressures (intervention 79.2, plasebo 78), pulse rate (intervention 92.2, plasebo 91.8), respiratory rate (intervention 22.8, plasebo 22.3), and blood oxygen saturation (intervention 92, plasebo 91.7). Changes in lung auscultation showed no statistically significant changes between the groups (p = 0.56). Conclusion: The finding of the present study revealed that inhaled furosemide had no positive effect in the patients with acute pulmonary edema. Therefore, considering the novelty of the issue, further studies are recommended.

The management of cultivation technology and fertilizer application may adjust adverse effects of abiotic stresses such as water deficit on agricultural products. Therefore, a field experiment was carried out on growth, yield, nutrient uptake and anatomical properties of maize under three water regimes (well-watered, moderate stress and severe stress as 25%, 50% and 75% soil moisture depletion), two cultivations methods (direct seeding and transplanting), and two Arbuscular Mycorrhizal Fungi (AMF) levels (inoculated with Glomus mosae and uninoculated). The results showed that in plants under moderate water stress, the AMF inoculation percent was significantly higher than those under well-watered and sever stress condition. Inoculation percent in direct seeding was lower than transplanting. Transplanting plants had higher biological and kernel yield compared to direct seeding plants. Water stress reduced the total chlorophyll (Chl) content. Transplanting had greater Chl content in comparison with direct seeding. In all irrigation regimes, transplanting significantly increased N content. In direct seeding, the highest P content was observed in moderate stress and uninoculated plants. Stomatal density increased under water stress, but stomatal size decreased. Plants under severe water stress showed increased stomatal density compared with well waterbed conditions. In addition, severe water stress enhanced the UCT compared to well-watered condition. This study suggests the use of transplanting with AMF application to cope with the adverse effects of severe water stress on maize.

Background and Objectives: The incidence of rifampin-resistant strains of Mycobacterium tuberculosis has attracted more attention than the tuberculosis infection due to laborious treatment and control. Recognizing the Mycobacterium tuberculosis genotypes involving in drug resistance via multiplex PCR, a simple and rapid genotyping method, is an emergency for better treatment and control of tuberculosis. This study was designed to specify the frequency of rifampin-resistant strains of Mycobacterium tuberculosis isolated from patients by multiplex allele-specific Polymerase Chain Reaction assay (MAS-PCR).Methods: In this study, 88 Mycobacterium tuberculosis positive samples were included from Qaem Hospital, Mashhad. MAS-PCR was used to detect the rifampin resistance associated mutations in rpoB gene. Results: Mutations in three codons of rpoB gene causing rifampin resistance were detected in 51 isolates (58.96%). The detected mutations in codons 531, 526, and 516 were 55.68%, 38.63%, and 13.63%, respectively. The simultaneous mutations were detected in 11 isolates (12.50%) in codons 531, 526 and 516, in 21 isolates (23.86%) in codons 531 and 526, and in one isolate (1.13%) in codons 526 and 516. Conclusion: According to the results of this study, the frequency of rifampin-resistant strains of Mycobacterium tuberculosis isolated from Khorasan province patients (North-East of Iran) was high. The developed MAS-PCR assay can be used for rapid detection in clinical diagnostic laboratories in areas with high prevalence of multidrug-resistant Mycobacterium tuberculosis strains. In this respect, MAS-PCR is simple, rapid, and highly sensitive method for drug susceptibility tests for detecting multidrug-resistant Mycobacterium tuberculosis.

Objectives: This study aimed at evaluating the correlation between mother-child relationship and the rate of participation of children and adolescents with cerebral palsy in leisure time activities. Methods: This study is a descriptive and correlational research. The statistical population included cerebral palsy children aged 7-17 years with a mother who is at least 25 years old. A sample size of 152 children was selected using systematic random sampling. The children filled the King assessment of participation and enjoyment questionnaire, whereas the mothers responded to a survey of Roth mother-child relationship evaluation. We collected the data and analyzed them (Spearman correlation test, One-way ANOVA, Kruskal-Wallis, and Mann-Whitney) using SPSS 16 software. Results: The results showed that there is a correlation between mother-child relationship and the rate of participation of cerebral palsy children in leisure time activities. There was a significant correlation between acceptance of child and the increasing involvement in leisure activities in case of cerebral palsy children. Over protection, excessive ease, and child rejection in a mother-child relationship was associated with reduction in the participation rate of the cerebral palsy children and adolescents in leisure activities. In case of quadriplegic children, the acceptance of child and participation rate was low compared to hemiplegic and diplegic children. Excessive ease of a mother-child relationship in girls was more than boys, but boys experienced more child rejection of a mother-child relationship than girls. Discussion: Participation rate, frequency (how often), and the enjoyment of participation in leisure time activities were correlated with mother-child relationship. Participation differences were existed among CP groups.

Context: Polypropylenimine (PPI), a cationic dendrimer with defined structure and positive surface charge, is a potent non-viral vector. Dexamethasone (Dexa) conveys to the nucleus through interaction with its intracellular receptor. Objective: This study develops efficient and non-toxic gene carriers through conjugation of Dexa at various percentages (5, 10 and 20%) to the fourth and the fifth generation PPIs (PPIG4s and PPIG5s). Materials and methods: The 21-OH group of Dexa (0.536 mmol) was modified with methanesulfonyl chloride (0.644 mmol) to activate it (Dexa-mesylate), and then it was conjugated to PPIs using Traut's reagent. After dialysis (48 h) and lyophilization, the physicochemical characteristics of products (PPI-Dexa) including zeta potential, size, buffering capacity and DNA condensing capability were investigated and compared with unmodified PPIs. Moreover, the cytotoxicity and transfection activity of the Dexa-modified PPIs were assessed using Neuro2A cells. Results: Transfection of PPIG4 was close to PEI 25 kDa. Although the addition of Dexa to PPIG4s did not improve their transfection, their cytotoxicity was improved; especially in the carrier to DNA weight ratios (C/P) of one and two. The Dexa conjugation to PPIG5s enhanced their transfection at C/P ratio of one in both 5% (1.3-fold) and 10% (1.6-fold) Dexa grafting, of which the best result was observed in PPIG5-Dexa 10% at C/P ratio of one. Discussion and conclusions: The modification of PPIs with Dexa is a promising approach to improve their cytotoxicity and transfection. The higher optimization of physicochemical characteristics, the better cell transfection and toxicity will be achieved.

Objectives: Social development in children is influenced by several factors, including family, school friends, television, gender, race, socioeconomic status, and locomotor activity, and depending on the situation and how they react to it, social development and maturity might get accelerated or get undermined. Therefore, in this study, we aimed to investigate the relationship between fine motor skills and social development and maturity in children. Methods: This is a descriptive-analytical study that included 85 children in the age group of 6-8 years (41 boys and 44 girls). We used a two-stage random sampling method in order to select samples from elementary schools in Regions 14 and 15, Tehran. Information was collected through the General Health Questionnaire and demographic questionnaire, which was filled by the parents. Fine motor skills test consisting of three subtests, i.e., response speed, visual-motor control, and upper-limb speed and dexterity, was measured using Bruninks-Oseretsky Test of Motor Proficiency. Social maturity was measured using Vineland social maturity scale. The entire process lasted for a month and the mean, standard deviation, range of changes, minimum, and maximum values were analyzed. Mann-Whitney test was used to compare mean scores of variables between male and female groups and significance level for statistical tests was analyzed at α=0.05. Results: Significant correlation between social quotient and total score of fine motor skills variable was obtained (P

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (RCA) (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction (AMI) helps detect more invasive patients and prevents extensive myocardial damage and other complications.

AbstractBackground and Aim: Using cervical collars is one of the treatment methods for releaving cervical pain. The effect of limb orthotics on proprioception and postural stability has been suggested. There is not sufficient studies about the effect of cervical collars on static and dynamic stability, and the effect of soft and hard collars have not been compared with one another. The objective of this study is investigating and comparing the immediate effect of soft and hard cervical collars on static postural stability in healthy young subjects. Methods & Materials: In standing position on firm surface with closed eyes, both soft and hard collars decreased the stability and there was not any significant difference among collars. In standing positions on soft surface with closed and opened eyes, using none of the soft and hard collars did not change the stability. This quasi experimental study through repeated measure method has been conducted on 65 healthy young male and female college students. Static stability was evaluated by modified Clinical Test for Sensory Interaction and Balance (CTSIB) in conditions without collar and by soft and hard cervical collars and were compared between the conditions. Results: Conclusion: Our results suggest that in static conditions, without vision, both collars decrease the stability in healthy young subjects. So considering the evaluation of stability and prevention of balance disturbance during the collar prescription seems to be necessary.

Background and Aim: The dramatically increased incidence of hallux valgus (HV) deformity is more related to the cultural rather than genetic parameters. Satisfaction rate following either conservative or surgical treatments are very low. The current study aimed to compare the effects of three commonly used conservative treatments including hallux valgus (HV) splint, HV splint plus electrical stimulation (ES) currents, or HV splint plus exercise to treat this deformity. Materials & Methods: Thirty-six university students with a mild to moderate HV deformity were recruited in this study. Before starting the study, anterior-posterior view radiographies were taken from their feet. HV angle (HVA) less than 20º was considered as normal, between 21-25º as mild, between 26-40 º as moderate and higher than 40 degrees was considered as a sever HV deformity. Then, the subjects were divided into three groups (n=12) and were randomly placed into Splint, Splint plus Exercise, and Splint plus Exercise plus ES groups for 6 weeks. At the end of week six, the radiographies were repeated and the pre/post treatments HVA were compared. Results: The results of the current study showed a non-significant 4.7% reduction of HVA in Splint group (p=0.12). However, 15.4% reduction of HVA occurred in Splint plus Exercise group, which was significant (p=0.005).The subjects used Splint plus Electrical stimulation showed a significant 13.9% reduction in HVA (p=0.008). Furthermore, AOFAS scores of the subjects revealed no significant differences among treatment groups in terms of pain reduction.Conclusion: Although using a HV splint alone could not significantly reduce the HVA, mixing it with either exercise or ES could significantly expedite its corrective effects. It should be mentioned that correction of the deformity was not always associated with decreasing the subjects’ pain, which might be due to the immediate counter force of the splint. Repeating the study with a long follow-up time is recommended.

Introduction: Higher education administrators believe that discipline choice method could be an important motivator to continue study. The field of health information technology in BS level which is a specialized field in health area was introduced by elimination of medical records associate degree. This study aimed to investigate factors affecting field choice among students of medical records and health information technology in 2010. Methods: In this descriptive cross-sectional study, the population included students of medical records and health information technology in Mazandaran University of Medical Sciences. Study was conducted through census in which 50 students (12 newly admitted students of health information technology and 38 senior students who had chosen this field under the title of “medical records”) were willing to participate. Questionnaire developed by researcher was used for data collection. Data was analyzed using Chi2 and the significance level was p

Background and aim: Osteoarthritis (OA) is the most prevalent joint disease in adults around the world and its incidence rises with age. Patients with severe knee osteoarthritis often complain of pain and severe functional disability. Most of conservative treatments used in this group of patients induce poor improvements. This study evaluated the effect of joint traction on quality of life of patients with severe knee osteoarthritis.Materials and Methods: In this clinical trial study, forty female patients with severe knee OA were randomly assigned to two following groups; common physiotherapy treatment and common physiotherapy treatment accompanied by knee distraction. Quality of life was evaluated pre- and post-treatment and also one month follow-up using the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire.Results: Common physiotherapy treatment accompanied by knee distraction resulted in significantly better quality of life post-treatment and at 1month follow-up, compared to common physiotherapy treatment alone (P

Background and Aim: The dramatically increased incidence of hallux valgus (HV) deformity is more related to the cultural rather than genetic parameters. Due to the lack of reliable information about the rate of this disorder in Iraninan societies, the researchers of the current study aimed to find out the incidence of this disorder in Iranian university students as a sample of Iranian youngsters. Materials and Methods: This descriptive study was carried out using a self-constructed and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaires among 290 university students with the mean age of 21±2 years old. The HV angles (HVA) was described as normal for up to 20º, mild for angles between 21º and 25º, moderate for angles between 26º and 40º, and severe for angles higher than 40 º. Then, the HVA of the subjects of this study was compared with the data from other societies.Results: The results of this study showed a 34.1% involvement of the participants (30% females and 41% males). 58% of the subjects showed a bilateral hallux valgus involvement. No significant differences were found between the males and females in terms of the severity of the deformity and the right or left side involvement (P>0.05). 71% of the involved subjects showed a mild degree and 29% showed a moderate degree of deformity. No severe deformity (above 40º) was found in this study. In terms of the associated deformities, in subjects with mild deformity, 25% showed flat foot and 69% showed bunion disorder; While these were 21% and 82% in subjects with moderate deformity, respectively. In terms of inheritance correlation, while this deformity was shown in only 7% of normal subjects’ first degree relatives (father, mother, brothers or sisters), it increased to 21.1% in mild degree and 46.4% in moderate degree groups. Conclusion: This study revealed a very high incidence of HV deformity in Iranian university students as a sample of Iranian youngsters, which is much higher than those in some Western societies. This deformity showed to be highly inherent due to the increasing level of this deformity among first degree relatives. Routine use of high heel or round tip shoes showed no influence on the rate of HV deformity.

Background and Aim: High levels of job stress experienced over time, as well as personal frustration and inadequate coping skills, can lead to the syndrome known as burnout. In it has been shown in several surveys that high job stress in occupational therapists could lead to the burnout syndrome. Since few studies have been conducted in Iran concerning burnout in occupational therapists, we felt the necessity of performing this study to make Iranian therapists more aware of the syndrome and its related factors.Materials and Method: A cross sectional survey was carried out on 87 Iranian occupational therapists in the current study. A questionnaire consisting of two parts (demographic dates & maslach burnout inventory) was sent to all therapists who were members of medical organization.Results: 80.4% of therapists reported mild to moderate symptoms of burnout, while nobody has reported severe burn out. Low job satisfaction (P value=0.038) and job experience less than 5 years (P value=0.049) were the two variables associated significantly with burnout.Conclusion: In the present study high rate prevalence of burnout shows that occupational therapists in Iran are not in a good health state and it can indicate that Iran health system should pay more attention to this group. According to our study the early years of a therapist’s carrier are the period when the therapist is at risk of burnout. So we believe that students should be given more information about burnout syndrome and its coping mechanisms during their education at the university.

In this paper, the model of foreign direct investment attraction into Iran’s Free Trade- Industrial Zones has been estimated on the basis of related theories and studies. The results of this study illustrate that inflation rate and domestic investment respectively have negative and positive effects on the attraction of foreign direct investment into those zones. For the success in absorbing foreign investment, the results of this paper also show that some policies other than mere liberalization policy of foreign capital inflow are necessary. If Iran successfully create a suitable economic atmosphere in order to motivate free domestic investors, both in the national economy and in the zones then Iran may manage to attract foreign investors. This study indicates that high inflation rate and low attraction of domestic investments are implications of country risk, which lead to less attraction of foreign investments to the zones on the other hand, small amount of domestic capital in free zones in turn decreases the attraction of foreign direct investment into zones, as a consequent effect on foreign investment.