comparative study of nurses as case manager and telephone follow-up on clinical outcomes of patients with severe mental illness

Background: Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean [affiliated with WHO]. The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness

Methods: A total of 182 patients were randomly allocated into three groups, namely, home-visit [n=60], telephone follow-up [n=61] and as-usual care [n=61] groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively

Results: Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group

Conclusion: Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network

Factors associated with breast cancer screening decision stage among women in Tehran, Iran

Early detection through screening is the best method to reduce death due to breast cancer. It has been shown, having knowledge and generating positive attitudes, influences the decision of women to participate in the screening programs. The aim of this study was to identify the factors associated with breast cancer screening [BCS] and with an intention to have screening among women in Tehran, Iran. A cross-sectional study was carried out from January to July 2011, among women who had attended to primary health-care centers in West Tehran using multi-stage sampling method. We invited 1,240 women sequentially to complete a self-administered survey questionnaire at the beginning of their visit; and 1,012 [82%] completed the survey. The questionnaire included, items drawn from the Preventive Health Model that assess socio-demographic background and perceptions about BCS. Multiple logistic regression analysis was performed to identify factors associated with screening and intention to do screening in the future. The mean age of subjects was 38.2 years. Women who perceived more screening efficacy [odd ratio [OR] =1.63; confidence interval [CI] 95%: 1.12-2.37] and fewer performance barriers [OR = 0.82; CI 95%: 0.68-0.97] were more likely to perform clinical breast exam in the future. The women who reported higher clinical breast exam self-efficacy [OR = 1.82; CI 95%: 1.39 2.37], mammography self-efficacy [OR = 1.31; CI 95%: 1.04-1.65], screening efficacy [OR = 1.53; CI 95%: 1.18 1.97], and family influence [OR = 1.27; CI 95%: 1.05-1.54], and those who reported fewer screening performance barriers [OR = 0.56; CI 95%: 0.48-0.67] were more likely to decide for carried out mammography in the future. Most respondents indicated that they intended to do clinical breast exam and mammography in the future [75.8% and 72.1% respectively]. About 65% of women reported they would do both. We found that women's intention to do BCS was very high and a comprehensive national program is needed to guide their intention. Among different demographic factors, the impact of education level on doing BCS was significant

Hypovitaminosis D: are medical students at risk?

Vitamin D deficiency is a pandemic problem mostly diagnosed in elderly. Few studies are available exclusively done on the topic among young adults. Specific professions such as medical students may have higher risk for developing hypovitaminosis D. We aimed to assess the vitamin D status in medical students of Iran University of Medical Sciences; and to define a cut-off point for 25-hydroxyvitamin-D [25[OH]D] level based on secondary hyperparathyroidism. This was a cross-sectional study on 100 medical students conducted during October 2012. Serum 25[OH]D, intact parathyroid hormone [iPTH], and calcium were measured. Age, sex, body mass index, daily dietary fish and egg consumption, sun exposure, and sunscreen usage were recorded. The association between serum 25[OH]D and iPTH was assessed. Receiver operating characteristics curve analysis was performed. 25-hydroxyvitamin-D level was <30 ng/ml in 99% of all participants, and <20 ng/ml in 77%. Mean serum 25[OH] D level was 16.8 +/- 4.7 ng/ml. iPTH level in the group with 25[OH]D level of <10 ng/ml was significantly higher than in those with serum 25[OH]D level of 10 to <20 ng/ml and 20 to <30 ng/ml [109 +/- 47 pg/ml, 47 +/- 27 pg/ml and 46 +/- 19 pg/ml, respectively; P = 0.0001]. There was a significant linear inverse correlation between serum iPTH and 25[OH]D [r= -0.36, P = 0.0001]. 25[OH] D level of 15.4 ng/ml was determined as the optimal cut-off point in detecting possible secondary hyperparathyroidism. To improve the community vitamin D status, in addition to population-based food fortification programs, educational programs seem essential; not only for general population, but also for the more educated groups

Survival predictors of preterm neonates: hospital based study in Iran [2010-2011]

Preterm birth [PTB] is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm [26-37 weeks] infants [n=1612] born alive in Shahid Akbar-abadi university hospital, during one year period [April 2010-2011]. These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights [LBW] and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age [GA] of 30 weeks and the youngest infants was a 970 gram female with GA of 25 weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation [CPR], need to neonatal intensive care unit [NICU] admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight [VLBW] and extremely low birth weight [ELBW], were risk factors for mortality in preterm neonates Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000 grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant

Quality of reports on randomized controlled trials published in Iranian journals: application of the new version of consolidated standards of reporting trials [CONSORT]

The Consolidated Standards for Reporting of Trials [CONSORT] statement is a device to standardize reporting and improve the quality of controlled trials. The aim of this study is to determine the quality of controlled clinical trial reports by national peer-reviewed journals in Iran. In a cross-sectional study, we evaluated clinical trial reports by national peer-reviewed Iranian journals between 2008 and 2010 by CONSORT2010. The sample was selected from Iran Medex. The proportion of adherence to each item of the CONSORT checklist was assessed for each clinical trial. The reliability of evaluation by reviewers was calculated by Pearson correlation coefficient, and was determined to be 0.73 - 0.89, with a significance level of P < 0.01 between reviewers. A total of 509 articles published in 80 peer-reviewed national journals were evaluated. The average adherence of evaluated randomized controlled trials [RCTs] to the 37 items of the CONSORT statement was 43.8%. The mean CONSORT score significantly differed across each year of publication. None of the articles mentioned the location where the full trial protocol could be accessed. The quality of reporting RCTs published in national peer-reviewed journals needs significant improvement as the majority did not adhere to CONSORT guidelines. It is necessary for the editors of Iranian journals to consider CONSORT criteria for evaluation of all future RCTs

[Quality of life in patients with Parkinson's disease: Assessing with the Parkinson's Disease Questionnaire [PDQ-39]]

The aim of this study was to examine the quality of life in patients with Parkinson's disease [PD] using a Parkinson's Disease Questionnaire [PDQ-39] as a measure. In this cross-sectional study, 200 consecutive patients with PD who referred to Tehran University of Medical Sciences Hospitals were enrolled. The PDQ-39 was used for evaluation. Statistical tests like ANOVA, t-test and Spearman rank correlations were used to assess the relationship between duration and clinical stage of disease and the quality of life. The mean age of the patients was 57.32years [10.5 SD]. 135[67.5%] were male and 65[32.5%] female. Most of the patients [46/5%] were in mild stage. The results showed total effect of PD on patient`s quality of life, on dimensions that measured by PDQ-39. The mean of Parkinson`s disease summary index [PDSI] was 35/17 +/- 15/43.Also severity [p=0.008] and duration [p=0.0001] of disease had a significant effect on Quality of life. Quality of life deteriorated significantly with increasing disease. Paying attention to other dimensions of quality of life than clinical symptoms is suggested to improve health related quality of life in patients with Parkinson's disease.

Subjective sleep quality in urban population

Sleep disturbances are common among adult populations and can have a significant effect on daytime activities. The aim of this study is to determine the prevalence of sleep problems and subjective sleep quality in the adult population of Tehran, Iran. From an urban community of Tehran, a random sample of 3400 adult men and women were selected by a cross-sectional design. Using the Persian version of the Pittsburgh Sleep Quality Index [PSQI], subjects were interviewed face-to-face. There were 3114 completed questionnaires returned and analyzed. The mean age of the subjects was 43.57 [ +/- SD 17.5] years. Overall 37% [95% CI: 35-39] of the population were categorized as poor sleepers. The PSQI > 5 showed 27% were males versus 35% among females. The global PSQI scores ranged from 4.20 +/- 2.67 to 5.60 +/- 3.74 for males and 5.03 +/- 3.00 to 7.97 +/- 4.31 for females by age groups. The difference across age groups for global PSQI score was significant in females [P < 0.01]. The prevalence rate of sleep complaints in this population-based study was high. Females, older adults, widows and separated couple were the most important risk factors for sleep disturbances

Knowledge and practice assessment of workers in a pharmaceutical company about prevention of coronary artery disease

Coronary artery disease is one of the most common reasons of death around the world. Also, according to previous studies, the incidence of coronary artery disease is rapidly increasing in developing countries such as Iran. The aim of this study was to evaluate the knowledge and practice of pharmaceutical company workers towards the prevention of cardiovascular disease. In this cross sectional study that was conducted in Tehran, 1223 workers of a pharmaceutical company were enrolled. Data was collected using a questionnaire that assessed the level of knowledge and practice of the participants towards coronary artery disease. Regression analysis was used to evaluate the relationship between study variables and the workers knowledge level. The results of this study showed that 49% of the workers were in a good level of knowledge and according to the regression analysis, the female gender, age above 28, education level higher than high school diploma, body mass index above 25 kilograms per square meters, history of hyperlipidemia, history of diabetes, history of hypertension, history of myocardial infarction, daily activity and exercise, were significantly related to a good knowledge towards coronary artery disease. In addition, the mean score of the participants' performance in preventing coronary artery disease was 4.66 out of 9. The results of this study showed that increasing level of knowledge of labors in order to prevent missing specialized work force, leads to imposition of health costs to the industry and the labor society

Study of prevalence of violence against nurses and related factors

The risk of violence is higher in some occupations, including nursing. Also, violence is becoming more prevalent in health care settings. The first step for reducing violence is recognition of its potential risk factors. The aim of present study was assessment of violence against nurses and related risk factors in Iran. In this descriptive-analytical and cross-sectional study Persian version of NEXT questionnaire was used. Sampling method was multistep sampling. Stratification was performed based on the hospital and then in each hospital questionnaires was given to nurses non-randomly. 1070 nurses working in 14 TUMS [Tehran University of medical sciences] hospitals were included in the study. Psychological violence from patients and their relatives against nurses included in the study was 60.3%. There was no significant relationship between age, sex, professional position, work experience, patients numbers who worked with participants in a single shift and average weekly work hours and psychological violence from patients and their relatives but participants ward, work schedule, and work disturbances, had a significant relationship with psychological violence from patients/relatives. Based on this study, violence against nurses is a common and important problem and further studies aimed to reduce that, with regard to risk factors achieved in this study, is essential

[Quality of life in patients with endometriosis in Tehran in 2009]

Endometriosis is a estrogen-depended and chronic gynecological disease. The symptoms of this with an overall negative impact on the psychosocial parameters in the patients, leading to a significant reduction of health-related quality of life. The aim of this study was to evaluate health-related quality of life in patients with endometriosis. This cross-sectional study was performed on women with endometriosis in Several hospitals affiliated Tehran University of Medical Sciences, with non randomized sampling method. Health-related quality of life in patients with endometriosis was investigated with endometriosis health profile [EHP-30] questionnaire in 5 scales including Pain, Emotional well-being, control and powerlessness, Social support and self imaging scales. Data analyzed by descriptive statistics in SPSS [15] software. Mean age of 100 Participants in this study was 39.5 +/- 7.54 years. Quality of life scores in core questionnaire domains was 36.20 to 46.73 and in modular questionnaire domains was 34.85 to50.55.Most aspects affected by disease were psychological and pain in core questionnaire and infertility in modular questionnaire. The least affected by the disease was self image domain. Our study showed that Endometriosis impairs health related quality of life, especially in the domains of psychological and pain. Emphasizing on life Quality of patients using appropriate medication therapy and Psychotherapy is necessary and important

Job stress and burnout syndrome in a sample of rural health workers, Behvarzes, in Tehran, Iran

In the last 30 years, ever since the PHC network in Iran has been established, the job duties of Behvarzes [Mental Health Workers in rural areas] have been constantly increasing. The aim of this study was to determine the burnout level, mental health status and the severity of occupational stress among Behvarzes. All Behvarzes [227] working in areas covered by Iran University of Medical Sciences were considered for participation in the study. Maslach Burnout Inventory, GHQ-12, and Stainmentz questionnaires were used. The completed questionnaires were returned by 93% of the subjects. The mean score of job stress was in the first percentile [42.8 +/- 27.16]. 17.6% of the study subjects had moderate to severe level of burnout; 12.3%, 5.3% and 43% of the subjects had abnormal scores on emotional exhaustion, depersonalization and personal subscales respectively; and 28.3% of the cases were suspected to have mental disorders by GHQ. In spite of increasing assigned jobs to Behvarzes, job stress and burnout are not seriously distressful. Providing more desirable personal accomplishment for Behvarzes by reducing job ambiguity/ conflict, participating in planning new programs, and improving interaction with health authorities may help them to overcome their job related pressure and increasing workload

assessment of reliability and validity of Persian version of the endometriosis health profile [EHP-30]

The Endometriosis Health Profile-30 [EHP-30] is a disease-specific questionnaire to measure the health-related quality of life in patients with endometriosis. The aim of this study was to evaluate the validity and reliability of the Persian version of Endometriosis Health Profile [EHP-30] in women with endometriosis referring to three Gynecology Clinics in Tehran, Iran. One hundred women [20 to 50 years old] with surgically confirmed endometriosis recruited from three outpatient Gynecology Clinics affiliated to the Iran University of Medical Sciences. All 100 patients were asked to complete EHP-30 questionnaire while referring to the Clinics. The findings were analyzed using descriptive statistics, internal reliability consistency, construct validity [using short form-36, which had already been validated in Iran], factor analysis [with principle component analysis method], and item total correlation to assess the validity and reliability of the questionnaire. The internal consistency reliability of the questionnaire was high [Cronbach's alpha ranged between 0.80 and 0.93 for core, and 0.78 and 0.90 for modular parts]. All items were loaded on their own factors except item 17 [feeling aggressive or violent] and item 18 [feeling unwell], which were loaded on pain and social support domains, respectively. Construct validity of EHP-30, established by using SF-36, indicates good correlations in several similar scales of these two questionnaires. The findings of the study demonstrate that Persian version of EHP-30 is a valid and reliable measure to assess the quality of life in women with endometriosis

Prevalence of anemia in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is associated with significant morbidity and mortality worldwide. This disease affects the lungs and organs outside the lungs. The aim of this study was to determine the prevalence of anemia in patients who were referred to teaching hospitals of Tehran University of Medical Sciences, Tehran, Iran. Three hundred ninety two patients with COPD who attended to the teaching hospitals of Tehran University of Medical Sciences, from March to June 2009 were assessed. Laboratory and clinical data of patients was gathered from their medical records. We used global initiative for chronic obstructive lung disease criteria in order to categorize severity of disease in patients. The mean age of patients was 66.5 +/- 12.3 years and 289 [73.7%] subjects were men. The overall prevalence of anemia was 36.7% [95% CI: 31%-41%]. Twenty two females [21.4%] and 110 males [38.1%] were anemic. There was a positive correlation between age and hemoglobin level. In group two [COPD stages I to II], there was 43.5% prevalence of anemia versus 34.1% in group three [COPD stages III to IV]. There was a high prevalence of anemia in patients with COPD. Anemia can limit the physical activity of these patients and worsen dyspnea. Therefore, more attention needs to he given to anemia while managing these patients in clinics

Ten-year experience of rhinocerebral zygomycosis in a teaching hospital in Tehran

Rhinocerebral zygomycosis is a rare, rapidly progressive and often fatal fungal infection occurring in several immunocompromised states. Prior investigators have reported an increasing incidence among Iranian population; therefore, we decided to present the clinical features and treatment outcome of a group of patients with rhinocerebral zygomycosis. Medical records of all cases with the diagnosis of rhinocerebral zygomycosis attending Rasoule- Akram Hospital, Tehran, Iran, were retrospectively reviewed from 1997 to 2007. Age, gender, predisposing illness, surgical procedures, and treatment outcomes were reviewed. Totally, 30 patients [17 males and 13 females] were reviewed with a mean age of 49.4 +/- 20.3 years. The lag time between onset of symptoms referable to zygomycosis and commencement of amphotericin B was 1 to 90 days with median of 10 days. An association between delayed treatment and mortality was found [p=0.01]. Visual loss was observed in 53.3%. The ethmoid [86.6%] and maxillary sinuses [66.6%] were most commonly involved. Eighteen patients had underlying diabetes mellitus [60%]. All patients received medical treatment, while 28 [93.3%] underwent surgical intervention. Twenty three patients [76.7%] had orbital involvement with a mortality rate of 43.5%. The overall mortality rate was 40% [12 cases]. Patients with higher doses of amphotericin B and multiple surgical intervention had lower mortality rate [p=0.00 and p=0.01, respectively]. Factors such as age, gender, predisposing diseases, orbital involvement, multi-sinus involvement, and white blood cell count had no impact on survival rate. Institution of aggressive surgical debridement of devitalized tissue and the timely initiation of systemic medical therapy is critical for good outcome

Delayed childbearing: pregnancy and maternal outcomes

Women 35-39 years old have a 2-3 fold higher risk of pregnancy-related death than women in their twenties, and the risk is even more dramatic for women 40 years and older. The aim of this study was to investigate the association of maternal age with risk of adverse pregnancy and mother outcomes in our setting, Tehran, Iran. In this retrospective observational hospital-based study, 538 nulliparous women were assessed. The association between maternal age and various pregnancy and neonatal outcomes were reported. Data were extracted from the database of Akbar Abadi hospital in Tehran from 2001-2006 records. Univariate and multiple logistic regression analyses were performed to investigate the association between maternal age and various relevant outcomes. Women aged 35 years or older had an increased percentages of gestational hypertension [18.8% vs 9.6%; p=0.02] and diabetes in pregnancy [3.7% vs 1.4%; p=0.08] compared with women younger than 35 years. There were no differences between the two age groups in Agar score at 1 min, antepartum hemorrhage, preterm labor, PROM, fetal distress, perinatal death, and postpartum hemorrhage. Advanced maternal age was shown to be independently associated with low birth weight, preterm labor and rate of cesarean delivery

Urinary incontinence: hospital-based prevalence and risk factors

This study was carried out to determine the prevalence and risk factors of urinary incontinence in women aged 30 to 70 years, who were attending to a gynecologic hospital. During 2006, married women [aged 30-70 years] attending to a teaching gynecological hospital were assessed during their visits for any gynecologic diseases. We used a questionnaire with interview for collecting data. The potential risk factors were measured; i.e., the demographics, menopausal status, urinary symptoms [frequency, nocturia and urgency], urinary incontinence, [urgency, stress and mixed], body mass index, medical history [type of delivery, parity, gravidity, chronic illnesses, medication use, pelvic surgery and seeking medical care for their problem]. The mean age was 46.5 [ +/- 8.4] years. The mean parity was 5.1 +/- 1.5. 27% of the participants reported urinary incontinence. Out of 111 women with urinary incontinence, 77 [18.7%, CI: 14.7-22.7%], 17 [4.1%, CI: 2.2-5.8%] and 17 [4.1%, CI: 2.2-5.8%] were classified as having stress, urge and mixed urinary incontinence, respectively. The overall prevalence of urinary incontinence was 18.9% [34 subjects] in women aged 30-44 years, 30.9% [46 subjects] in those aged 45-54 years and 37.8% [31 subjects] in those aged 55 years and older. Out of 117 menopause women, 39 [33.3%] were incontinent. On average, women reported 4.4 [ +/- 1.06] diurnal and 0.55 [ +/- 0.66] nocturnal voidings in 24 hours. Diurnal and nocturnal frequencies were different between continent and incontinent women. The high parity, excessive birth weight, pelvic trauma, constipation, chronic illnesses [specially diabetes] and gynecologic and other pelvic surgeries were known as risk factors for urinary incontinence. There was a significant association between urinary incontinence and high parity, excessive birth weight, pelvic trauma, constipation, chronic illnesses [specially diabetes], and gynecologic and other pelvic surgeries

Vitreopapillary traction in nonarteritic anterior ischemic optic neuropathy

To describe the association between vitreous traction on the optic disc and nonarteritic anterior ischemic optic neuropathy [NAION]. Eighty three eyes of 83 patients with NAION were evaluated by optical coherence tomography [OCT] for detecting vitreous adhesion to the optic nerve head with separation from the adjacent retina [partial posterior vitreous detachment]. Eyes which were negative for such adhesion underwent ultrasonography to detect complete posterior vitreous detachment [PVD]. Fifty male and 33 female subjects with mean age of 51.9 +/- 10 years were studied. Partial PVD with optic nerve head adhesion was found in 54 patients [65.1%] using OCT. Ultrasonography detected complete PVD in all other eyes with optically empty spaces on OCT. Vitreous traction on the optic nerve head from partial PVD may play a causative role in some cases of NAION. This traction may impair vascular supply and/or axoplasmic flow leading to signs and symptoms of NAION