[ role of health technology assessment in evidence- based decision making and health policy: a review study]

Introduction: The purpose of this study was to show the major challenges and opportunities related to Health Technology Assessment [HTA] that most countries have faced with when launching and developing an HTA system for making appropriate decisions in policy making

Review of studies: This was a review study in the field of HTA and health policy. All literature potentially relevant to this issue had been studied via library and the Internet search of data bases related to HTA to select and present materials extracted. The search was focused on English papers published in 1980-2014.The impact of HTA depends in large part on the quality and transparency of the assessment and decision-making processes, as well as institutional, organizational, political and cultural dynamics broader than the scopes of national health care systems. As many countries increasingly gear their health systems towards policies emphasizing measurement, accountability, transparency and evidence-based practices, the challenges of HTA should be addressed in order to achieve concurrent health care system goals, and support those services offering large value of money and impact on health care outcomes

Conclusion: The role of HTA offering extensive opportunities to support governments and other stakeholders in decision-making has grown substantially. Countries should, therefore, seek to capitalize on the strengths of established HTA systems, while pioneering solutions to address major challenges and strengthening the HTA enterprise

Association of vitamin D receptor polymorphism [VDR rs 2238136] with colorectal cancer

Many studies have demonstrated that Vitamin D has an important role in cell growth and proliferation and vitamin D receptor polymorphism has significant relationship with colorectal cancer [CRC]. The aim of this study was to assess the incidence of VDR rs 2238136 polymorphism in Iranian population and to investigate the relationship between this single nucleotide polymorphism [SNP] and increased risk of CRC. In this case-control study, genotyping of vitamin D receptor gene polymorphism [VDR rs2238136] was determined in a series of 112 colorectal cancer patients and 112 controls by using polymerase chain reaction and restriction fragment length polymorphism genotyping assays [PCR-RFLP]. Statistical analysis was done through SPSS 16. VDR polymorphism [rs 2238136] had no significant relationship with CRC risk. The result of statistical analysis for the genotype AG compared with GG was OR=0. 59, CI=0.33-1.03 and for AA versus GG was OR=0.8, Ct=0.29-2.17. Incidence of mutant allele in patients and controls did not show significant difference [OR=0.74, CI=0.49 -1.13]. These findings suggest that VDR [rs 2238136] is not associated with increased risk of CRC. Moreover age, sex and smoking are not predisposing factors for increased risk of CRC

[Relationship between chronological, dental and skeletal ages among 7 to 13 year old children]

Efforts to find correlation between ossification events in the hand and wrist, developmental conditions of the teeth, and chronological age can lead to assessment of developmental status of an individual as a simple and useful method. The aim of this study was to investigate the relationship between chronological, dental and skeletal ages among 7 to 13 year old children referring to Orthodontic Department, Shiraz Dental School. This cross-sectional study was conducted on 40 female and 22 male subjects. Sixty two panoramic and hand wrist radiographs were obtained. Dental ages were assessed according to Demirjian based on the lower left canines, first and second premolars and second and third molars. Greulich and Pyle standard atlas was used to determine the skeletal age. The results were analyzed using Pearson coefficient correlation. A statistically significant relationship [p<0.01] was found between dental and chronological ages. The relation between dental and skeletal ages was significant too [p<0.05]. At the same skeletal maturity stage, dental maturation patterns of the male subjects were ahead and the G stage of the canine for both sexes [60%] coincided with the MP3cap stage. It is suggested that tooth calcification stages in panoramic radiographs might be a valuable indicator to assign timing of growth spurt

[Evaluating curvilinear hypothesis in quality of life and glycemic control in diabetic patients]

Quality of life [QOL] has become an important concept in medical research. Some research has shown a curvilinear relationship between QOL and glycemic control, but some did not so. The aim of this study is to investigate different aspects of QOL and also assess the hypothesis in diabetic patients. In a cross-sectional study, a random sample of adult diabetic outpatients [n=110] were selected and completed the WHO-QOL assessment instruments. In addition HbA1c was measured in these patients by calorimetric method. Patients were divided in to 3 groups: 1-good control [HbA1c<7], 2-fair control [7 >= HbA1c<9] and 3-poor control [HbA1c >= 9]. QOL was assessed by measuring physical, psychological, social and environmental domains. Data were analyzed with one way ANOVA [Tukey as post hoc], Chi2 and Mann-Whitney, and correlation tests. A significant correlation was seen between BMI and glycemic control, physical and social aspects, physical and environmental aspects, psychological and environmental aspects, and social and psychological aspects. No significant difference was seen between mean score of different dimensions of QOL in relation to HbA1c changes. The mean score of each dimension in relation to glycemic control showed that, better score of psychological, environmental and social dimensions is seen in patients with fair glycemic control. But regarding the overall score of QOL this is completely reverse. The mean score of physical dimension is decreased with increasing HbA1c. There was no correlation between other domains of QOL and glycemic control. In this survey higher quality of life was seen in fair glycemic control in social, environmental and psychological dimensions, but physical dimension in patients was decreased when HbA1c was increased. Regarding the overall score of QOL it can be seen that the lowest score of QOL is in patients with fair glycemic control which is in contrast with curvilinear hypothesis

effect of childbirth preparation classes on childbirth fear and normal delivery among primiparous women

There has been an increase in the number of women willing to have a caesarean birth because of their fear of childbirth. It seems the childbirth preparation educational class is a good way to remove or alleviate fears associated with pregnancy and childbirth.This research designed to identify the effect of childbirth preparation classes on childbirth fear on the primiparous women. The present study is a clinical trial which was carried out in 2007 at Milad Hospital, with 100 nulliparous pregnant women. Childbirth fear was measured by childbirth attitudes questionnaire. Normal pregnant women in the second trimester with childbirth fear score was 28 or more were randomly selected and dirided into experimental and control group with 50 subject in each qroup. The experimental group attended nine childbirth preparation class sessions and control group received routine antennal care. The mean scored fear of childbirth in case and control group were 39.35 +/- 6.96 and 40.71 +/- 6.23 respectively. There was not significant difference between two groups. After the sessions, comparing childbirth fear score between two groups in third trimester showed the mean score of childbirth fear among experimental group was lower than control group [29.82 +/- 7.18 compare to 38.03 +/- 9.27], and the differences statistically was significant [p < 0.001]. Mode of delivery was significantly different between the two groups. Primiparous women attended childbirth preparation classes acquired lower score of childbirth fear in compare to women received routine prenatal care. The results of this research showed relaxation training decreased childbirth fear and increased normal vaginal delivery

Assessment of health belief model structures along with HbAlC in diabetic patients with optimum and unfavorable diabetes control

Nowadays implementing educational models for identifying reasons of rejecting health issues in the treatment process is increasingly concerned. One of the models which has been a matter of concern in recent years is health belief model. The objective of this study is assessing the structures of this model along with HbAIC in diabetic patients. In this cross-sectional study 76 [insulin dependent and non-insulin dependent] diabetic patients who referred to diabetes clinic of Hormozgan University of Medical Science during July and August 2006 and had been detected as diabetic at least one year prior to recruitment, entered the study after filling consent form. Data collection was performed via 3 questionnaires including demographic information, health belief model and self-efficacy questionnaires. HbA1C was calculated by calorimetry and body mass index [BMI] were calculated. Data by SPSS software, using t-test and pearson's correlation coefficient. 46 women [60.5%] and 30 men were studied. Data analysis revealed that there is no significant difference between HbA1C and the following factors: amount of perceived barriers according to sugar control, amount of perceived self-efficacy based on sex, rate or perceived self-efficacy on the basis of literacy and sensitivity rate perceived by the number of years inflicted with diabetes. Diabetes control is not satisfactory in patients despite long term medication and prejudiced diets. The level of health belief model structures in patients with unfavorable diabetes control is lower than those with optimum control. Hence, a precise educational program based on health belief model is necessity for excelling severity and sensitivity perceived by patients, increasing the perceived benefits and removing perceived barriers