Occupational Therapy Outcome Measures in Preschool Children With Autism Spectrum Disorders: A Scoping Review.

With the rising prevalence of autism spectrum disorder (ASD), early assessment of preschool children is vital for occupational therapists. This scoping review aimed to provide detailed information about outcome measures used in occupational therapy interventions in preschool children with ASD and map the focus of the outcome measures based on the International Classification of Functioning, Disability, and Health (ICF) components. A thorough search from 2000 to 2022 was conducted that employed ICF linking rules to categorize the outcome measures. Seventy-four outcome measures were identified. They predominantly targeted body function and activity/participation, with less emphasis on environmental factors, and none assessed body structure. The most common measures were Vineland Adaptive Behavior Scale (VABS-2), Canadian Occupational Performance Measure (COPM), and Parenting Stress Index-Short Form (PSI-SF). This study offers a diverse array of outcome measures and underscores the potential of the ICF framework in enhancing evaluations, particularly concerning broader environmental components as one of the primary facilitating/hindering factors in the participation of children with ASD.

METHOD: We did a scoping review following steps by Arksey and O'Malley. Scoping reviews help us to find important information. We wanted to see what works in occupational therapy for young children with ASD, using the ICF. We looked at studies from 2000 to 2022 and also checked different sources for studies. We made a summary of what we found. RESULTS: We found 802 articles but only used 46 after checking. Most kids in the studies were 4 years or older. We found 74 different tools to see whether treatments worked. The most common tools were COPM, Vineland-II, and PSI-SF. These tools looked at how children move, do things, and feel. Some ways looked at how children play, talk, and connect with others. Others focused on how parents feel. Two ways, Pediatric Evaluation of Disability Inventory (PEDI) and Functional Emotional Assessment Scale (FEAS), looked at everything. Some general ways were used too. Over time, people looked more at how the environment affects children with ASD. CONCLUSION: We gathered many ways to see whether treatments work for children with ASD. The most common ones were COPM, Vineland-II, and PSI-SF. Each tool looked at different parts of how children do things. We did not see big changes in how people looked at treatments over time. Children with ASD need better ways to see whether treatments help them. We should look more at how the environment affects children.

Mapping the Available Tools for Occupational Therapy Effectiveness in Young Children With ASD Based on the ICF StructureIntroduction: Autism spectrum disorders (ASD) affect how people communicate and behave, with about one in 44 children having it. Early help for ASD, such as occupational therapy, is really important. Occupational therapy helps with everyday skills and makes life better. Not many studies use good ways and tools to see whether occupational therapy works for young children with ASD. The International Classification of Functioning, Disability, and Health (ICF) is a reference that helps to see how well treatments work.

The Global Road Traffic Death Rate and Human Development Index from 2000 to 2019: A Trend Analysis.

BACKGROUND: Numerous studies on the association between the human development index (HDI) and road traffic death rate (RTDR) merely focus on developed countries, not reflecting the relationship between the HDI components and RTDR in a time-trend analysis. Accordingly, this study analyzes the trends of RTDR and their association with the HDI and its components from 2000 to 2019. METHODS: The RTDR data of 154 countries were imported into the unconditional latent growth model (LGM) to assess the RTDR trends. The impact of the HDI and its components (viz., education, income, and life expectancy [LE viz]) on the trajectory of RTDR was also evaluated using the conditional LGM. RESULTS: The results of the unconditional LGM indicated an overall decreasing trend in RTDR. The conditional LGM results revealed the negative effect of the HDI and its components on the model parameters. The findings of random forests indicated that education and LE were the most crucial variables. CONCLUSION: Overall, this study emphasizes the significance of HDI and its components, particularly education and LE, in lowering the number of traffic fatalities. In this sense, improving formal education and LE could be one of the main policies that policymakers could consider to reduce RTDR.

Factors contributing to the burnout of the faculties of a medical university in Iran: A cross-sectional study.

BACKGROUND AND AIMS: Faculty members confront a variety of obstacles over time, the most recent of which is the coronavirus disease 2019 pandemic, which may increase their vulnerability to burnout (BO). This study aims to examine BO in medical school faculties, as well as the factors that lead to BO and well-being in them. METHODS: This cross-sectional study was conducted in 2021 using online questionnaires completed by 222 faculty members of a medical university in Iran. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Well-being index (WBI) were used. Additionally, we gathered individual-level profiles (demographic, well-being) and occupational information (job profile, attitude toward work). RESULTS: A total of 60 (27%) faculties reported having high BO, and 112 (50.5%) reported having low well-being. Being female (odds ratio, OR = 2.69), having time to spend with the family (OR = .26), the intent of turnover (OR = 8.65), job recommendation to the offspring (OR = .26), and experiencing violence last year (OR = 2.97) were some of the individual-level factors and job-related attitudes associated with a higher BO. In the neural network for BO, the most important variables were the intention of turnover, followed by adequate family time. CONCLUSION: One third of the responding faculty reported severe BO, and BO was found to be significantly associated with lower well-being. The increased levels of BO and a decreased experience of well-being were both associated with a higher intention of turnover. According to the study, it is important to pay attention to both clinical and nonclinical field faculty members, female faculty members, those who have a high workload, and members who have experienced violence in the workplace. By acknowledging the unique challenges and experiences faced by these individuals, tailored measures can be developed to address their specific concerns and foster a supportive and inclusive environment.

CD68 Antigen and Cerebral Aneurysms: A Case-Control Study.

BACKGROUND: Intracranial aneurysms are more commonly associated with inflammation as a cause of their development, progression, and rupture. Macrophages and other cells can express the CD68 antigen. The aim of this study was to assess the CD68 antigen levels in cerebral aneurysm (CA) patients compared to a control group at a referral center in Iran. METHODS: A case-control investigation was undertaken on 88 individuals (44 of whom were cases and 44 were controls). Individuals with CA as the case group consisted of 28 ruptured and 16 unruptured subgroups. Clinical, radiographic, and CD68 levels were evaluated and registered. RESULTS: The average age of the participants was 49 years. Males comprised 43.2% of the patients, while 56.8% were females (p = 0.002). There was a statistically significant difference in the CD68 levels between the two groups. There was no significant difference (p = 0.42) between the ruptured and unruptured subgroups (23.66 and 20.47, respectively) in this comparison. No significant correlation was seen between the patients' CD68 and Glasgow Coma Scale (GCS) levels and their aneurysm diameter (p = 0.74 and 0.45, respectively). A link between CD68 levels and age was found, but it was not statistically significant (r = 0.44 and p = 0.002). CONCLUSIONS: A possible involvement of CD68 as an inflammatory agent in the development of CAs but not in aneurysm rupture has been suggested. Inflammation and CD68 were positively associated with age. The CD68 antigen should be studied further in population-based cohort studies.

Emotional intelligence and happiness in clinical medical students: A cross-sectional multicenter study.

Background and Aims: Emotional intelligence (EI) has improved job performance and has been associated with the success of individuals. The interfering role of happiness in this equation is unneglectable; however, this association has not been established in clinical medical students exposed to work pressures and stressful hospital atmospheric. The present perusal was conducted to evaluate the relationship between EI and happiness in clinical medical students. Methods: A multicenter cross-sectional investigation was conducted in Iran from December 2021 to June 2022. Multi-stage cluster sampling followed by a systematic random selection was applied to choose participants. Data gathering was carried out online by Brief Emotional Intelligence Scale-10 and Oxford Happiness Questionnaire. Results: Data from 405 participants were analyzed. The mean age was 24.2 years; men and women constituted 208 (51.4%) and 197 (48.6%) of all participants. Gamma regression analysis has determined age (Exp (B) = 1.016, p-value < 0.001), female gender (Exp (B) = 0.966, p-value = 0.04), extrovert personality (Exp (B) = 1.076, p-value < 0.001), perceived somatic health (Exp (B) = 1.002, p-value < 0.001), and stress level (Exp (B) = 0.990, p-value = 0.01) as predictors of happiness. EI comprises five domains, and except for appraisal of others' emotions, an increase in all other domains of emotional intelligence was associated with higher happiness. GBRT model of significant variables revealed regulation of own emotions is the most happiness-predictor variable (Exp (B) = 1.042, p-value < 0.001). Conclusion: Diminishing the stresses helps medical students have a happier life. In happiness-boosting strategies, vulnerable individuals (women, introverts, and those of higher age) ought to be noted as the targeted population. In this investigation, emotional intelligence was the most effective predictor of happiness in clinical medical students. Planning to promote happiness in these medical staff by enhancing their EI leads to better decision-making and more prosperity in their job, resulting in better patient care services.

Hospital Cost of Inflammatory Bowel Disease and Its Determinants in a Multicenter Study From Iran.

Background: In the current era of monitoring healthcare costs for patients with inflammatory bowel disease (IBD), there has been a shift in the pattern of such costs. In this cross-sectional study conducted in three hospitals in Iran from 2015 to 2021, we aimed to assess the in-hospital costs of IBD and identify predictors of higher total hospital costs in hospitalized patients with IBD. Methods: This cross-sectional study was conducted at three hospitals in Iran. For the purpose of this study, we collected demographic and clinical information, as well as cost data for patients with IBD. Two non-parametric statistical procedures, classification and regression trees (CARTs) and quantile regression forests (QRFs), were employed to identify the main factors related to hospital costs of IBD, which served as the dependent variable in our analysis. Results: During 7 years, 930 admissions occurred in these three hospitals. 22.3% of patients (138 of 619) were readmitted, and 306 (49.4%) were male. The mean age of the patients was 33 (SD=18.9) years. A total of 454 patients (73.3%) had ulcerative colitis (UC), and 165 patients (26.7%) had Crohn's disease (CD). Hotelling and medication costs accounted for the largest share of the total hospital costs, with percentages of 30.61% and 23.40%, respectively. Length of stay (LOS) was found to be the most important variable related to hospital costs of IBD in both QRF and CART models, followed by age and year of hospital admission in QRF. Additionally, in the CART model, hospital type and year of hospital admission were also significant predictors of hospital costs for patients with IBD. Conclusion: The present study showed that LOS, age, year of admission, and the hospital where the patient is admitted are all important factors that determine hospital costs for patients with IBD. Patients admitted for 20.5 days or longer had the highest hospital costs. These findings can be used as thresholds for future DRG policies.

Health-related quality of life variation by socioeconomic status: Evidence from an Iranian population-based study.

BACKGROUND: Health-Related Quality of Life (HRQoL) values based on the accurate and reliable European Quality of Life Five Dimension (EQ-5D) questionnaire gives health-state utilities as a helpful data set for studying socio-demographic and socio-economic inequalities in health status in the general population. We aimed to do a population-based study to see how HRQoL varies by socio-demographics and socioeconomic status (SES). MATERIALS AND METHODS: The study was a cross-sectional population-based study in Shiraz, Iran's southwest. Data was gathered utilizing a personal digital assistant (PDA). A trained interviewer administered the EQ-5D questionnaire to a representative sample of 1036 inhabitants. Principal component analysis (PCA) was used to create SES indices. Because of the skewed distribution, quantile regression was utilized to model the quartiles of HRQoL values. STATA 12.0 was used to perform all statistical analyses. P <0.05 was considered statistically significant. RESULTS: In 1036 study respondents, women had a mean HRQoL of 0.67 ± 0.28, whereas men had a mean HRQoL of 0.78 ± 0.25. Gender and age remained significant in all quartiles of HRQoL value. Participants with insurance showed 0.14 and 0.08 higher HRQoL values in the first and second HRQoL quartiles than those without coverage, respectively. Education [95% CI: 0.034, 0.111)], economy [95% CI: 0.013, 0.077], and assets [95% CI: 0.003, 0.069] all had an impact on HRQoL value in the lowest quintile. CONCLUSION: In all quartiles of HRQoL value, women had lower reported HRQoL than men. Insurance programs aimed at more disadvantaged groups with poorer HRQoL may help to minimize inequity. Education, economics, and assets all had an impact on the lower quartiles of HRQoL value, emphasizing the importance of general policies in determining public health status.

The association of patient-reported social determinants of health and hospitalization rate: A scoping review.

Introduction: The interplay between social determinants of health (SDOH) and hospitalization is significant as targeted interventions can improve the social status of the individuals. This interrelation has been historically overlooked in health care. In the present study, we reviewed studies in which the association between patient-reported social risks and hospitalization rate was assessed. Method: We performed a scoping literature review of articles published until September 1, 2022 without time limit. We searched PubMed, Embase, Web of Science, Scopus, and Google Scholar to find relevant studies using terms representing "social determinants of health" and "hospitalization." Forward and backward reference checking was done for the included studies. All studies that used patient-reported data as a proxy of social risks to determine the association between social risks and hospitalization rates were included. The screening and data extraction processes were done independently by two authors. In case of disagreement, senior authors were consulted. Results: Our search process retrieved a total of 14,852 records. After the duplicate removal and screening process, eight studies met the eligibility criteria, all of which were published from 2020 to 2022. The sample size of the studies ranged from 226 to 56,155 participants. All eight studies investigated the impact of food security on hospitalization, and six investigated economic status. In three studies, latent class analysis was applied to divide participants based on their social risks. Seven studies found a statistically significant association between social risks and hospitalization rates. Conclusion: Individuals with social risk factors are more susceptible to hospitalization. There is a need for a paradigm shift to meet these needs and reduce the number of preventable hospitalizations.

The cost of illness analysis of inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving individuals across all age groups. Recent data suggests the increase in the prevalence of IBD and the surge in applying the biologic drugs in which both change the cost of IBD in recent years. Comprehensive assessment of direct and indirect cost profiles associated with IBD in our area is scarce. This study aimed to determine the economic burden of IBD in Iran from a societal perspective, using cost diaries. METHODS: Patients available on clinic registry and hospital information system (HIS), who were diagnosed with IBD, were invited to take part in this study. Demographic and clinical data, the healthcare resource utilization or cost items, absenteeism for the patients and their caregivers were obtained. The cost of the used resources were derived from national tariffs. The data regarding premature mortality in IBD patients was extracted from HIS. Productivity loss was estimated based on the human capital method. Then, cost date were calculated as mean annual costs per patient. RESULTS: The cost diaries were obtained from 240 subjects (Ulcerative colitis: n = 168, Crohn's disease, n = 72). The mean annual costs per patient were 1077 US$ (95% CI 900-1253), and 1608 (95% CI 1256, 1960) for the patients with ulcerative colitis and Crohn's disease, respectively. Of the total costs, 58% and 63% were in terms of the indirect costs for the patients with ulcerative colitis and Crohn's disease, respectively. The cost of illness for country was found to be 22,331,079 US$ and 15,183,678 US$ for patients with ulcerative colitis and Crohn's disease, respectively. Highest nationwide economic burden of IBD was found for patients older than 40 years were estimated to be 8,198,519 US$ and 7,120,891 US$, for ulcerative colitis and Crohn's disease, respectively. CONCLUSION: The medication was found to be the greatest contributor of direct medical costs. Productivity loss in terms of long-term disability and premature mortality were major components of IBD's economic burden in Iran.

Adalimumab versus Infliximab Treatment Outcome in Ulcerative Colitis: Application of EQ-5D, Visual Analogue Scale, and IBDQ-9 Measures: A Prospective Observational Study.

BACKGROUND: Ulcerative colitis (UC) is a chronic global disease, and its incidence and prevalence are increasing worldwide. OBJECTIVE: Our objective was to compare the secondary outcome of treatment with Infliximab (IFX) and Adalimumab (ADA) in the UC patients. METHODS: This was a one-year prospective observational study of moderate- to -severe UC patients treated with ADA or IFX. Patients' secondary health outcomes were measured using the EQ-5D 3L, EQ-VAS, and IBDQ-9 tools. T-test, Mann-Whitney, chi-square, and Fisher's exact tests were used to compare health-related quality of life (HRQoL) among UC patients. HRQoL predictor variables were identified by multivariate linear regression and multivariate logistic regression. RESULTS: A total of 238 UC patients (patients taking IFX: 78, patients taking ADA: 160) with a mean age of 37.66 and a mean disease duration of 9.29 years were enrolled. The EQ-5D index, EQ-VAS, and IBDQ-9 scores of patients taking IFX were 0.65, 55.93 and, 37.42, respectively. Similarly, patients taking ADA were 0.68, 59.27 and, 36.61, respectively. The highest problem reports were in P/D: 86.1% and A/D: 73.5%. The main independent predictors of HRQoL were: education over 12 years (ß = 0.054 [EQ-5D index], ß = 13.63 [EQ-VAS], OR: 0.28 [MO], OR: 0.07 [SC]), education between 6-12 years (ß = 11.23 [EQ-VAS]), and having "other chronic diseases" (ß = -0.074 [EQ-5D index], ß = -5.29 [IBDQ-9], OR: 2.84 [UA], OR: 3.80 [A/D]). CONCLUSION: There was no significant difference between the effect of ADA and IFX on secondary health outcomes in patients with moderate-to-severe UC.

Health care workers' mental health in the face of COVID-19: a systematic review and meta-analysis.

BACKGROUND: Healthcare workers are leading the way in treating patients with coronavirus disease 2019 (COVID-19). Due to the high levels of psychological stress, this group is more likely to experience psychological issues. These psychological problems in healthcare providers include depression, anxiety, insomnia, stress and post-traumatic stress disorder (PTSD). The goal of this systematic review and meta-analysis was to find out how common these problems were in the face of COVID-19. METHODS: On 20 February 2022, systematic searches were conducted in the PubMed, Cochrane Library, Scopus, EMBASE, Science Direct, Web of Science and ProQuest databases. Two authors selected articles based on search keywords. As a last step, articles about the prevalence of psychological problems among healthcare workers in the face of COVID-19 were looked at and analysed for five different outcomes. RESULTS: The initial search yielded 18,609 articles. After reviewing the titles, abstracts and full texts of the articles, 44 were chosen for the final analysis and 29 were subjected to a meta-analysis. Insomnia, anxiety, depression, PTSD and stress are among the psychological issues faced by healthcare workers. Furthermore, the highest pooled prevalence of depression, anxiety, insomnia, PTSD and stress was 36% (95% confidence interval (CI) 24-50%), 47% (95% CI 22-74%), 49% (95% CI 28-70%), 37% (95% CI 19-59%) and 27% (95% CI 6-69%). CONCLUSIONS: In this meta-analysis, insomnia was found to be the most common mental health problem, followed by anxiety, PTSD, depression and stress in healthcare workers in the face of the COVID-19 pandemic. Generally, the pooled prevalence of these mental health problems was higher among physicians, nurses and older staff in the subgroup analysis. As a result, health policymakers and managers of the health care system should think about effective interventions to promote mental health, paying particular attention to these two groups.Key pointsStudies conducted in China reported more mental problems than in other countries.Health policymakers and health system managers should hold training programs to promote healthcare workers' mental health with a particular focus on more vulnerable groups.The prevalence of PTSD, stress, anxiety, depression and insomnia were higher among physicians, nurses and older staff.Health systems at both national and local levels have to take older physicians, nurses and healthcare providers into consideration while designing interventions.

Resilient Nurses in the COVID-19 Compared With Non-COVID-19 Wards.

INTRODUCTION: Owing to daily exposure to high job stress, nurses need to use coping techniques. One of the coping strategies helping a person to cope with stressful situations effectively is resiliency skills. The aim of this cross-sectional study was to examine the factors related to nurses' resiliency during the coronavirus disease 2019 (COVID-19) epidemic. METHODS: The resiliency of 288 nurses, 145 nurses from the COVID-19 wards , and 143 nurses from other wards were compared using 25-item Connor & Davidson Resilience Questionnaire. This study was conducted in 2021 in four referral hospitals at Shiraz. RESULTS: The mean age of participants was 32 y. The average resilience score in the in the participants worked in COVID-19 wards was 95.30 for men and 87.72 for women, and in the non-COVID-19 wards was 85.82 for men and 88.48 for women. The mean resiliency scores of nurses working in COVID-19 and non-COVID-19 wards did not show a statistically significant difference. Factors affecting resilience included age, employment status, gender, and job expectancy. CONCLUSIONS: In this study, the resiliency of nurses working in COVID-19 wards did not differed from that of working in non-COVID-19 ones. This result should be further investigated and elaborated. Health policymakers should consider job expectation, gender, age, and employment status of nurses when making plans for future pandemics.

Surgical Outcome of Pediatric Posterior Fossa Tumors in Shiraz, Southern Iran: A Brief Report.

Posterior fossa tumors (PFTs) are prevalent in children, and about half of all childhood brain tumors arise from the structures of the posterior fossa. Studies on PFTs in Iranian children have mainly focused on epidemiological characteristics. This study aimed to evaluate surgical outcomes and predictive factors for survival in children with PFTs in Shiraz, Iran. A prospective cohort study was conducted from March 2014 to September 2019 in Namazi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 87 pediatric patients under the age of 16 who were diagnosed with PFT and had undergone surgery were recruited. The children were followed up for postoperative outcomes such as mortality and neurological complications. Data were analyzed using SPSS software (version 20.0) and R software (version 3.3.1). P<0.05 was considered statistically significant. The mean age of the patients was 6.49±4.14 years and 64.4% were male. Sixteen patients were lost to follow-up, 31 died after surgery, and 40 were in remission during phone calls. The median survival time of the patients was four years. The most common type of PFT was medulloblastoma (n=46, 53%). The result of the multivariate Cox proportional hazards model showed that age (P=0.034) was correlated with postoperative survival, hazard ratio 0.90 (95% confidence interval 0.82 to 0.99). Among various predictive factors, lower age was associated with poor outcomes in pediatric children with PFTs.

Estimating willingness to pay for diabetes complications.

BACKGROUND: Maximum willingness to pay (WTP) for a health benefit is connected to perceived value. This two-center study aims to analyse diabetic patients' WTP for obtaining a specific preventive treatment package to reduce severe diabetic complications and determine the factors that impact this value. METHODS: This cross-sectional research included 557 diabetics from two cities in Iran. The WTP for a preventative package minimising major diabetes complications (cardiovascular, renal, ocular, and diabetic foot) by 50% and 100% was tested using eight scenarios. The Diabetes Attitude Scoring Questionnaire (DAS-3) was used to examine patient attitudes toward diabetes. To determine WTP, a two-stage hurdle method was used. The level of significance was fixed to 0.05. RESULTS: Around 80% of 557 people interviewed (mean age 47.54) stated they wanted to pay for a diabetes prevention package. This package's WTP varied from 169.4 to $374.5 depending on the complication and degree of risk reduction. The largest value diabetic patients willing to pay for preventative packages that reduce the chance of blindness was reported, while the lowest cost was stated for the diabetic foot. WTP is influenced by wealth, location of study, marital status, and attitude toward special training, but not by the type of diabetes, inpatient or outpatient setting, or the complications diabetes patients are impacted by. Patients' diabetes attitudes were mainly negative. The score of the attitude of patients towards diabetes was generally suboptimal. CONCLUSION: Most diabetic patients were willing to pay for a preventive package and this value was not affected by the type of diabetes and its severity. Our research found that diabetic individuals are willing to pay the most for a preventative package that reduces the chance of blindness, and the least for diabetic foot care. WTP can help health officials allocate resources and manage budgets. The attitude of diabetic patients toward diabetes still needs further interventional research, however.

Preserving natural teeth versus extracting them: a willingness to pay analysis.

BACKGROUND: Maximum willingness to pay (WTP) for a health benefit is related to perceived value. The goal of this study was to find out how much Iranian healthy people would be willing to pay to keep their natural teeth instead of having them pulled. This was done separately for the anterior and posterior teeth. METHODS: The highest value was posed as an open-ended question in this cross-sectional analysis conducted in 2021. Four distinct scenarios for treating a tooth with a poor prognosis for natural tooth preservation versus extraction were offered. WTP for the preferred treatment option was asked for painful and painless anterior and posterior teeth separately. A two-stage hurdle approach was employed to determine factors influencing the WTP for a hopeless case. The level of significance was fixed at 0.05. RESULTS: Out of 795 individuals, 355 (44.7%) were male and 209 (26.3%) had poor self-stated dental health. Over 65% of those interviewed said they wanted to keep their teeth. The mean WTP was highest for dental preservation up to 94 USD and the lowest was for extraction without replacement 19 USD. The WTP for anterior tooth therapy was greater than the WTP for posterior dental care, regardless of treatment type or tooth discomfort. Participants with higher education, jobs, income-to-expenditure matching, older age, preference for the treatment in a private office, and female gender (except for WTP for a painful posterior tooth) were more likely to have a WTP of at least 1 USD. CONCLUSION: The average WTP for treatment of teeth with a poor prognosis was lower than the average fee charged in dental facilities, and more than 65% of participants preferred to keep their teeth. Regardless of the treatment option or whether it was painful or not, WTP for anterior teeth treatment was higher than for posterior teeth. Generally, we found that sociodemographic factors influenced WTP decision-making the most. This study has practical implications for public oral health policymakers and insurance organizations.

Factors affecting medication adherence among older adults using tele-pharmacy services: a scoping review.

BACKGROUND: Medication adherence among older adults (aged 60 and above), particularly those with chronic conditions who take several medications, is critical, and tele-pharmacy services are a way to improve medication adherence. This study sought to determine the factors influencing medication adherence (MA) in older adults using tele-pharmacy services. METHOD: The Joana Briggs Institute scoping review methodology was implemented. Searches were conducted in databases PubMed, Scopus, ProQuest, Web of Science, and Embase from 2000 to the present day, to identify both qualitative and quantitative studies focusing on the use of tele-pharmacy by older people. Factors impacting MA were extracted and analyzed into themes using a qualitative approach. A concept map was also designed summarising these factors. RESULTS: Of 7495 articles obtained in the initial search, 52 articles met the inclusion criteria. The analysis resulted in 5 themes and 21 sub-themes representing factors that impacted MA with tele-pharmacy. These themes are divided broadly into technology and user related factors. Technology factors included design of the tele-pharmacy intervention, commercial aspects, and adherence measurement method. User factors included user-health constraints, behaviors and perceptions. CONCLUSION: Industry, policymakers, and stakeholders should consider using tele-pharmacy services for improving medication adherence among older adults; however, ensuring interventions facilitate communication between patients and health care teams, and are accompanied by user training and support, is essential for technology uptake and effectiveness.

Determining Factors Influencing Specialty Preferences of Iranian Medical Doctors: A Qualitative Study.

Background: The medical specialty choice of physicians directly affects the healthcare system, community wellbeing, and their own professional life. It is therefore important to identify its underlying factors to predict such medical career choices and to draw up a comprehensive evidence-based public health policy and health human resources planning. The present qualitative study aimed to identify these determinants of career choices through semi-structured interviews with medical doctors in the context of country-specific social and cultural characteristics. Methods: The present qualitative study was carried out in 2019-2020 at Shiraz University of Medical Sciences (Shiraz, Iran). The target population was medical students, junior doctors, and medical residents. The purposive sampling method was used to recruit the participants and sampling continued until data saturation, i.e., no new information could be extracted. Data were collected through individual, face-to-face, semi-structured interviews and analyzed using the conventional content analysis method. Inductive thematic analysis was used to interpret the data based on which a thematic map was developed illustrating the factors influencing medical specialty preferences in Iran. Data trustworthiness was assessed according to the criteria proposed by Guba and Lincoln. Results: Analysis of the interview data resulted in three main themes and fourteen sub-themes. The main themes were "Personal determinants", "Career-related factors", and "Interpersonal influences". The most important sub-themes were personal interests, income, and prestige. Conclusion: The determinants influencing the specialty preferences of Iranian medical doctors are identified. Our findings will facilitate the development of a comprehensive evidence-based public health policy, health human resources planning, and appropriate medical education policy.

Impact of Octreotide on Early Complications After Liver Transplant: A Randomized, Double-Blind Placebo-Controlled Trial.

OBJECTIVES: Acute kidney injury and early allograft dysfunction are 2 common complications after liver transplant. Octreotide, through its various mechanisms, may have a role in preventing these complications. MATERIALS AND METHODS: In this randomized, double- blind placebo-controlled clinical trial, we randomly assigned 50 patients who underwent deceased donor liver transplant and fulfilled the study inclusion requirements to receive either octreotide infusion for 3 days in the first 3 days after transplant in the intensive care unit or placebo. The eligible patients were properly informed while on the transplant wait list and gave their consent to participate in the study. The rates of acute kidney injury within the first 7 days after transplant (based on KDIGO criteria), early allograft dysfunction, and nosocomial infection; total length of hospital stays and intensive care unit admissions; and intubation time were recorded and compared between the 2 groups. RESULTS: No significant differences were found between the 2 groups with regard to demographic characteristics and graft factors (P > .05). However, acute kidney injury, early allograft dysfunction, and nosocomial infection rates were significantly lower in the octreotide group compared with the control group (P < .05). Moreover, a significant difference was observed between the 2 groups with regard to length of hospital stay and intensive care unit admissions (P < .05). For infection, female patients had a higher likelihood of infection than male patients (odds ratio = 23.19). Intensive care unit admission was associated with a higher probability of early graft dysfunction (odds ratio = 1.34). In contrast, longer intubation time was associated with a decrease in the probability of early graft dysfunction (odds ratio = 0.93). CONCLUSIONS: This study showed that octreotide infusion in the first 3 days after liver transplant could improve renal and allograft function and reduce infection and length of hospital stay.

What do Iranian physicians value most when choosing a specialty? Evidence from a discrete choice experiment.

BACKGROUND: Choosing a specialty by physicians is fundamentally linked to the performance of health systems and public health outcomes. Identifying the determinants of specialty selection is important to health policy for targeting resources and planning the development of services. This study examined preferences of Iranian physicians for medical specialty using a discrete choice experiment (DCE) method. METHODS: In this study, the attributes of the DCE were determined using rigorous qualitative approach. Then we applied D-efficiency criteria to design the DCE and validated it at a pilot study. In the final survey, we recruited participants from six Iranian provinces and analyzed data using conditional logit model. We estimated willingness to pay (WTP) for non-monetary attributes. RESULTS: The WTP analysis revealed that the most important non-monetary attributes in the selection of a specialty were job burnout, opportunity for procedural activities, and job prestige. The results imply that the attributes that were related to the quality of personal life was more important only for physicians who preferred to choose non-surgical specialties. CONCLUSIONS: The findings demonstrate that traditional gender patterns of specialty selection are changing and quality of personal life characteristics might be the most important factor when developing policies to recruit physicians into non-surgical specialties.