Prevalence of depression, anxiety, and stress and associated reasons among Iranian primary healthcare workers: a mixed method study.

BACKGROUND: Different mental disorders may be associated with many work-related factors to which primary health care workers (PHCWs) are exposed. The current research aims to measure the rates of depression, anxiety, and stress among PHCWs, and their associated causes in primary health care (PHC) settings. METHODS: An explanatory sequential mixed methods design was employed in this research from January 2021 to January 2022 in Tabriz, Iran's PHC centers. First, this study followed an online-based cross-sectional survey using a self-reported questionnaire. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) and questions on demographic and work-related characteristics were completed by 303 frontline PHCWs during the quantitative phase. In the qualitative phase, a semi-structured interview was held with 12 PHCWs who had the highest level of depression, anxiety, and stress to identify the reasons and sources of mental health prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-26. A content analysis was performed to analyze qualitative data. RESULTS: The results showed that self-reported stress, anxiety, and depression had a prevalence of 40.3%, 42.9%, and 42.6%, respectively. Symptoms of at least one mental disorder were experienced by 54% of respondents, while 28% had all three. Major sources of stress, anxiety, and depression among PHCWs were working environment conditions, organizational policies, job-related reasons, and interpersonal relations. CONCLUSIONS: The results of current study indicated that PHCWs experienced high levels of depression, anxiety, and stress. The main factors and reasons that contributed to these mental health issues among PHCWs were work environment conditions, organizational policies, job-related reasons and interpersonal relations. Therefore, interventions should be implemented to promote mental health of PHCWs. This can include measures such as psychological screening, supportive care, workload management, flexible scheduling, and access to mental health resources. Additionally, training programs can be implemented to enhance resilience and coping skills among healthcare professionals.

The burden of neck pain in the Middle East and North Africa region, 1990-2019.

Background: Neck pain is a common cause of disability across the world. The objective of the present study was to present a thorough investigation of the burden caused by neck pain in the Middle East and North Africa (MENA) region, by country, sex, age group and socio-demographic index (SDI). Methods: The data on the burden of neck pain, encompassing its prevalence, incidence and years lived with disability (YLDs), were extracted from the Global Burden of Disease (GBD) 2019 study. These findings are reported as age-standardised numbers and rates (per 100,000), accompanied by 95 % uncertainty intervals (UIs). Results: The age-standardised point prevalence of neck pain in 2019 was 3066.7 (95 % UI: 2407.8 to 3894.3) per 100,000, with an age-standardised incidence rate of 649.2 (509.2-829.2) in the MENA region, neither of which have changed since 1990. The age-standardised YLD rate of neck pain was 303.0 (201.5-438.8) per 100,000 population in 2019. The highest YLD rate of neck pain was found in Iran [423.5 (280.3-609.8)] and the lowest in Kuwait [215.0 (141.0-314.1)]. The highest number of prevalent cases were seen in the 45-49 age-group for both sexes in 2019, but overall females had a higher point prevalence than males. Furthermore, over the study period (1990-2019) there was no clear and consistent relationship between the SDI and the burden of neck pain. Conclusion: Although the burden of neck pain has largely remained stable over the past three decades, the prevalence and morbidity in the MENA region remains high. Preventive and rehabilitative programs should be implemented that firstly target middle-aged females and males.

The burden of vision loss in the Middle East and North Africa region, 1990-2019.

BACKGROUND: The loss of vision is a substantial public health concern that has important implications for an individual's quality of life. The primary objective of this research was to document the burden of vision loss in the Middle East and North Africa (MENA) region, spanning the years 1990-2019, by age group, sex, underlying cause and sociodemographic index (SDI). METHODS: Publicly available data concerning the burden of vision loss were acquired from the Global Burden of Disease study 2019. The data encompassed all 21 countries within the MENA region for the period spanning 1990 to 2019. The estimates were reported as raw counts and age-standardised rates per 100,000, accompanied by their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2019, MENA had an age-standardised point prevalence of 7040.0 (95% UI: 6195.0, 8002.7) and an YLD rate of 314.5 (222.1, 427.6) per 100,000 for vision loss, which were 11.1% (-12.5, -9.7) and 24.3% (-27.6, -20.8) lower, respectively, than in 1990. In 2019, Afghanistan [469.6 (333.0, 632.8)] had the largest age-standardised YLD rate and Turkey [210.7 (145.3, 290.9)] had the lowest. All countries showed a decrease in the age-standardised point prevalence and YLD rate between 1990 and 2019, except for Oman, Afghanistan, and Yemen. Furthermore, in 2019 the largest number of prevalent cases and YLDs were found in the 65-69 age group. Also in 2019, the age-standardised YLD rates in MENA exceeded the global averages for most age groups, for both males and females. In 2019, refractive disorders were the most common types of vision loss among children, adolescents, and middle-age adults in MENA, while near vision loss and cataracts were the most common among older adults. Finally, the burden of vision loss had a slightly negatively association with SDI over the period 1990-2019. CONCLUSION: Although the burden of vision loss has decreased over the last three decades, the prevalence remains high. These results underscore the importance of healthcare policymakers taking action to implement preventive measures, especially among the elderly and those living in low socioeconomic countries, to decrease the attributable burden in MENA.

Scoping review of outpatient health services utilization among women.

BACKGROUND: Health services utilization, as one of the mechanisms of the health system, guarantees a healthy life and improves well-being for everyone. AIMS: The aim of this study was to identify factors affecting the use of outpatient health services among women. METHODS/DESIGNS: This scoping review examined the studies related to outpatient health services utilization (OHSU) and its determinants among women. This review was conducted on English language studies published between 2010 and 2023 (All searches were conducted on 20 January 2023). Studies available in databases such as Web of Science, MEDLINE (PubMed), Scopus, Wiley library, Proquest, and Google Scholar were searched manually. Selected keywords and their equivalents were used to search for related articles in each database. RESULTS: A total of 18 795 articles were identified, of which 37 met the inclusion criteria. Findings showed that age, marital status, level of education, employment status, income level, socioeconomic status, rape experience, health insurance, health status, ethnicity, living in rural areas, quality of services, area of residence, having a purpose in life and access to health services affect OHSU among women. CONCLUSIONS: The results of the present review showed that in order to achieve the universal goals of health services coverage and health service utilization, it is necessary for countries to provide insurance coverage to the maximum number of people. Also, policies should change in favor of the elderly, poor and low-income, low-educated, rural, ethnic minority, and chronically ill women and provide them with free preventive health services.

Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran.

BACKGROUND: Defining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework. METHODS: The first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards. RESULTS: Analysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations. CONCLUSIONS: We developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.

The Relationship of COVID-19 Morbidity and Mortality with the History of Influenza Vaccination.

Background: COVID-19 is currently the leading global health issue. Low- and middle-income countries (LMICs) face challenges in supplying COVID-19 vaccines. To assess an adjunctive preventive measure for COVID-19 burden, we aimed to evaluate the relationship of influenza vaccination in the previous year with outcomes of COVID-19 in affirmed cases after adjustment for relevant factors. Methods: This prospective study was conducted using the provincial registry of confirmed COVID-19 cases in East-Azerbaijan province in North-West of Iran. The main outcomes were COVID-19 mortality and hospitalization. The influenza vaccination history in 2019 was collected by phone calls. Data analysis was done by SPSS software version 16, separately for healthcare workers and the general population. The logistic regression model was applied to compare the covariates in influenza vaccinated versus unvaccinated patients. Results: From 1 March to 10 October 2020, 17,213 positive COVID-19 cases were registered, of which 916 patients were included. A total of 88 patients (9.6%) deceased due to COVID-19. Two hundred subjects (21.8%) reported receiving the influenza vaccine during the past year. Healthcare workers had a significantly higher vaccination rate than the general population (28.9% vs. 7.1%; p<0.001). After adjustment for socioeconomic and health covariates, the vaccinated cases in the general population had 84% lower odds of death (OR: 0.16; 95%CI: 0.05-0.60; p=0.017). In multivariate analysis, the influenza vaccination history in the previous year was not significantly related to the lower COVID-19 hospitalization rate. Conclusion: The flu vaccination rate was not optimal in our community. The flu vaccination can be an independent preventing factor for COVID-19 mortality in the general population. The influenza vaccine can be considered as an effective adjutant preventive countermeasure for the COVID-19 burden.

The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990-2019.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. The present study reported the burden of COPD, and its attributable risk factors, in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex and socio-demographic index (SDI). METHODS: Data from the Global Burden of Disease (GBD) 2019 study were used to report the burden of COPD in the MENA countries. The prevalence, deaths, and disability-adjusted life-years (DALYs) were presented as counts and age-standardised rates per 100,000 population, with their associated 95% uncertainty intervals (UIs). RESULTS: In 2019, the regional age-standardised point prevalence and rates of death due to COPD were 2333.9 (2230.1, 2443.6) and 26.1 (22.2, 29.5) per 100,000, which represent a 30.6% (28.2%, 33.0%) increase and an 18.0% (2.8%, 30.9%) decrease, respectively, since 1990. The regional age-standardised DALY rate in 2019 was 649.1 (574.6, 717.7) per 100,000, which had decreased by 11.8% (0.9%, 21.1%) since 1990. Turkey had the highest age-standardised point prevalence in 2019 [3287.1 (3187.4, 3380.3)], while Afghanistan had the highest age-standardised death [40.4 (24.2, 52.6)] and DALY [964.5 (681.8, 1203.2)] rates. The regional age-standardised point prevalence, death and DALY rates in 2019 increased with advancing age and were higher in males in almost all age groups. There was a U-shaped association between SDI and the burden of COPD over the period 1990 to 2019. Moreover, in 2019 smoking (43.7%), ambient particulate matter pollution (22.8%) and occupational particulate matter (11.4%) had the largest proportion of attributable DALYs for both sexes. CONCLUSIONS: COPD is one of the leading causes of death and disability in the MENA region, although the age-standardised burden has decreased over the last 30 years. Nevertheless, COPD accounted for a substantial number of deaths and DALYs, especially among the elderly. Programs targeting risk factors, like smoking, should be taken into consideration.

Compliance with education on evidence-based oral hygiene principles among dental students and staff: a best practice implementation project.

OBJECTIVES: This study aims to assess compliance with evidence-based criteria regarding oral hygiene principle education provided for children and adolescents in the Tabriz Faculty of Dentistry. INTRODUCTION: Oral health problems might lead to lowering the quality of life amongst children and adolescents; so, providing education regarding oral health principles is of great importance. METHODS: Eight audit criteria were assessed using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GriP) audit and feedback tool. Barriers were identified and dental students and staff were instructed by the team members and asked to educate children and adolescents referred to orthodontic department about oral hygiene practices. Changes in audit criteria were collected by direct observation and interview and reported using descriptive statistics. RESULTS: In the follow-up phase, the percentage of patients who were advised to brush their teeth with fluoride toothpaste twice a day, floss daily, and seek regular dental check-ups increased, as compared with the baseline audit (37, 43 and 33%, respectively). Professional fluoride application, fissure sealant and individualized intervention and/or prevention treatment plans increased by 30, 35 and 15%, respectively in the follow-up phase; while advice on diet and risks of alcohol, tobacco and smoking increased by 93%. CONCLUSION: The use of standard clinical audit tools in dentistry wards causes improvement in the compliance with providing oral hygiene principle instructions among dental students and staff. Standard tools can increase the effectiveness of corrective interventions by identifying weaknesses in patient care process.

The burden of rheumatoid arthritis in the Middle East and North Africa region, 1990-2019.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0-135.7) and an annual incidence rate of 5.9 (5.2-6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2-136.7), with an age-standardised rate of 19.0 (13.9-24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7-28.2). The highest point prevalence was found in females aged 50-54, and in males aged 45-49. The highest number of DALYs was observed in the 50-54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.

The Burden of Osteoarthritis in the Middle East and North Africa Region From 1990 to 2019.

Objective: We aimed to report the most current data on the prevalence, incidence, and years lived with disability (YLDs) associated with osteoarthritis (OA) for the 21 countries and territories located in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, cause, and sociodemographic index (SDI). Methods: Publicly available data from the Global Burden of Disease 2019 study were used to report the OA-related burden. Estimates are reported as counts and age-standardized rates, along with their corresponding 95% uncertainty intervals (UIs). Results: In 2019, the age-standardized prevalence of OA in MENA was 5,342.8 per 100,000 (95% UI: 4,815.9-5,907.8), which is 9.3% higher than in 1990 (8.1-10.5%). Similarly, the age-standardized annual incidence of OA per 100,000 was 430.4 (382.2-481.9), demonstrating a 9.4% increase since 1990 (8.3-10.5). OA was the cause of 185.4 (92.8-370.2) age-standardized YLDs per 100,000 in 2019, which was 10% higher than in 1990 (8.7-11.4). Saudi Arabia, Kuwait, and Iran had the highest OA burden in MENA, while Yemen, Afghanistan, and Sudan had the lowest burden. In all MENA countries, OA affected more women than men, had an increasing burden with increased age, and had the highest impact on the knee, hip, and hand joints, respectively. OA was also positively associated with the SDI. Conclusion: The burden of OA increased over 1990-2019 in the MENA region. The study emphasizes the importance of early preventative approaches in order to control any future health, economic, and quality of life crises imposed by OA in this region.

Moving shared decision-making forward in Iran.

Although there have been breakthroughs in patients' rights and informed consent legislation in Iran during the last few years, there is still no policy regarding shared decision-making (SDM). Besides, SDM training and clinical implementation initiatives remain scarce within the country. In this article, we aim to provide an update on the current state of SDM in Iran and discuss future directions. Lastly, we propose an SDM model adapted to the Iranian context, through a consensus-building process with Iranian clinicians and SDM experts, to assist in its implementation in a culturally sensitive manner.

Burden of polycystic ovary syndrome in the Middle East and North Africa region, 1990-2019.

Polycystic ovary syndrome (PCOS) is one of the most important contributing factors to infertility. In this study, we report the burden of PCOS by age and sociodemographic index (SDI) for the 21 countries in the Middle East and North Africa (MENA) region. Publicly available data on the point prevalence, incidence and years lived with disability (YLDs), from 1990 to 2019, were retrieved from the Global Burden of Disease (GBD) 2019 study for the 21 countries in MENA. The results are presented with age-standardised numbers and rates per 100,000 population, along with their corresponding 95% uncertainty intervals (UIs). In 2019, the age-standardised point prevalence and incidence rate for PCOS in the MENA region were 2079.7 (95% UI: 1392.0 to 2812.3) and 77.2 (95% UI: 51.6 to 105.4) per 100,000, respectively, which represents a 37.9% (95% UI: 31.7 to 45.0) and a 33.7% (95% UI: 27.7 to 40.3) increase since 1990, respectively. Also in 2019, the age-standardised YLD rate of PCOS in this region was 18.7 (95% UI: 7.8 to 37.9) per 100,000 women, which has increased by 36.1% (95% UI: 29.4 to 43.4) since 1990. Kuwait [25.4 (10.7, 51.2)] had the highest age-standardised YLD rate, while Afghanistan [10.8 (10.1, 49.2)] had the lowest. Moreover, the largest increase in the YLD rate, from 1990 to 2019, was seen in Sudan [90.3% (64.1, 120.9)], whereas no country decreased during the measurement period. The total prevalent number and point prevalence of PCOS (per 100,000) were both highest in the 20-24 age group. The prevalence of PCOS was highest among women of reproductive age, but decreased rapidly after 45 years of age. Moreover, at the country level there was a positive association between SDI and the age-standardised YLD rates of PCOS. The growing prevalence and burden of PCOS in the MENA region highlights the need to implement cost-effective preventive programs, especially for women in their third decade of life, and in MENA countries with higher SDI levels.

Viewpoint changes of medical sciences graduates in evaluating the performance of faculty members: a qualitative study.

BACKGROUND: This study aimed to identify which dimensions of faculty members' evaluation criteria changed from the viewpoint of students after their graduation, and to determine the effective factors in changing their viewpoints. METHODS: This study was carried out through the qualitative approach and with conventional content analysis method. The target population included all graduates who accomplished their job duty and had a working experience of 2-4 years. A purposive sampling technique with maximum variation used to recruit and interview. Twenty-eight in depth semi-structured interviews were conducted in Tabriz University of Medical Sciences (TBZMED), Iran. The data were analyzed using content analysis. RESULTS: The data analysis led to the development of two themes and 8 categories. The two types of changes in the viewpoint that were experienced by graduates in evaluating the performance of faculty members were: individual and environmental. Individual factors included the responsibility of graduates, social maturity, personal experience, intellectual maturity, understanding the causes of teachers' behaviors, and understanding the importance of evaluation. The environmental factors were applicability of learning experiences in the work environment and workplace conditions. CONCLUSION: From the perspective of graduates, the importance of some evaluation criteria in the educational, professional, and personal dimensions changed over their study period due to some factors, such as personal experience, experiences in the work environment, workplace conditions, and intellectual maturity.

The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990-2019.

Stroke is one of the leading causes of mortality and morbidity across the globe. Providing comprehensive data on the burden of stroke in the Middle East and North Africa (MENA) could be useful for health policy makers in the region. Therefore, this article reported the burden of stroke and its attributable risk factors between 1990 and 2019 by age, sex, type of stroke, and socio-demographic index. Data on the point prevalence, death, and disability-adjusted life-years (DALYs), due to stroke, were retrieved from the Global Burden of Disease study 2019 for the 21 countries located in the MENA region from 1990 to 2019. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals (UIs). In 2019, the regional age-standardised point prevalence and death rates of stroke were 1537.5 (95% UI: 1421.9-1659.9) and 87.7 (78.2-97.6) per 100,000, which represent a 0.5% (- 2.3 to 1.1) and 27.8% (- 35.4 to - 16) decrease since 1990, respectively. Moreover, the regional age-standardised DALY rate in 2019 was 1826.2 (1635.3-2026.2) per 100,000, a 32.0% (- 39.1 to - 23.3) decrease since 1990. In 2019, Afghanistan [3498.2 (2508.8-4500.4)] and Lebanon [752.9 (593.3-935.9)] had the highest and lowest age-standardised DALY rates, respectively. Regionally, the total number of stroke cases were highest in the 60-64 age group and was more prevalent in women in all age groups. In addition, there was a general negative association between SDI and the burden of stoke from 1990 to 2019. Also, in 2019, high systolic blood pressure [53.5%], high body mass index [39.4%] and ambient particulate air pollution [27.1%] made the three largest contributions to the burden of stroke in the MENA region. The stroke burden has decreased in the MENA region over the last three decades, although there are large inter-country differences. Preventive programs should be implemented which focus on metabolic risk factors, especially among older females in low SDI countries.

A Qualitative Study on the Establishment of an Interpersonal Violence Registry System in Iran.

Establishment of an interpersonal-violence registry system (IPVRS) is a promising initiative to tackle violence. This qualitative study aimed to fill the gap in knowledge regarding the feasibility of establishing the IPVRS in the East-Azerbaijan province of Iran. This qualitative study using content analysis was conducted to explore the importance, challenges, and facilitating factors of establishing the IPVRS from the viewpoints of stakeholders. Forty-six individuals from the Forensic Medical Organization, the University, the Welfare Organization, the Training and Education Organization, hospitals, and primary health centers participated in the study. Six themes and 13 sub-themes were identified. The importance of the establishment of the IPVRS was sub-categorized into two main themes, including violence as a public health priority and severe consequences of violence including intensive health and social outcomes and high use of medical services. The most critical challenges of establishing the IPVRS were categorized into two main themes including victims' under-reporting due to financial difficulties as well as psychosocial barriers and structural barriers such as organizational barriers and methodological challenges. Inter-sectoral partnership was identified as the main facilitating factor in the successful establishment of the IPVRS. The participants recommended improving the development of the IPVRS by stepwise development of the program, resource absorption from other beneficiary organizations, and making more coverage in the registry system. In conclusion, the establishment of the IPVRS is identified as an effective strategy to tackle violence-related issues. Close collaboration with different governmental and non-governmental sectors and the gradual development of the registry system can pave the way for establishing the IPVRS. This study has several implications for identifying potential challenges and facilitators of the IPVRS applicable to other developing countries with similar contexts.

Age at Diagnosis of Breast Cancer in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast cancer is responsible for up to 25% of all cancers in Iran. The age at diagnosis of Iranian breast cancer patients starts a decade earlier than most of developed countries. This study aimed to evaluate the mean age at diagnosis of Iranian breast cancer patients. METHODS: In this systematic review and meta-analysis, the mean age at diagnosis of Iranian breast cancer patients and its pattern between 2008 and 2017, were evaluated. All papers with age at diagnosis of histopathological verified breast cancer patients were considered eligible to enter to the analysis. We used databases including Medline/PubMed, Scopus, Embase, Cochrane Library, Iranmedex and SID for the search process. The meta-analysis was performed only on studies with separate data for female patients, using random-effects model, Mantel and Haenszel method and the Comprehensive Meta-analysis software. RESULTS: Finally, 92 studies with 19,784 patients (both-genders) were included. The mean age at diagnosis had increased from 47.93 (2008) to 49.91 (2016) years. The meta-analysis was done on 78 studies containing of 15,071 female patients and the mean age at diagnosis was 46.76±1.19. There was a wide range of age at diagnosis within different provinces. The mean age at Hamadan and Khuzestan provinces were the lowest and highest, respectively (42.48±7.96 vs. 51.00±11.47). The heterogeneity of studies was statistically significant (I2=99.744). CONCLUSION: Mean age at diagnosis of Iranian women with breast cancer was 46.76±1.19. There was an increasing pattern in mean age of diagnosis at breast cancer patients within the past 10 years.

Development, validation, and pilot implementation of the minimum datasheet for a domestic violence registry system: The case of a developing country.

BACKGROUND: Domestic violence (DV) is a universal issue and an important public health priority. Establishing a DV Registry System (DVRS) can help to systematically integrate data from several sources and provide valid and reliable information on the scope and severity of harms. The main objective of this study was to develop, validate, and pilot-test a minimum datasheet for a DVRS to register DV victims in medical facilities. MATERIALS AND METHODS: This study was conducted in two main phases. Phase one includes developing the datasheet for registration of DV in the DVRS. In phase two, the datasheet designed in the previous step was used in a pilot implementation of the DVRS for 12 months to find practical challenges. The preliminary datasheet was first developed using information on similar registry programs and guidelines of the World Health Organization (WHO) and then reviewed by four expert panels. Through a two-round Delphi technique, experts evaluated the instrument using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The consistency of the responses was evaluated by test-retest analysis. Finally, two physicians in two forensic medical clinics registered the victims of physical and/or sexual violence perpetrated by a family member. RESULTS: Preliminary datasheet consisted of 31 items. In the first round of Delphi, fifteen items had good content validity (I-CVI and CVR) and were kept, and seven items were moved to the next round. Also, in the first round of Delphi, experts suggested adding three items, including history of the violence, custody of the child, and custody of the elderly. All items evaluated in the second round were kept due to good CVR and CVI scores. As a result of Test-retest correlation coefficients for self-reprted items, two items including perpetrator's alcohol and drug use status were excluded (r(30) = +.43, and +.38, p< .01, two-tailed, respectively). Finally, 24 items were included in the datasheet including 15 items for individuals' characteristics (victims' characteristics and perpetrators' characteristics), eight items for incidents' characteristics, and one item for past history of violence experience. A total of 369 cases were registered from September 23, 2019, to July 21, 2020. The majority of the reported cases were female (82%) and were 19-40 years old. No physical and/or sexual violence was reported from rural areas, which calls upon researchers to explore how services for detecting and treating the victims can be made accessible to these areas. CONCLUSION: DVRS can show trends in DV by age, sex, the context of the violence, and incidence characteristics at every point in time. This is particularly valuable in planning and prioritizing research areas and interventions for DV prevention. Additionally, DVRS can be linked to other disease registry programs which can contribute to continuity and coordination of care, and major research in the future. Although a DVRS can be a promising initiative in identifying the areas in need of urgent interventions, there is no guarantee for its proper implementation due to limited resources and other challenges.

Improvement in use of best practice in the care of patients with oral mucositis in a comprehensive cancer center in Iran: a best practice implementation case study.

INTRODUCTION: Oral mucositis is a common debilitating complication of cancer treatments, particularly chemotherapy and radiation. OBJECTIVES: The purpose of this study was to improve oral mucositis prevention and control among cancer patients through the implementation of best practice guidelines in a tertiary referral center in Northern Iran. METHODS: A clinical audit design was utilized in this implementation project. A preimplementation audit was conducted against nine best practice criteria for the prevention and treatment of oral mucositis among new cases of cancer patients in November and December 2019. Fifty cancer patients and 20 nurses participated in this phase of the clinical audit. The next step included a facilitated multidisciplinary focus group identifying targeted strategies and implementing them, completed in late December 2019. A postimplementation audit was then conducted on another 50 cancer patients and the same 20 nurses in January and early February 2020. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice software. RESULTS: The preimplementation audit revealed gaps between the current practice and best practice across eight of the nine criteria. After implementing the targeted strategies, the outcomes improved across most of the criteria in the follow-up audit: 80% increase was observed in compliance of staff education, 100% increase in providing standard oral hygiene protocol in place, 64% increase in carrying out a dental examination and conducting initial oral cavity examination, and also 34% increase in conducting of ongoing oral cavity examination by a dentist, and finally 100% increase in providing preventive and therapeutic oral care regimens in place and oral pain assessment using a validated tool. CONCLUSION: The results of this project indicate that clinical auditing is an effective approach to the assessment of evidence-based care practices for oral mucositis among new cancer patients. Evidence-based oral mucositis management among cancer patients can be achieved by educating the patients and nursing staff using the newest guidelines and dentists' comprehensive dental and oral hygiene examinations.

The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults.

BACKGROUND: Adherence to treatment is an important factor in the management of diabetic patients. The aim of this study was to examine the psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetes. METHODS: This study carried out in Family Medicine Clinics (FMCs) in Tabriz, North West of Iran from May to September 2018. A total of 320 patients suffering from Type 2 diabetes were included. Content and face validity of the Persian version of MMAS-8 were quantitatively evaluated. The Cronbach's alpha and intra-class correlation (ICC) were calculated to assess the reliability. Exploratory factor analysis (EFA) was used to assess the construct validity of the questionnaire. RESULTS: Content and face validity of the Persian version of MMAS-8 were confirmed. Good internal consistency (Cronbach's a = 0.83) and test-retest reliability (ICC= 0.87, P<0.001) were found. According to the results of the EFA, Persian version of MMAS-8 among diabetic patients had two dimensions: stopping to take medication due to the forgetfulness and for reasons other than forgetfulness. CONCLUSION: The Persian version of the MMAS-8 is a high valid and reliable questionnaire to screen medication adherence of Persian-speaking patients with diabetes.