Systematic Review and Meta-Analysis of the Placebo Effect and its Correlates in Obsessive Compulsive Disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a major mental health condition with a lifetime prevalence rate of 1.3% among adults. While placebo effects are well described for conditions such as depressive and anxiety disorders, they have not been systematically characterized in OCD. OBJECTIVES: We aimed to determine the impact of placebos in improving different symptom domains in patients with OCD. METHODS: We systematically searched PubMed, EMBASE, Scopus, Web of Science, Ovid, the Cochrane Library, and Google Scholar databases/search engine from inception to January 2021 for randomized controlled trials of treatments for OCD with a placebo arm. A modified Cohen's effect size (ES) was calculated using change in baseline to endpoint scores for different measurement scales within placebo arms to estimate placebo effects and to investigate their correlates by random-effects model meta-analyses. RESULTS: Forty-nine clinical trials (placebo group n = 1993), reporting 80 OCD specific (153 measures in general) were included in the analysis. Overall placebo ES (95% confidence interval [CI]) was 0.32 (0.22-0.41) on OCD symptoms, with substantial heterogeneity (I-square = 96.1%). Among secondary outcomes, general scales, ES: 0.27 (95%CI: 0.14-0.41), demonstrated higher ES than anxiety and depression scales, ES: 0.14 (95%CI: -0.4 to 0.32) and 0.05 (95%CI: -0.05 to 0.14), respectively. Clinician-rated scales, ES: 0.27(95%CI: 0.20-0.34), had a higher ES than self-reported scales, ES: 0.07 (95%CI: -0.08 to 0.22). More recent publication year, larger placebo group sample size, shorter follow-up duration, and younger age of participants were all associated with larger placebo ES. Egger's test reflected possible small-study effect publication bias (P = 0.029). CONCLUSION: Placebo effects are modest in OCD trials and are larger in clinician ratings, for younger patients, and early in the treatment course. These findings underscore the need for clinicians and scientists to be mindful of placebo effects when formulating treatments or research trials for OCD. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019125979.

Systematic review and meta-analysis of the placebo effect in panic disorder: Implications for research and clinical practice.

OBJECTIVE: This review aimed to measure the degree of placebo response in panic disorder. DATA SOURCES: We searched major databases up to 31 January 2021, for randomized pharmacotherapy trials published in English. STUDY SELECTION: A total of 43 studies met inclusion criteria to be in the analysis (with 174 separate outcome measurements). DATA EXTRACTION: Changes in outcome measures from baseline in the placebo group were used to estimate modified Cohen's d effect size. RESULTS: A total of 43 trials (2392 subjects, 174 outcomes using 27 rating scales) were included in the meta-analysis. Overall placebo effect size was 0.57 (95% confidence interval = [0.50, 0.64]), heterogeneity (I2: 96.3%). Higher placebo effect size was observed among clinician-rated scales compared to patient reports (0.75 vs 0.35) and among general symptom and anxiety scales compared to panic symptoms and depression scales (0.92 and 0.64 vs 0.56 and 0.54, respectively). There was an upward trend in effect size over the publication period (r = 0.02, p = 0.002) that was only significant among clinician-rated scales (r = 0.02, p = 0.011). There was no significant publication bias, Egger's test (p = 0.08). CONCLUSION: We observed a substantial placebo effect size in panic disorder. This effect was more prominent for some aspects of panic disorder psychopathology than for others and was correlated with the source of the assessment and publication year. This finding has implications both for research design, to address the heterogeneity and diversity in placebo responses, and for clinical practice to ensure optimal quality of care. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO, CRD42019125979.

Community-Based Preventive Interventions for Depression and Anxiety in Women.

BACKGROUND: Depression and anxiety are the most common mental disorders and currently, they constitute one of the main causes of disability and death. The high prevalence of psychiatric disorders and their increasing burden are noteworthy. The aim of this study is to investigate the effectiveness of community-based preventive interventions for depression and anxiety in women. METHODS: We systematically searched for articles published up to the beginning of 2018, which addressed community-based preventive interventions for depression and anxiety in women. The studies were searched in PubMed, Scopus, Cochrane Library, Web of Science, PsycInfo, IranMedex, SID and EMBASE electronic databases. Articles that complied with our inclusion criteria (preventive interventions involving healthy adult women aged 18 to 65 years) were reviewed. Quality assessment of the articles was performed using standard tools. We extracted the required data and reported the results in a narrative form. RESULTS: Twenty-three articles were identified and entered into the final review. Depression and anxiety symptoms were decreased in more than 70% of interventions. Cognitive behavioral therapy (CBT) and exercise were the most effective interventions. In addition, computer and internet-based programs had positive outcomes in both categories of depression and anxiety. CONCLUSION: Community-based preventive programs for depression and anxiety in women had promising and positive results. CBT and exercise were the most effortless, yet the most effective interventions to apply. Computer and internet-based programs had the benefit of covering many people simultaneously. These interventions are cost-effective and feasible among Iranian women.

Adherence of cardiologist physicians to the American Heart Association guideline in approach to risk factors of cardiovascular diseases: An experience from a teaching hospital.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death globally and has enormous costs for healthcare systems. This disease has a strong association with lifestyle behaviors. Therefore, applying reliable and effective strategies for prevention and treatment of CVD is important. In this study, we aimed to evaluate the adherence of cardiologist physicians to the American Heart Association (AHA) guideline for prevention of CVD. METHODS: Using a cross-sectional study, data were gathered for 208 patients using their medical records in the cardiology ward of a general teaching hospital. A physician systematically reviewed the medical records and completed the checklist in each domain. Adherence to the AHA guideline was evaluated in treating physician's choices and recommendations regarding these eight variables: hypertension (HTN), dietary intake, weight management, diabetes management, physical activity, blood lipid management, smoking, and aspirin prescription. RESULTS: Medical records of 208 patients (109 men and 99 women) with the mean age of 62 ± 14 years were reviewed. The frequency of CVDs was 5.3% for coronary heart failure (HF) and 67.8% for the acute coronary syndrome (ACS). Cardiovascular risk factors of patients were HTN (53.8%), diabetes (34.6%), hyperlipidemia (17.3%), smoking (17.8%), and obesity (31.7%). We found a proportion of 59%, 15%, and 26% for high, moderate, and low adherence to AHA guideline, respectively. CONCLUSION: Our study showed almost 60% high adherence to the AHA guideline by physicians in a teaching hospital. The most and the least adherence to the AHA guideline were for obesity and diabetes recommendations, respectively. More studies are needed to evaluate preventive guideline adherence in Iran. Establishing national preventive and therapeutic guidelines may increase the physicians' adherence to them.

Delivering clinical preventive services in the Islamic Republic of Iran: A model for screening and behavior consultation practices.

Background: Screening and behavior consultation are considered to be limited, dispersed and expensive services across the country. To deliver efficient and equitable services current disordered practices need to be consolidated. Methods: An analysis of current situation, learned lessons and future scopes of country's preventive care delivery, along with a review of international experience and generous participation of various stakeholders, led to proposing a model for screening and behavior consultation practices in IR. Iran. Results: Upon the results of the previous steps, the desired model was based on the network system and family physician. Comprehensive health centers and other centers affiliated to the network are the most appropriate service positions. However, private and academic preventive centers are playing their rules. Conclusion: The proposed model matches the overall pattern of service delivery in the health system (network system with the private sector and the educational sector).

Academic performance in Iranian medical students during the pre-clinical stage.

Background: Better understanding of factors associated with medical school performance is necessary to improve admission processes and to help students succeed in their career. This study follows a group of Iranian med students during their first 2.5 years of medical education, to evaluate their academic success in accordance with their demographic, cognitive and non-cognitive characteristics. Methods: 143 of 200 matriculants of Iran University of Medical Sciences medical school in 2010, were followed for 5 consecutive semesters of the preclinical stage. Demographic and cognitive characteristics were collected using self-administered data collection forms. The NEO Five-Factor (personality) Inventory (NEO-FFI) was used to assess participants' non-cognitive characteristics. The 5 semesters' cumulative Grade Point Average (GPA) was the measure of academic performance. Pooled t-test, one-way ANOVA, multiple linear regression and logistic regression model, and Spearman coefficients of correlation were applied in data analysis Results: There was a significant difference in participants' GPA regarding their gender (p=0.008), using privilege in National University Entrance Examination (NUEE)(p<0.0001), the number of times one has taken part in NUEE (p=0.034) and being occupied in paid jobs (p=0.01). There were no significant differences in participants' GPA regarding NEO-FFI domains. Conclusions: Females and students with a better academic performance prior to their admission in medical school had better academic records. We found no association between academic performance and personality because participants were followed through a preclinical stage where non-cognitive characteristics plays a less important role in their performance and evaluations.

Domestic violence against women as a risk factor for depressive and anxiety disorders: findings from domestic violence household survey in Tehran, Iran.

Domestic violence (DV) especially intimate partner violence is a global health problem responsible for significant part of burden of diseases in women. Mental health problems such as depression and anxiety are possibly results and resulted in IPV. To investigate correlation between IPV and depression and anxiety among married women, in a household survey of married women in Tehran, Iran, at summer 2011, we recruited 615 samples with cluster sampling method and they are directly asked about experience of 23 different types of physical and non-physical IPV during marital life and last 12 months. Depression and anxiety were assessed by Beck depression inventory II (BDI) and Beck Anxiety inventory (BAI). Multinominal regression model was used to assess the independent relationship of factor on IPV. Mean (±SE) age and duration of marriage were 42.6 ± 0.9 and 22 ± 0.8, respectively. Non-physical violence and physical violence during marital life reported in 77.2 and 35.1 %. Clinically significant depression and anxiety was reported in 15.3 and 32.7 % of women, respectively. The odds ratio (95 % CI) of clinically significant depression and anxiety in DV victims were 5.8 (2.3-14.6) and 2.6 (1.6-4.3). DV as a social factor is significantly correlated factor with depression and anxiety. Comprehensive view and collaborative work to detect and address social determinants of mental illness like DV is a crucial point in mental health promotion programs.

Validation of the 15-item myasthenia gravis quality of life questionnaire (MG-QOL15) Persian version.

INTRODUCTION: The 15-item Myasthenia Gravis Quality Of Life (MG-QOL15) questionnaire is a valid and reliable instrument for evaluation of myasthenia gravis (MG) associated disability. Our study aim was to assess its validity and reliability in the Iranian population. METHODS: We enrolled 75 consecutive patients with established MG at 2 neuromuscular clinics in Tehran, Iran. All 75 patients completed the Persian MG-QOL15 and SF-36 questionnaire initially, and 30 filled out the MG-QOL15 questionnaire from 2 to 4 weeks after the initial visit. Concurrent and construct validity, internal consistency, and test-retest repeatability of the questionnaire were evaluated. RESULTS: The Persian MG-QOL15 showed satisfactory internal consistency (Cronbach alpha = 0.94) and test-retest reliability(r = 0.98; P < 0.001). It also demonstrated adequate concurrent and construct validity; moreover, the MG-QOL15 scores were higher in patients with more severe conditions. CONCLUSIONS: The Persian MG-QOL15 is a valid and reliable questionnaire for determination of quality of life in Iranian MG patients. Muscle Nerve 54: 65-70, 2016.

Amyotrophic lateral sclerosis progression: Iran-ALS clinical registry, a multicentre study.

This study was designed to evaluate ALS progression among different subgroups of Iranian patients. Three hundred and fifty-eight patients from centres around the country were registered and their progression rate was evaluated using several scores including Manual Muscle Test scoring (MMT) and the revised ALS Functional Rating Scale (ALSFRS-R). Progression rate was analysed separately in subgroups regarding gender, onset site, stage of disease and riluzole consumption. A significant difference in MMT deterioration rate (p = 0.01) was noted between those who used riluzole and those who did not. No significant difference was observed in progression rates between male/female and bulbar-onset/limb-onset groups using riluzole. In conclusion, riluzole has a significant effect on muscle force deterioration rate but not functional scale. Progression rate was not influenced by site of onset or gender.

The Epidemiology of Suicide Behaviors among the Countries of the Eastern Mediterranean Region of WHO: a Systematic Review.

This systematic review aimed to help better to understand the epidemiology of suicidal behaviors among Eastern Mediterranean Region (EMR) countries. The PubMed, EMR medex, Scopus, PsychInfo, ISI, and IMEMR were searched with no language limitation for papers on the epidemiology of suicidal behaviors in the general population, published up to August 2013. A total of 13 articles were reviewed. The incidence (per 100.000) of committed suicide ranged from 0.55 to 5.4. The lifelong prevalence of attempted suicide, suicidal plan and thoughts were 0.72-4.2%, 6.2-6.7%, and 2.9-14.1%, respectively. The figures for suicide are higher than those officially reported. Suicide behaviors' statistics is susceptible to underestimation presumably due to the socio-cultural, religious and legal barriers, not to mention the lack of well-organized registries and methodologically sound community-based surveys.

Diagnostic value of "bedside ultrasonography" and the "water bath technique" in distal forearm, wrist, and hand bone fractures.

Bedside ultrasonography (BUS) has been widely used in many emergency evaluations, but the technique was not thoroughly evaluated for use in adult fractures. The water bath technique (WBT) is a modality which overcomes some important limitations of using BUS in extremity fractures. The study aims to evaluate and compare diagnostic values of BUS and WBT. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-), and accuracy of BUS and WBT were calculated and compared by the McNemar chi-square test. BUS had the highest sensitivity, specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of BUS were seen in phalangeal and wrist injuries, respectively. The WBT examination had the highest sensitivity in phalangeal injuries and the highest specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of the WBT examination were seen in phalangeal and wrist injuries, respectively. The McNemar χ (2) values for the comparison of BUS and WBT indicate that the two techniques provide statistically different results. The ultrasound revealed excellent diagnostic values which make it a favorable alternative in evaluating upper extremity fractures in adults. The WBT provides even better results.

Normobaric hyperoxia preconditioning ameliorates cisplatin nephrotoxicity.

BACKGROUND: Cisplatin is a potent anticancer drug, but its nephrotoxicity limits the clinical use of it. To reduce the Cisplatin-induced nephrotoxicity, various interventions have been implicated. The aim of this study was to examine whether preconditioning with normobaric hyperoxia would prevent Cisplatin-induced nephrotoxicity in patient with solid tumor. METHODS: In a prospective study, 80 adult patients with solid tumor who were treated with Cisplatin between February 2011 and December 2011 were included. Forty-three patients were exposed to pure oxygen via non-rebreathing reservoir mask which increased the provided oxygen rate to 60% oxygen for 2 hours at 48, 24, and 6 hours before intravenous administration of Cisplatin and 37 patients received only Cisplatin as a control group. Estimated glomerular filtration rate (eGFR) calculated in all patients on day 1 before and on days 1, 3, 6, 30 after Cisplatin exposures. RESULTS: Patients treated with Cisplatin and 60% oxygen showed a mild improvement in eGFR and mild reduction of serum creatinine after 30 days with statistically mild significant differences (p = 0.048). CONCLUSION: This study showed that normobaric and intermittent precondition of 60% oxygen prior to Cisplatin treatment had an acute transient adverse effect on renal function; however, the improvement of renal function will be seen after 30 days. Thus, it may help to prevent Cisplatin nephrotoxicity.

National registration system of suicide behaviors in Iran: barriers and challenges.

The present article describes the process of developing a national suicide registry in Iran and evaluates the obstacles in this respect. We established a systematic and uniform portal data collection system in the country and evaluated it from March 2009 for a year. The quality of database and data registration challenges were assessed from different aspects. A total number of 41,109 suicide attempts and 1,338 completed suicides were reported from an area that covered 83.6% of Iran's population in 2009. The rate of suicide attempt was 65.8 per 100,000 people. This study revealed some of the obstacles and challenges of implementing a national registration system. Nationwide suicide registry can serve as a solid foundation for conceptual work, data collection, and preventive interventions. A concerted effort between various organizations is required to efficiently collect data on suicide behaviors.

Psychometric evaluation of the Persian version of the quality of life in epilepsy inventory-31.

BACKGROUND: Health assessment in patients with epilepsy (PWE) should include both clinical outcomes and health related quality of life (HRQOL) measures. The quality of life (QoL) in epilepsy-31 inventory (QOLIE-31) is widely used for QOL studies in epilepsy. This study aims to evaluate psychometrics of the Persian version of the inventory (QOLIE-31-P). METHODS: Following a standard forward-backward translation and cultural adaptation, the construct validity of the QOLIE-31-P was assessed by explanatory factor analysis, multi-trait scaling analysis, and known group comparison. The criterion validity was assessed by calculating the Pearson correlation to SF-36 (36-item short-form health survey). The reliability was assessed by calculating Cronbach's alpha and test-retest study. RESULTS: The factor analysis extracted from 8 factors explaining 70.35% of the variations. Item-scale correlations revealed that individual items significantly had the strongest association with the domain they were loaded on. The Pearson coefficient of correlation between QOLIE-31-P and the overall scores of SF-36 was 0.876 (P < 0.0001). Patient with medically controlled seizures scored higher than those who experienced seizures during the previous year to study date (P < 0.0001). The Cronbach's α of overall QOLIE-31-P inventory was 0.9. The overall test-retest coefficient of correlation was 0.68 (P = 0.003). CONCLUSION: QOLIE-31-P is a valid and reliable tool to be applied in health assessment of patients with epilepsy.

Citrullus colocynthis as the Cause of Acute Rectorrhagia.

Introduction. Citrullus colocynthis Schrad. is a commonly used medicinal plant especially as a hypoglycemic agent. Case Presentation. Four patients with colocynth intoxication are presented. The main clinical feature was acute rectorrhagia preceeded by mucosal diarrhea with tenesmus, which gradually progressed to bloody diarrhea and overt rectorrhagia within 3 to 4 hours. The only colonoscopic observation was mucosal erosion which was completely resolved in follow-up colonoscopy after 14 days. Conclusion. The membranolytic activity of some C. colocynthis ingredients is responsible for the intestinal damage. Patients and herbalists should be acquainted with the proper use and side effects of the herb. Clinicians should also be aware of C. colocynthis as a probable cause of lower GI bleeding in patients with no other suggestive history, especially diabetics.

Correlates of mental health service utilization in married women in tehran 2011.

OBJECTIVE: There are disparities in mental health services (MHS) utilization within and between populations and several factors are studied as its potential correlates. Identifying those correlates would help health policy makers to adjust service provision with characteristics of their community. To evaluate demographic, socioeconomic and system correlates of MHS utilization among married women from Tehran, Iran. METHODS: A household survey of 615 married women residents of 22 municipal districts of Tehran selected via a cluster sampling method. All subjects were asked about health services utilization during last one and 12 months as well as need and access for MHS, demographic and socioeconomic factors. Independent correlates of MHS use were determined with logistic regression analysis. RESULTS: Total 615 women, mean±SE age and duration of marital life of 42.6±0.9 and 22±0.8 years, respectively were selected, rate of MHS utilization during last one and 12 months were 5.2% and 10.1% respectively. 23.6% of women reported having mental illness and 19.3% and 17.9% had need for MHS and access to outpatient health services, respectively. Logistic regression models showed that need for MHS (OR:5.25, 95%CI:2.7-10.1), access to outpatient services (OR:2.17, 95%CI:1.04-4.52), smoking (OR:3.4, 95%CI:1.16-10.2) and crowding index (OR:0.69, 95%CI:0.48-0.99). CONCLUSIONS: Rate of MHS utilization in women are low considering the near to estimated rate of perceived illness. Bridging the gap between perceived illness and need for services, then providing better access to services in areas with higher crowding index and higher rates of smoking in residents should considered in any mental health promotion programs. DECLARATION OF INTEREST: None.

Assigning residents of emergency medicine to screen patients before admission: a strategy to overcome overcrowding.

BACKGROUND: The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death. OBJECTIVES: This study proposes a strategy to overcome ED overcrowding. MATERIALS AND METHODS: The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards. RESULTS: The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day. CONCLUSIONS: Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered.