Predictors of poor responsiveness in physical rehabilitation centers in Tehran.

Background: Responsiveness as a nonmedical, nonfinancial aspect of a health system's goals requires special attention, particularly in people with physical disabilities. This study aimed to investigate the predictors of poor responsiveness of rehabilitation centers in Tehran. Methods: A cross sectional study was conducted to investigate 610 individuals with physical disabilities who referred to 10 comprehensive rehabilitation centers in Tehran using Quota sampling in 2016-2017. The following questionnaires were used in this study: Health System Responsiveness questionnaire, recommended by World Health Organization (WHO); Activities of Daily Living (ADL); and Instrumental Activity of Daily Living (IADL). Multiple logistic regression models were used to determine the sociodemographic characteristics (sex, age, perceived social class, etc.), self-assessed health, and physical functioning [(eg, Instrumental Activities of Daily Living (IADL)] as predictors of poor responsiveness in comprehensive rehabilitation centers of Tehran. Results: The mean years of education of respondents was 12.57 (SD=5.07). The majority of the participants perceived themselves as belonging to the middle class. Among the participants, 17.1% were completely dependent in their instrumental activities of daily living (IADL). Respondents who were not satisfied with their health insurance accounted for 40.2% of the sample. Also, 20.9% of the participants reported poor responsiveness. Based on the logistic regression model, variables of education, perceived social class, satisfaction with health insurance, and IADL were predictors of overall poor responsiveness after adjusting other covariates. Conclusion: Level of education was a strong predictor of poor responsiveness. Insurance companies should make policies to facilitate people's access to rehabilitation services and increase customer satisfaction. Moreover, rehabilitation service providers should pay special attention to those with physical disabilities who are more severely disadvantaged.

Inequality in Responsiveness: A Study of Comprehensive Physical Rehabilitation Centers in Capital of Iran.

OBJECTIVE: Responsiveness refers to meeting the legitimate expectations of people who interact with the health system. This study aimed to assess the presence of any inequality in responsiveness based on the different sociodemographic groups. METHODS: This cross-sectional study was carried out in Tehran. A total of 610 people with a physical disability from 10 comprehensive physical rehabilitation centers (5 public and 5 private) were included in the study through quota sampling. Data were gathered using the World Health Organization Standard Responsiveness Questionnaire and a sociodemographic checklist. Relative inequality indices were used for the analytical statistics. RESULTS: Study respondents between 18 and 59 years and those equal to or older than 60 years formed 78.1% (475/610) and 21.9% (133/610) of the total study sample, respectively. The study sample consisted of 298 (48.7%) women and 312 (51.3%) men, and their mean age was 46.4 and 45.6 years, respectively. No significant inequality was found in responsiveness of total centers based on the socioeconomic status of the study participants. However, in the private comprehensive physical rehabilitation centers, significant inequality was found in responsiveness based on residential area per capita, with more reporting of poor responsiveness by people with physical disability in the lower residential area per capita quintiles (Wagstaff index [WI] = -0.262; P = .01). Inequality in responsiveness was also found in the public centers based on education level, with poorer experience in people with higher level of education quintiles (WI = 0.163; P = .02). CONCLUSION: In the private sector, economic issues are the main reason for the poorer experiences. Furthermore, residential area per capita showed to be a more sensitive index among economic indices to measure inequality. In public sector, education level was the key social factor. More attention and interventions need to be implemented by mid-level policymakers and rehabilitation service providers to meet the needs of people with physical disability.

Responsiveness of Physical Rehabilitation Centers in Capital of Iran: Disparities and Related Determinants in Public and Private Sectors.

Background: Responsiveness as a non-medical, non-financial goal of the health system is of special importance to people with physical disability. The current study assessed the experiences of people with physical disabilities when they encounter rehabilitation centers in Tehran. Methods: This cross-sectional study was conducted in Tehran, the capital of Iran. The sample consisted of 610 people with physical disabilities referred to 10 comprehensive rehabilitation centers (CRCs) selected by Quota sampling. Data were collected by a standard responsiveness questionnaire proposed by the World Health Organization (WHO) and were analyzed by a standard protocol. Blinder-Oaxaca analysis was done to explain the inequality in performance of public and private sectors. Results: Study participants included 298 (48.7%) women and 312 (51.3%) men. The mean age of the respondents was 46.3 (SD = 14.3) for women and 45.6 (SD = 15.4) for men. Prompt attention (33.3%) and confidentiality (1.3%) were the most and least important reported domains, respectively. Overall poor responsiveness was reported by 20.9% of respondents. Private rehabilitation centers showed significantly better performance in communication, basic amenities and autonomy compared to public centers (P ≤ 0.05). Perceived social class explained 76% of the inequality in autonomy in the private and public sector (P ≤ 0.05). Conclusion: Improving overall responsiveness in domains that are of high importance from the respondents' viewpoint but are performing poorly-areas such as prompt attention and basic amenities-is essential. Additionally, interventions are needed to improve the performance of the public centers and providers in the areas of participation of service users in all social classes in their rehabilitation decisions and procedures, clear communication, and basic amenities.

The value of prostate MRI with endorectal coil in detecting seminal vesicle involvement in patients with prostate cancer.

BACKGROUND: In prostate cancer, detection of seminal vesicle involvement is important because it influences the treatment planning and prognosis of the patients. OBJECTIVES: The objective of this study was to determine the value of prostate MRI with endorectal coil in the detection of seminal vesicle involvement in patients with prostate cancer. PATIENTS AND METHODS: A total number of 238 biopsy-proven prostate cancer patients were examined by 1.5 Tesla MRI with a combination of pelvic and endorectal coils to detect seminal vesicle involvement. After radical prostatectomy, the MRI results were compared with pathology results. RESULTS: Seminal vesicle involvement was detected in 67 (28.1%) patients. Pathology confirmed the involvement of seminal vesicles by prostate cancer in 63 patients. In two patients, seminal vesicle involvement was diagnosed by pathology but not detected by MRI. The sensitivity was 0.97 [95% confidence interval = 0.89-0.99], the specificity was 0.98 [95% confidence interval = 0.94-0.99], the positive predictive value was 0.94 [95% confidence interval = 0.85-0.98], and the negative predictive value was 0.99 [95% confidence interval = 0.96-0.99]. CONCLUSIONS: MRI with endorectal coil is a valuable imaging technique with suitable accuracy in detecting seminal vesicle involvement in prostate cancer.

Prostate Biopsy Using Transrectal Ultrasonography; The Optimal Number of Cores Regarding Cancer Detection Rate and Complications.

BACKGROUND: Transrectal ultrasound guided biopsy of the prostate is the most common modality used to diagnose prostate cancer. OBJECTIVES: The aim of this study was to evaluate the optimal number of cores at prostate biopsy, which have the most diagnostic value with least adverse effects. PATIENTS AND MATERIALS: Transrectal ultrasonography (TRUS) guided biopsy was performed in 180 patients suspicious for prostate cancer due to either abnormal rectal examination or elevated PSA. The patients were divided randomly into three groups of six-core, twelve-core and eighteen-core biopsies. The detection rate of prostate cancer in each group with the rate of post biopsy urinary infection and prostatitis were compared. RESULTS: Prostate cancer was diagnosed in 8 (13.3%), 21 (35%) and 24 (40%) patients in six, twelve and eighteen core biopsy groups, respectively. Urinary tract infection and prostatitis occurred in 17 (28.3%), 23 (38.3%) and 35 (58.3%) patients in six, twelve and eighteen core biopsy groups, respectively. Considering the detection rate of prostate cancer, there was a significant difference between 6 and 12 core biopsy groups (P = 0.006) and 12-core biopsies detected more cases of prostate cancer, but there was no significant difference between 12 and 18 core biopsy groups (P = 0.572). Considering the infection rate, there was no significant difference between 6 and 12 core biopsy groups (P = 0.254), but there was a significant difference between 12 and 18 core biopsy groups (P = 0.028) and infectious complications occurred more frequently in 18-core biopsy group. CONCLUSIONS: The best balance between detection rate of prostate cancer and infectious complications of biopsies achieved in twelve-core biopsy protocol. Twelve-core biopsy enhances the rate of prostate cancer detection with minimum adverse effects.

Quantitative evaluation of Iranian radiology papers and its comparison with selected countries.

BACKGROUND: Recent technological developments in medicine, including modern radiology have promoted the impact of scientific researches on social life. The scientific outputs such as article and patents are products that show the scientists' attempt to access these achievements. OBJECTIVES: In the current study, we evaluate the current situation of Iranian scientists in the field of radiology and compare it with the selected countries in terms of scientific papers. For this purpose, we used scientometric tools to quantitatively assess the scientific papers in the field of radiology. MATERIALS AND METHODS: Radiology papers were evaluated in the context of medical field audit using retrospective model. We used the related databases of biomedical sciences for extraction of articles related to radiology. In the next step, the situation of radiology scientific products of the country were determined with respect to the under study regional countries. RESULTS: Results of the current study showed a ratio of 0.19% for Iranian papers in PubMed database published in 2009. In addition, in 2009, Iranian papers constituted 0.29% of the Scopus scientific database. The proportion of Iranian papers in the understudy region was 7.6%. CONCLUSION: To diminish the gap between Iranian scientific radiology papers and other competitor countries in the region and achievement of document 2025 goals, multifold effort of the society of radiology is necessary.

MRI in prostate cancer.

Imaging studies play an important role in detection and management of prostate cancer and MRI especially with the use of endorectal coil because of high contrast resolution is recognized as the best imaging modality in evaluation of prostate cancer. Multiparametric MR study including T1 and T2 weighted images, diffusion weighted images, dynamic contrast study and MR spectroscopy is useful for detection and local staging of prostate cancer as well as posts treatment evaluation of patients either after surgery or radiation therapy for detection of local recurrence.

The effect of group play therapy on social-emotional skills in pre-school children.

BACKGROUND: Childhood is important and critical period in human life. The foundation of ego is shaped in childhood. Play therapy is one of the successful strategies to help children with inner conflicts problems. This method of psychotherapy is base on the normal learning processes of children, provides solutions to relieve feelings of stress, and expands self-expression. Group play therapy can enhance the self-awareness, self- regulation, social communication, empathy and adoptability in children. METHODS: Present study investigated the effects of play therapy on relational and emotional skills of pre-school children. For this purpose, the total numbers of 372 pre-school children were randomly selected, and divided into two equal groups (case and control). In next step, the BUSSE-SR methodology was used for evaluation and comparison of self-awareness, self-regulation, social interaction, empathy, adoptability, and control groups. Pre-test were performed for both groups and case group was involved in-group play therapy. According to the results of post-test, correlation of variables between case-control groups was examined by multivariate analysis of covariance. RESULTS: Frequency of boys and girls in our sample were 51.3 and 48.7 percent, respectively. The mean age of children was 5.1±0.6 year. According to the results of present study, play therapy significantly enhanced the social-emotional skills (P< 0.001). Our findings are consistent with the results of previous studies in other nations with different environmental and cultural properties. In conclusion, it seems that play therapy can be used in pre-school centers to help children learn problem-solving skills and communicate with others.

Value of MRI in local staging of bladder cancer.

PURPOSE: To evaluate the accuracy of magnetic resonance imaging (MRI) in bladder cancer staging as well as differentiating superficial from invasive tumors and organ-confined from non-organ-confined tumors. MATERIALS AND METHODS: A total number of 108 bladder tumors in 86 patients (86% men and 14% women) were evaluated by 1.5 Tesla MRI machine. The tumor stages that were determined by MRI study were compared with pathology results after resection of the tumor. RESULTS: The most common stage determined by both MRI and pathology was T2a. Considering stages in details, the kappa agreement coefficient between MRI and pathology was 0.8 (P < .0001). Combining groups a and b in each stage, the kappa agreement coefficient between MRI and pathology was 0.87 (P < .0001). Considering stages in details, we had 22 (20.3%) mismatches in staging between MRI and pathology; 10 (45.5%) were underestimation and 12 (54.5%) were overestimation. Combining groups a and b in each stage, we had 14 (13%) mismatch cases; 6 (46.2%) were underestimation and 8 (53.8%) were overestimation. The detection rate of MRI was 0% in stage Ta, 80% in stage T1, 88.1% in stage T2, 81.2% in stage T3, and 100% in stage T4. The sensitivity and specificity of MRI in differentiating superficial from deep tumors were 0.98 and 0.82, respectively. The sensitivity and specificity of MRI in differentiating organ-confined from non-organ-confined tumors were 0.93 and 0.94, respectively. CONCLUSION: Magnetic resonance imaging is a reliable modality for determining the stage of bladder tumors with high accuracy, and could show the depth of invasion and extension of tumor that is useful for treatment planning.

Dietary habits among adolescent girls and their association with parental educational levels.

BACKGROUND: Adolescence is a period of rapid psychological development and the appearance of secondary sex characteristics. Changes in facial structure are the most visible manifestation during this period. It is during adolescence period that the importance of optimal nutrients is greatest. Improving the nutrition of teenage girls especially is important girls because consequently will affect the health in future. In present study hypothesis is that improving the nutrition of teenage girls is correlated with the level of parental education and the adolescents' eating habits. METHODS: In this study, 386 random selected adolescent girls were selected by cluster sampling. We used questionnaire to study the level of knowledge to major nutritional problems and consuming optimal nutrients. Finally, collected data were analyzed by using descriptive techniques and statistical analysis. RESULTS: According to the results of present study the mean of age, weight and height of the participants were 13/2 years, 159/1 cm, and 52.05 kg respectively. The 48.4 percent of the participants not eat breakfast. The 67.4 percentages of girls daily were consuming bread and cereals, 57.5 fruits and vegetables, 62.7 dairy products, and 27.7 meat and eggs. In addition, 36.3 percentages of these girls consumed sweets everyday as part of their diet. The nutritional knowledge of participating in diet was on the average and common source of information were counselors and teachers at school (36 percentages). The results of our study revealed that there was a significant relationship between variations in level of parental educational level and dietetic safety of offspring (p < 0.05). Our conclusion is the interactive education and parental literacy especially is important regarding to the adolescent nutrition and health.