The economic costs of diabetes: a population-based study in Tehran, Iran

AIM/HYPOTHESIS

The aim of the study was to determine the annual healthcare expenditures of an individual with diabetes in Tehran, between March 2004 and March 2005.

METHODS

This prevalence-based 'cost-of-illness' study was conducted in two phases. In the first phase, 23,707 randomly selected individuals were interviewed to gather a cohort of participants with diabetes. In the second phase, 710 diabetic patients and 904 age- and sex-matched controls were followed up for 1 year at intervals of 3 months and the direct (physician services, medications and devices, hospitalisation, laboratory, paraclinical and transport) and indirect (loss of productivity) expenditures were recorded. The excess costs of a person with diabetes were estimated through comparison with matched controls. The estimates were also extrapolated to the total population of Tehran and Iran. The costs were converted from the Iranian rial to the US dollar (exchange rate September 2004).

RESULTS

Total annual direct costs of diabetic and control participants were $152.3 +/- 14.5 and $52.0 +/- 5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalisation in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were $39.6 +/- 2.4 and $16.7 +/- 1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be $112.424 +/- 10.732 million and $590.676 +/- 65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes.

CONCLUSIONS/INTERPRETATION

Diabetes is an expensive medical problem in Iran and planning of national programmes for its control and prevention is necessary.

A histopathological study of esophageal cancer on the western side of the Caspian littoral from 1994 to 2003

Esophageal cancer (EC) accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in the population of the Caspian littoral. The global histologic pattern of the disease has changed recently. The intent of this study was to determine the incidence of EC over the past decade in Eastern Azerbaijan--a north-western province of Iran--on the western side of the Caspian littoral and to assess the alteration of the histological pattern of the disease. In a retrospective study, all 1792 documented EC cases of all registered cancer, surgery, pathology, and radiotherapy centers of the province over a period of 9 years (from March 1994 to March 2003) were enrolled in the study. Data concerning demographic characteristics, EC risk factors, and histological findings were recorded. The incidence and the relative incidence of the pathological subtypes of EC in the population of the province were determined. The change in incidence rates and the interaction between main risk factors and tumor histology of the patients were assessed over the study years. The average incidence of EC in the over 30-year-old population of the province was 16.2 (12.7 for squamous cell carcinoma [SCC] and 1.9 for adenocarcinoma [AC]) cases per 100 000 person-years. Incidence of SCC, as well as AC, peaked at ages older than 65. Compared to women, men had higher incidences of AC and lower incidences of SCC; the average incidence rate of EC was equal in men and women. AC and SCC accounted for 12.8% and 86.9% of cases, respectively. Upper, middle and lower thirds of the esophagus were the location of tumors in 9.8%, 32.9% and 57.3% of cases, respectively. During the study period, incidence rates of EC and SCC tended to decrease. The incidence rate of EC from 1995 to 1998 was almost 30% higher than that of the period from 1999 to 2002. Incidence rate of EC on the western side of the Caspian littoral is moderately high, but much lower than that of the eastern Caspian littoral as it was three decades ago. The incidence of EC was lower in the second half than the first half of the study period. Unlike the global pattern of EC, the incidence of EC as well as SCC in women is as high as or higher than in men, which is identical to the pattern in the eastern Caspian littoral.

Spouse-assisted training in pain coping skills and the outcome of multidisciplinary pain management for chronic low back pain treatment: a 1-year randomized controlled trial

This study examined the comparative efficacy of three interventions: a spouse-assisted coping skills training protocol for patients undergoing a multidisciplinary pain management programme (SA-MPMP), conventional patient-oriented multidisciplinary pain management programme (P-MPMP) and standard medical care (SMC). Thirty-six chronic low back pain (CLBP) patients and their spouses were randomly assigned to one of the three conditions. The SA-MPMP condition consisted of seven, weekly, 2-h, group sessions of training in dyadic pain coping and couple skills, delivered by a clinical psychologist with support of a multidisciplinary team of specialists, to patients together with their spouses. P-MPMP consisted of the SA-MPMP training delivered to the patient only (i.e., no spouse participation and assistance). The SMC condition entailed continuation of routine treatment, entailing medical care only. Data analysis revealed that, at the 12-month follow-up time point, patients receiving SA-MPMP had significant improvements in kinesiophobia and rumination about pain compared to those receiving P-MPMP and SMC. In patients suffering from CLBP, an intervention that combines spouse-assisted coping skills training with a multidisciplinary pain management programme can improve fear of movement and rumination about low back pain.

The culture of patient safety in an Iranian intensive care unit

AIM

To explore nurses' and physicians' attitudes and perceptions relevant to safety culture and to elicit strategies to promote safety culture in an intensive care unit.

BACKGROUND

A strong safety culture is essential to ensure patient safety in the intensive care unit.

METHOD

This case study adopted a mixed method design. The Safety Attitude Questionnaire (SAQ-ICU version), assessing the safety climate through six domains, was completed by nurses and physicians (n = 42) in an academic intensive care unit. Twenty semi-structured interviews and document analyses were conducted as well. Interviews were analysed using a framework analysis method.

RESULT

Mean scores across the six domains ranged from 52.3 to 72.4 on a 100-point scale. Further analysis indicated that there were statistically significant differences between physicians' and nurses' attitudes toward teamwork (mean scores: 64.5/100 vs. 52.6/100, d = 1.15, t = 3.69, P < 0.001) and job satisfaction (mean scores: 78.2/100 vs. 57.7/100, d = 1.5, t = 4.8, P < 0.001). Interviews revealed several safety challenges including underreporting, failure to learn from errors, lack of speaking up, low job satisfaction among nurses and ineffective nurse-physician communication.

CONCLUSION

The results indicate that all the domains need improvements. However, further attention should be devoted to error reporting and analysis, communication and teamwork among professional groups, and nurses' job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can contribute to promoting a safety culture by encouraging staff to report errors, fostering learning from errors and addressing inter-professional communication problems.

Metabolic syndrome: a common problem among office workers

Background:

Metabolic syndrome (MSx) is associated with several health problems. Workers are an important part of any organization.

Objective:

To determine the prevalence of MSx and related variables among office workers.

Methods:

This cross-sectional study evaluated 1488 office workers in Qom province, Central Iran, by using a multi-stage cluster sampling. Diagnosis of MSx was based on blood HDL-cholesterol, triglyceride, and fasting blood sugar (FBS) levels and waist circumference, and blood pressure.

Results:

The overall prevalence of MSx was 35.9% (95% CI 33.5% to 38.3%), higher in men (37.2%) than in women (20.6%), and increased with age. The most common laboratory findings of MSx were hypertriglyceridemia (45.9%) and low HDL-cholesterol level (45.5%). Office workers with MSx had a significantly (p<0.001) higher body mass index than those without MSx. Lack of regular leisure time physical activity (p=0.003), and low intake of fruits (p=0.02) were associated with MSx.

Conclusion:

The prevalence of MSx was very high among office workers. Workplace health improvement programs through identifying and preventing MSx are necessary for improvement of staff's health.

Epidemiological trends of dermatophytosis in Tehran, Iran: A five-year retrospective study

OBJECTIVE

Dermatophytosis is the most frequent fungal infection all over the world and its frequency is constantly increasing. The aim of this study was to evaluate clinical features and epidemiological trends of dermatophytosis over the years 2010 to 2014 in Tehran, Iran.

PATIENTS AND METHODS

A total of 13,312 patients clinically suspected of cutaneous fungal infections were examined. Skin scales, plucked hairs, nail clippings and sub-ungual debris were examined by direct microscopy and culture. Dermatophyte species were identified at the species level by a combination of morphological and physiological criteria.

RESULTS

Direct microscopy confirmed a contamination rate of 19.7% (2622/13,312 cases) of which 1535 cases (58.5%) were culture positive distributed in male (1022 cases) and female (513 cases). The most commonly infected age group was the 30-39 years old. Tinea pedis (30.4%) was the most prevalent type of dermatophytosis followed by tinea cruris (29.8%) and tinea corporis (15.8%). Epidermophyton floccosum (31%) was the most prevalent causative agent, followed by Trichophyton rubrum (26.2%) and Trichophyton mentagrophytes (20.3%).

CONCLUSION

Our results showed considerable distribution of dermatophytosis from zoophilic, anthropophilic and geophilic species among population with diverse age groups. Although anthropophilic fungi such as T. mentagrophytes, E. floccosum, and T. rubrum were the main etiologic agents of dermatophytosis, the prevalence of T. verrucosum showed a meaningful increase over the years, which highlights the importance of rural dermatophytosis mainly transmitted from large animals. This noticeable information improves our current knowledge about dermatophytosis and assists to establish effective prevention and therapeutic strategies to overcome the disease.

Adsorption behavior of Cu(II) and Co(II) using chemically modified marine algae

In this study, brown algae-modified biomass Padina sanctae crucis was used for copper (Cu(II)) and cobalt (Co(II)) heavy metal ions adsorption in synthetic wastewater. The effects of solution pH and adsorption efficiency for Cu(II) and Co(II) removal from aqueous solutions were studied. In order to study the kinetic behavior of adsorption, pseudo-first-order, pseudo-second-order kinetic models, liquid film penetration, and Ritchie second-order models were used. The results showed that the pseudo-second-order kinetic model was able to describe adsorbent behavior in comparison to the other models. Moreover, in order to study adsorbent equilibrium behavior, Langmuir and Freundlich isothermal models were used. Based on the Langmuir model, the adsorption capacity of Co(II) and Cu(II) was determined and their values were 13.73 and 13.996 mg/g, respectively. It was shown that both metal ions adsorption process is favorable and adsorption is physical. In this research, thermodynamic parameters were also studied in order to determine Gibbs free energy for both metal ions which were negative, indicating that metal ions adsorption process is spontaneous and the degree of self-adsorption increases as temperature increases.

Novel Human Acute Ischemic Stroke Blood Clot Analogs for In Vitro Thrombectomy Testing

BACKGROUND AND PURPOSE

Previous studies have successfully created blood clot analogs for in vitro endovascular device testing using animal blood of various species. Blood components vary greatly among species; therefore, creating clot analogs from human blood is likely a more accurate representation of thrombi formed in the human vasculature.

MATERIALS AND METHODS

Following approval from the Mayo Clinic institutional review board, human whole-blood and platelet donations were obtained from the blood transfusion service. Twelve clot analogs were created by combining different ratios of red blood cells + buffy coat, plasma, and platelets. Thrombin and calcium chloride were added to stimulate coagulation. Clot composition was assessed using histologic and immunohistochemical staining. To assess the similarities of mechanical properties to patient clots, 3 types of clot analogs (soft, elastic, and stiff) were selected for in vitro thrombectomy testing.

RESULTS

The range of histopathologic compositions produced is representative of clots removed during thrombectomy procedures. The red blood cell composition ranged from 8.9% to 91.4%, and fibrin composition ranged from 3.1% to 53.4%. Platelets (CD42b) and von Willebrand Factor ranged from 0.5% to 47.1% and 1.0% to 63.4%, respectively. The soft clots had the highest first-pass effect and successful revascularization rates followed by the elastic and stiff clots. Distal embolization events were observed when clot ingestion could not be achieved, requiring device pullback. The incidence rate of distal embolization was the highest for the stiff clots due to the weak clot/device integration.

CONCLUSIONS

Red blood cell-rich, fibrin-rich, and platelet-rich clot analogs that mimic clots retrieved from patients with acute ischemic stroke were created in vitro. Differing retrieval outcomes were confirmed using in vitro thrombectomy testing in a subset of clots.

The Incidence and Risk Factors of Delayed Graft Function in 689 Consecutive Living Unrelated Donor Renal Transplantation

Due to the severe shortage of deceased donor kidneys, the number of renal transplantation from living-related and living-unrelated donors has increased worldwide. The incidence and risk factors of delayed graft function after deceased donor renal transplantation have been extensively studied. In this analysis, the incidence and predictors of delayed graft function was investigated in 689 living-unrelated kidney recipients. In 53 recipients, dialysis was needed within the first week after renal transplantation (7.7%). The risk factors for delayed graft function upon univariate analysis models were: female gender of kidney donor (P=.027), renal allograft with multiple arteries (P=.005) and previous transplantation (P<.005). Upon multivariate analysis, the only risk factor for development of delayed graft function was retransplantation (P=.001).

Trends of diabetes according to body mass index levels in Iran: results of the national Surveys of Risk Factors of Non-Communicable Diseases (1999-2007)

AIMS

The prevalence of diabetes is increasing dramatically worldwide. Less is known about whether this trend is similar among obese and lean individuals.

METHODS

We analysed the data sets of three cross-sectional national surveys in adults aged 25-64 years: the National Health Survey-1999 (n=21,576), and the national Surveys of Risk Factors of Non-Communicable Diseases (SuRFNCD)-2005 (n=70,981) and SuRFNCD-2007 (n=4233). Diagnosed diabetes was ascertained, and height and weight were measured in all surveys. In SuRFNCD-2005 and SuRFNCD-2007, fasting plasma glucose was used to identify subjects with newly diagnosed diabetes (≥ 7 mmol/l) and impaired fasting glucose (5.6 - 6.9 mmol/l) among individuals not reporting diabetes.

RESULTS

The prevalence of diagnosed diabetes (after adjustment for age, sex and residential area) was 2.5, 4.0 and 4.6% in 1999, 2005 and 2007, respectively. The total prevalence of diabetes increased from 7.7% in 2005 to 8.7% in 2007, about half of which was attributed to newly diagnosed disease (in both surveys). The prevalence of diabetes increased in all categories of obesity, with the most evident trend being among subjects with body mass index <25 kg/m(2) .

CONCLUSIONS

The prevalence of diabetes among Iranian adults has increased more than 1.8-fold in a period of only 8 years since 1999. This is the first report from Iran, and urgent measures need to be taken in order to prevent the progression and worsening of the problem and emergence of its undesired consequences.

Design, preparation and characterization of a new ionic liquid, 1,3-disulfonic acid benzimidazolium chloride, as an efficient and recyclable catalyst for the synthesis of tetrahydropyridine under solvent-free conditions

In the present work, 1,3-disulfonic acid benzimidazolium chloride as a new ionic liquid, is synthesized, and characterized by studying its FT-IR, ¹H NMR, ¹³C NMR as well as mass spectra.