To assess the effectiveness of a cognitive-behavioral treatment (CBT) program on weight reduction among Iranian adolescents who are overweight. MethodsUsing a randomized controlled trial design, 55 adolescents who were overweight (mean [SD] age=14.64 [1.69] years; zBMI=2.18 [0.65]) were recruited in the CBT program and 55 in the treatment as usual (TAU; mean age=14.88 [1.50]; zBMI=2.09 [0.57]) group. All the participants completed several questionnaires (Child Dietary Self-Efficacy Scale; Weight Efficacy Lifestyle questionnaire; Physical Exercise Self-Efficacy Scale; Pediatric Quality of Life Inventory; and self-reported physical activity and diet) and had their anthropometrics measured (height, weight, waist and hip circumferences, and body fat). ResultsThe CBT group consumed significantly more fruits and juice, vegetables, and dairy in the 6month follow-up as compared with the TAU group (p-values <0.001). The CBT group consumed significantly less sweet snacks, salty snacks, sweet drinks, sausages/processed meat, and oils in the six-month follow-up compared with the TAU group (p-values<0.001).Additionally, the waist circumference, BMI, waist-hip ratio, and fat mass were significantly decreased in the CBT group in the six-month follow-up compared with the TAU group (p-values<0.005). The CBT group significantly improved their psychosocial health, physical activity, and health-related quality of life (p-values<0.001). ConclusionThe CBT program showed its effectiveness in reducing weight among Iranian adolescents who were overweight. Healthcare providers may want to adopt this program to treat excess weight problems for adolescents. 24 to estimate the duration of mild activities. The duration of each activity was summed up to calculate a weekly amount. The time elapsed during sleep and for each activity is multiplied by a constant number, which was 1 for sleep, 1.5 for light activity, 4 for moderate activity, 6 for hard activity, and 10 for very hard activity. To estimate adolescents' energy expenditure (in kilocalories), the scores are summed. To estimate the average amount of consumed energy on a day from the past week, the score was divided by 7. This questionnaire has been translated into Persian and was found as a useful tool for assessing the level of physical activity (47). Anthropometric measurements and body compositionAll body measurements were performed at the beginning of the study and after six months of the intervention. The weight of each adolescent was recorded using the SECA scale (SECA, Hamburg, Germany) with the least clothes and no shoes (100g accuracy). Height was recorded using a portable 217 SECA (SECA GmbH, Hamburg, Germany) with a precision of 0.1cm, when the heel was against the wall and the face was towards the researcher. The body mass index (BMI) was calculated with weight divided by the height in square meters. The anthropometric index of Z-scores for height-for-age, weight-for-age, and BMI-for-age were calculated as indicators of growth status for the children using Anthroplus softw...

Background: The global population has grown and is still growing. This growth is happening in more cities than in rural areas, given the continual search for economic opportunities. The implication of this growth is the growth of healthcare centers to meet the growing healthcare demand. Accordingly, healthcare waste production has posed a big challenge to health waste disposal and management. Objectives: This study aimed to prioritize and select the best method of waste management in the health sector with multi-criteria decision making (MCDM) approaches. Methods: The present cross-sectional study was carried out to select the best method of managing healthcare wastes through MCDM approaches in Qazvin. The sample was selected and assigned to two groups of 28 experts (five categories) who evaluated the criteria and a group of 22 individuals (four categories) to rank disposal methods of healthcare waste. First, six waste disposal methods and 12 criteria for designing a questionnaire were identified. After designing the questionnaire, the analytic hierarchy process (AHP) was used to calculate the weights of the criteria. Then, the TOPSIS method was used to rank different waste disposal methods. We used EC (ver. 8), Excel (Microsoft, 2007), and Lingo (ver. 14) for analyzing the data. Results: Concerning the rank of health waste disposal methods based on common existing criteria, urban and rural areas should use different disposal methods. The best disposal methods are irradiation (0.839) and microwave (0.794) in urban areas and steam sterilization (0.867) and microwave (0.840) in rural areas. In both areas, incineration was ranked the last. Conclusions: To achieve the effective disposal and safety of health waste in urban and rural areas, varied but applicable disposable methods should be used for the management of health waste disposal.

Background: Research is one of essential elements for development of each country and is a pioneer and precursor in providing accurate and making decision. Objective: This study evaluated the results of comprehensive health plan projects of Qazvin University of Medical Sciences from 2009 to 2013. Methods:This descriptive-analytical study was performed in four steps. The first two steps included the formation of a leadership team and holding of meetings with representatives of 22 executive authorities of the province. The third step included the compilation of the executive proposals of each organization and fourth step, received final reports and evaluations. In each step, a variety of methods were used for data collection, including reviewing all the documents, expert panel, focused group discussion and stakeholder analysis, Delphi technic and nominating group. Findings: From 43 conducted projects, only 31 projects (72%) were completed by Qazvin University of Medical Sciences. As the results, projects were in the field of policy documents (n=10), regulation (n=1), educational packages (n=4), educational programs (n=5), health index (n=1), models (n=7) and applications (n=18). Conclusion: Some of the defined projects were essential in 2010 and their implementation could solve some of health problems of the province. It seems that implementation joint projects could solve complex and multi-dimensional problems by promoting and applying intersectoral collaboration between health sector and executive authorities of the province.

Background:Cervical spine involvement is common in patients with rheumatoid arthritis (RA). The most common abnormality is atlantoaxial dislocation (AAD). It may lead to severe neurological symptoms and even death. Currently, there is a lack of consensus on the best approach to treatment.Objectives:We investigated the prevalence of and risk factors for AAD in patients with RA, as well as its relationship to treatment modalities.Methods:We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck, anteroposterior and odontoid projection view. Patients were divided into two groups: (G1) a group with AAD and (G2) without ADD. We compared clinical, radiological, and laboratory findings between the two groups, as well as the treatments used: Steroid therapy, classic and biologic disease-modifying anti-rheumatic drugs (DMARDs). Structural joint damage was assessed with the Sharp/van der Heijde radiographic method. Functional impairment was assessed using the Health Assessment Questionnaire (HAQ). We used Statistical Package for Social Sciences (SPSS) 22.0 to analyze the results. The level of statistical significance was set at 0.05.Results:ADD was present in 16% of the cases (n=36). Female predominance was noted, with a sex ratio of 0.25 (p=0.530). The mean age was 58±12 years, with no significant difference between groups (p=0.146). The mean disease duration was significantly higher in G1 (11.5 ± 10.5 years versus 5.9 ± 6.3, p=0.004). A noticeable relationship between AAD and immunopositivity was found: rheumatoid factor (RF) was present in 86.1% of the cases in G1 versus 67.5% in G2 (p=0.025). Anti-citrullinated protein antibodies (ACPA) were present in 86.1% of the cases in G1 versus 64.8% in G2 (p=0.012). We found a significant difference between AAD and disease activity assessed by DAS28-VS (5.8±1.3 in G1 versus 5.3±1.6 in G2,p=0.027). AAD was significantly associated with more structural joint damage: erosions (121.1±60.9 in G1 versus 61.8±56.5 in G2,p<10-3), joints space narrowing (77.4±47.4 in G1 versus 38.7±40 in G2, p<10-3), Sharp/van der Heijde radiographic score (190.2±103.1 in G1 versus 100.1±90.6 in G2, p<10-3). Hip involvement was more frequent in G1 (22.2% versus 9.4% in G2, p=0.038).HAQ score was higher in G1 (1.8±0.7 versus 1.2±1, p=0.002).Seventy-five percent of patients in G1 had received methotrexate versus 82.3% in G2 (p=0.301). The mean duration of methotrexate therapy was longer in G1 (24.6±23.5 versus18±24 months, p=0.015). G1 patients received a higher mean dose and cumulative dose of methotrexate: 13.2±3.5 g/week versus 11.8±4.4 g/week (p=0.048), and 6.5±6.8 versus 4.8±8.5 (p=0.025), respectively.Thirty-five percent of patients in G1 had received corticosteroids versus 25% in G2 (p=0.217). Patients in G1 had a significantly longer duration of steroid therapy: 17.8 + 20.2 versus 13.3 + 24.3 months (p=0.22). The mean dose of corticosteroids was similar between the two groups: 6.9±4.3 mg/day versus 5.7±4.6 mg/day (p=0.132). The total cumulative dose was significantly higher in G1: 6.5±6.8 mg/day versus 4.8±8.5 mg/day (p=0.025).There was no significant difference in using other DMARDs: Sulfasalazine (p=0.182) and leflunomide (p=0.276).No significant difference was observed with patients under biologic DMARDs: 24.1% in G1 versus 17% in G2 (p=0.725).Conclusion:Cervical spine involvement is common in RA and may be asymptomatic. Immunopositive patients seem to have more frequently ADD, as well as those with high disease activity and severe structural joint damage. The treatment modalities do not appear to be affected by AAD; however, patients with ADD seem to have higher cumulative doses of corticosteroids and methotrexate. Given the cross-sectional nature of our study, it is difficult to confirm the connection between the two. Further studies are needed.Disclosure of Interests:None declared

Background:Peripheral joint involvement is frequent among patients with peripheral spondylarthritis (SA). However, the root joint involvement, such as hip involvement, has been described as being associated with axial spondylarthritis, while data for shoulder involvement are scarce. Cuff tendonitis and enthesitis are common features in the shoulder in patients with SA.Objectives:This study aimed to identify the prevalence of shoulder involvement in SA patients and describe its clinical and radiological features.Methods:We conducted a retrospective study including SA patients, all fulfilling the assessment of Spondyloarthritis International Society (ASAS) criteria.For all patients, we collected the following data: Age, the clinical presentation of SA, the inflammatory biomarkers C-reactive protein (CRP), and the disease activity assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).Regarding shoulder involvement, we assessed the following items: tenderness, mobility, rotator cuff tests, as well as the results of X-ray and Ultrasound examination (US).Results:We included one hundred and thirty-one SA patients (mean age 39,77 years). Among them, sixty-two percent were male. Ten percent of patients were smokers, 46,6% had the peripheral beginning of the disease. Fourteen patients complained of shoulder pain. The majority of them were male.X-rays showed no abnormalities (n=2), while a destructive form was noted in (n=7).Rotator cuff rupture or enthesopathy was also revealed by the reduction of subacromial space (n=5), condensation of the greater tuberosity (n=3), crooked aspect of the acromion (n=2), and Moloney’s line disruption(n=1).US showed no abnormalities (n=1), supraspinatus tendinopathy (n=5), supraspinatus transfixing tear (n=1), infraspinatus tendinopathy (n=2), supraspinatus enthesopathy (n=2), infraspinatus enthesopathy (n=1), moderate synovitis (n=1), subacromiodeltoid bursitis (n=1).Shoulder involvement was correlated significantly with the peripheral beginning of SA (P < 0.05). There were no significant differences in gender, tobacco use, CRP value, and the disease activity between the two groups (P > 0.05).Conclusion:The shoulder involvement was rare in our study. It is characterized by cuff tendonitis and enthesitis, especially in supraspinatus insertion. However, the glenohumeral synovitis was uncommon in our series, even in the peripheral form of the disease.References:[1]Hip and Shoulder Involvement and Their Management in Axial Spondyloarthritis: a Current Review Clementina López-Medina1,2,3,4 & M. Carmen Castro-Villegas1,2,3 & Eduardo Collantes-Estévez1,2,3, 23 July 2020.Acknowledgements:I would like to thank all the authors listed above, for they helped me make writing my first abstract less harder.Disclosure of Interests:None declared.