Background and AimLiver transplantation is a potential cure for liver damage from Wilson’s disease but the course of neuropsychiatric manifestations after transplantation remains undetermined.Material and methodsIn this study, data on all patients who’d received a liver transplant for Wilson’s disease at the Shiraz Organ Transplantation Center between December 2000 and March 2014 were reviewed and compared to data on a control group who’d received a liver transplant over the same period but due to other causes.ResultsOut of 2198 patients who’d received a liver transplant in the period; 107 patients were diagnosed with Wilson’s disease (21 with fulminant hepatic failure); age of patient ranged from 5 to 59 years; 56.07% of patients in this series had some type of neuropsychiatric manifestation before transplantation, of which 66.67% showed improvement after the procedure. 18 patients had aggravation of neuropsychiatric symptoms after transplantation. These neuropsychiatric symptoms were mostly for anxiety, tremor and depression but there were four cases of new onset dysarthria, rigidity and ataxia in various combinations. Survival rates of 1-month, 1-year, and 5-years for patients with Wilson’s disease were 88%, 86%, 82%, respectively, evaluations were not statistically different from that of the control group.ConclusionsLiver transplantation showed good long-term results in patients with Wilson’s disease, even in those presenting fulminant hepatic failure. Neuropsychiatric manifestations normally show improvement after transplantation but in some cases new onset of manifestations occurred after successful liver transplantation.

Background Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services. Methods This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation. Results The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach’s α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance. Conclusion GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.

Objective Although treatment patterns analyses at scale can provide insights into associated health outcomes, they remain relatively uncharacterized for most chronic diseases, including hypertension (HTN). To address this gap, we analyzed HTN treatment patterns among US health-insured patients. Materials and Methods New (n = 200,786) or all (n = 4.1 million) HTN patients were identified from 2015, 2016 enrollments in a nationwide administrative claims database and compared for HTN-specific treatment (Rx) choices, Rx count, and distinct rounds of treatment options (ROTO), respectively. Selected treatment patterns were risk-assessed using predictive modeling and/or literature-based recommendations. Results For 2016, ACE inhibitors/ARBs were most frequent choices in new HTN patients vs more diverse Rx-choices among all HTN patients. All HTN patients had ~3-fold and ~5-fold-higher prevalence of (same-year) polytherapy and Rx interventions, respectively. New HTN patients with at least 2 rounds of treatment options (vs single/initial round) were associated with 5-fold or higher predicted HTN complications risk (p-value < 0.0001). All HTN patients with at least 3 rounds of treatment options (vs single/initial round) had 3.8-fold higher next-year HTN complications risk (p-value < 0.0001). Co-morbidities/persistence of least 3 rounds of treatment options over 2 years further increased these odds and total medications/chronic disease score correlated with ROTO counts. Discussion 95% of new HTN patients in 2016 did not start treatment with current literature-recommended first option, Thiazides. Assuming sticky prescription patterns, opportunity exists to improve (current) initial HTN treatments. Additionally, ROTO counts can inform HTN complications risk/management thereof. Conclusion We highlight opportunities to improve initial HTN treatments and treatment patterns associated with higher risk among HTN patients.

Background: The global incidence of STIs is rising. It is estimated that 499 million new cases of curable STIs occur every year. The existence of more than one million reported cases of STIs annually in Iran shows that addressing this issue must be a priority for Iranian health authorities. While recognition of the importance of gender issues to reproductive health (RH) programs has grown significantly in the past several years, major challenges remain in implementing gendersensitive programs. Gender mainstreaming in Iranian reproductive health program is a relatively new issue, so this study aims to explore gender sensitive STIs/HIV/AIDS prevention policies. Method: This study employed a qualitative research design. Participants were health managers, health policy makers and reproductive health providers. They were selected purposefully and then continued by snowball sampling method. 43 semi-structured in-depth interviews with 37 key informants were done. All the interviews were recorded and transcribed. The data were analyzed by content analysis method. Trustworthiness of the data was achieved by using credibility, transferability and conformability. Results: Key informants clearly explained the gender sensitive STIs/ HIV/AIDS prevention policies in three main categories: 1) advocacy, 2) collaboration between different sectors and 3) community empowerment to gender sensitive STIs/HIV/AIDS prevention programs. Conclusion: Changing gender neural STIs/HIV/AIDS prevention policy to more complete gender sensitive policy needs advocacy, collaboration of sectors and community empowerment.

Objective A challenge in hypertension-related risk management is identifying which people are likely to develop future complications. To address this, we present administrative-claims based predictive models for hypertension-related complications. Materials and Methods We used a national database to select 1,767,559 people with hypertension and extracted 112 features from past claims data based on their ability to predict hypertension complications in the next year. Complications affecting kidney, brain, and heart were grouped by clinical severity into three stages. Extreme gradient boosting binary classifiers for each stage were trained and tuned on 75% of the data, and performance on predicting outcomes for the remaining data and an independent dataset was evaluated. Results In the cohort under study, 6%, 17%, and 7% of people experienced a hypertension-related complication of stage 1, stage 2, or stage 3 severity, respectively. On an independent dataset, models for all three stages performed competitively with other published algorithms by the most commonly reported metric, area under the receiver operating characteristic curve, which ranged from 0.82-0.89. Features that were important across all models for predictions included total medical cost, cost related to hypertension, age, and number of outpatient visits. Discussion The model for stage 1 complications, such as left ventricular hypertrophy and retinopathy, is in contrast to other offerings in the field, which focus on more serious issues such as heart failure and stroke, and affords unique opportunities to intervene during earlier stages. Conclusion Predictive analytics for hypertension outcomes can be leveraged to help mitigate the immense healthcare burden of uncontrolled hypertension.

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BackgroundA dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents.ObjectiveThis study aims to assess needs for gender sensitive reproductive health care services for adolescents.MethodsThis was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21.ResultsThree hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services.ConclusionsProviding gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.