فرهاد آزادی

Proper physical activities play an important role in reducing disease and mortality in old age, and is one of the main causes of active aging; however, the fear of falling is a barrier to having proper physical activity. Due to the difference between the elderly living in urban and rural areas regarding the risk factors of fear of falling and the amount and type of physical activity, this study aims to investigate and compare the fear of falling, physical activity, and activities of daily living (ADL) in the elderly living in urban and rural areas of Konarak County, Iran.

In this analytical cross-sectional study, 350 elderly people  aged ≥60 years, who were under the coverage of comprehensive rural and urban health service centers in Konarak, Sistan and Baluchestan province (224 from rural areas and 126 from urban areas) were selected using a random sampling method and based on the inclusion and exclusion criteria. In addition to recording their demographic information, their fear of falling, physical activity, and ADL were measured by the Persian version of falls efficacy scale-international (FES-I), Rapid Assessment of Physical Activity (RAPA), ADL scale, and Instrumental ADL scale (IADL), respectively.

The mean overall age of the elderly was 68.48±7.84 years (69.53±8.29 years in the rural group and 66.62±6.61 years in the urban group), and there was a significant difference between the two groups in terms of age (P<0.001). Pearson correlation test results showed that the FES-I score had a statistically significant negative relationship with the scores of ADL, IADL, and RAPA1 in total and in each group (P<0.001), but there was no statistically significant relationship between the FES-I score and the RAPA2 neither in total (P=0.40) and nor in rural (P=0.38) and urban (P=0.81) groups.

The fear of falling is significantly higher in the elderly living in rural areas of Konarak county compared to those living in urban areas. The RAPA1 and basic ADL of the elderly living in urban areas are higher compared to those living in rural areas, but there is no significant difference between them in RAPA2 and IADL. In addition, fear of falling has a significant relationship with physical activity of the elderly in overall and in rural and urban groups.

Balance disorder is an important risk factor in older people while walking. Knee pain (KP) and low back pain (LBP) are the most common disorders related to aging that disturb the balance of the elderly. This study aims to investigate the relationship between chronic LBP and chronic KP with dynamic balance in the elderly.

In this analytical cross-sectional study, 79 older adults aged ≥65 years living in a nursing home in Mashhad, Iran, were selected using the census method and based on the inclusion and exclusion criteria of the study. In addition to measuring demographic information, fear of falling was assessed with the Persian version of the falls efficacy scale - international (FES-I), and the pain was assessed using the visual analog scale (VAS). To assess dynamic balance, the time up & go (TUG) test was used. Data analysis was done in SPSS software, version 23.

There was a significant difference among the three study groups of LBP, KP, and control in TUG score (P=0.050). With the increase in the FES-I score, the mean score TUG score increased significantly (P=0.01). With the increase of age, the mean score of TUG score increased significantly (P=0.006).

The elderly with chronic KP have poorer dynamic balance than the elderly with chronic LBP. Therefore, focusing on the prevention and treatment of knee injuries at younger ages can play an important role in preventing balance disorders in the elderly.

Today, profit rates and the possibility of managing and manipulating the profits are clear to all, and researchers have always sought solutions to remove the uncertainties facing investors and stakeholders when making their financial decisions. To clarify users' decision path of financial data users, Beneish (1999) has developed a profit-management predicting model that has yielded different results in different societies. Thus, this article aims to optimize and localize Beneish’s model by adding the Tunneling variable to Beneish’s variable and using a modern neural network and particle swarm algorithms. The statistical research population consisted of 196 companies listed at the Tehran Stocks Exchange from 2014 to 2019. The research method was a descriptive-library method in which the variables are interrelated through the causal-correlational method. From an objective point of view, it is an Ex-Post Facto research design. To analyze the data, the regression method and artificial neural and the PSO algorithms were used. The model analysis results suggested that all financial ratios had significant effects on Beneish’s profit management, as the Tunneling phenomenon and the financial leverage had the highest and lowest effects on predicting Beneish’s profit management, respectively.

Objectives :

Due to the decline in the function of balance system in older adults and the importance of having an active old age, it is very important to maintain independence during daily living activities such as shopping, holding and carrying an external load. This study aims to determine the effect of external load magnitude and holding mode on the postural sway during standing in healthy community-dwelling older adults.

Methods & Materials:

 In this quasi-experimental study, 15 healthy community-dwelling older adults in Tehran, Iran (7 men and 8 women) with a mean age of 71.53±6.18 years who were independent in daily living activities such as shopping and carrying shopping bags were enrolled using a conveneince sampling method. The independent variables were holding manual loads with a magnitude of 0%, 5%, 10%, 15%, and 20 % of body weight in symmetrical (both hands) and asymmetrical (dominant or non-dominant hand) conditions, standing still on the force plate for 30 seconds. Dependent variables included the amount and velocity of the displacement of the center of pressure (COP) in two anteroposterior and mediolateral directions and the area of the COP displacement.

Results:

 The effect of holding manual loads symmetrically and asymmetrically and the manual load magnitude on the amount and velocity of COP displacement in anteroposterior direction was signifcant, while their interaction effect was not significant on any variables. The paired t-test results showed that the amount and velocity of COP displacement in anteroposterior direction at asymmetric condition was significantly different compared to the symmetrical condition, but there was no significant difference between holding with dominant and non-dominant hands. The amount of COP displacement in anteroposterior direction with 5%, 10%, 15% and 20% of body weight were higher and statistically significant compared to the load magnitude of 0% (P<0.05). The effects of load holding mode and load magnitude were not statistically significant on any of the COP variables in the mediolateral direction. 

Conclusion:

 Aging, Postural balance, External load Holding external loads asymmetrically with any magnitudes can increase the amount and velocity of COP displacement in the anteroposterior direction. For preventing falls, it is recommended for the elderly to pay attention to the fact that holding an external load with two hands is less challenging to the balance system than holding with one hand, whether dominant or non-dominant. In terms of the load magnitude, an external load with 5% of body weight can challenge the balance system compared to the situation without external load. With some exceptions, there is no difference between loads of 5%, 10%, 15% and 20% of body weight.

The purpose of this study is to optimize the Bayesian profit management model with tunneling phenomenon and cumulative particle motion optimization algorithm. The statistical population of the study included companies listed in the Tehran Stock Exchange and the number of companies under study, including 196 companies listed during the years 2015 to 2020. The research method is descriptive-correlational and in terms of causal-correlational variables and in terms of purpose and event, it is post-event. In order to analyze the data, regression and artificial neural network and cumulative particle motion optimization algorithm were used. The results of the model analysis showed that all financial ratios had a significant effect on the earnings management prediction of insight and the greatest impact on the prediction of earnings management was on the INE tunneling phenomenon and the least on financial leverage. The results of the estimation of the designed neural networks show that the use of cumulative particle optimization algorithm to predict the Profit management for companies listed in Tehran Stock Exchange is acceptable.

 To investigate the effect of 12 weeks of neck stabilization, core stabilization, and combined stabilization exercises on pain and disability among elderly people in Tehran City, Iran.  This study was a 12 weeks open-label clinical trial. A total of 18 elderly patients with chronic neck pain were randomly assigned into three groups: neck stabilization training (6 people), core stabilization training (6 people), and combined stabilization training (6 people). The severity of neck pain and disability before the beginning of the training, 8 weeks after training and one week after the completion of the exercises were measured using the Visual Analog Scale (VAS), Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDI). To investigate the effect of time, repeated measure analysis of variance was used to analyze the data in SPSS version 21.   The Mean±SD scores of pain before and after neck stabilization treatment were respectively 6.08±0.58, 4.83±0.52 for VAS and 49.17±2.86 and  39.17±2.79 for NDI; and 56.4±2.11 and 50.0±1.64 for NPDI; those differences between pairs were significant. The Mean±SD scores of pain before and after core stabilization treatment were respectively, 6.00±0.55, 4.92±0.20 for VAS; 49.67±1.86 and 39.17 ±1.94 for NDI; and 56.01±2.44, and 48.92±1.16 for NPDI; those differences between pairs were significant. Also, the Mean±SD scores of pain before and after combined stabilization treatment were respectively,  6.00±0.45, 4.00±0.32 for VAS; 49.83±2.23 and 37.17±2.86 for NDI; and 55.25±0.28 and 47.51±1.44 for NPDI; those differences between pairs were significant (P<0.05). Among the underlying variables, gender was the only significant factor in pain relief in the elderly (F=6.21, P=0.02), while other variables were not significant (P>0.05). The findings of this study showed that 12 sessions of neck, core, and combined stabilization training in the neck region could improve the tolerance and pain of the elderly with non-specific chronic neck pain.

Objectives The eye refractive errors, including myopia, hyperopia, and astigmatism, are the most important visual impairments worldwide. Based on the existing evidence suggests, the visual impairment could contribute to falling in the elderly. Therefore, this study aimed to determine the influence of vision impairment of older adults with eye refractive errors on the occurrence of falls and postural control.
Methods & Materials The older people referred to the health center of the 9th district of Tehran municipality for ophthalmic examination were examined (using ophthalmoscope and Snellen chart) by skilled ophthalmologists. Then, certain information such as their age, sex, history of special eye disease or operation, history of fall during the last 12 months, etc. was gathered through questionnaires from the older people who accepted to participate in this study after giving their informed consents. Based on eye screening results, 77 older adults with refractive errors of hyperopia (n=19, mean [SD] age=67 [5.85] y); astigmatism (n=22, mean [SD] age=70.32 [5.60] y); and both hyperopia and astigmatism (n=36, mean [SD] age=69.78 [7.69] y), as well as 23 older healthy adults, mean (SD) age=70.29(5.29) y, without any obvious eye disorders were enrolled in this study. Their history of falls and postural control were evaluated. The postural control was determined using the Timed Up and Go (TUG) test. The statistical tests were analysis of variance (ANOVA) for comparing the groups with regard to postural control and the Chi-square test for comparing the prevalence of falls between groups with refractive errors and the healthy group.
Results The studied subjects comprised 23% (n=23) healthy ones, 19% (n=19) people with hyperopia, 22% (n=22) people with astigmatism, and 36% (n=36) people with both hyperopia and astigmatism. About 70% of them were women, and 30% were men. The results of our study showed that 15.8% of study participants with normal vision, 26.1% with hyperopia, 22.7% with astigmatism, and 38.9% with both hyperopia and astigmatism had experienced at least 2 falls in the past 12 months. The people with refractive errors showed a higher prevalence of falls; however, the result of the Chi-square test did not reveal any significant differences among these groups (P=0.25). Furthermore, the results of ANOVA for comparing TUG test (test of postural control) results showed no differences among these groups (P=0.64).
Conclusion Vision impairment of older adults due to refractive error is not associated with an increase in falls. Furthermore, TUG test results did not show balance disorders in these groups. Further research, such as assessment of postural control with advanced devices and considering other falling risk factors is also needed to identify the predictors of falls in older adults with eye refractive errors.

. Relative and absolute reliability are the important aspects of the test that many clinical decisions are based on them. in many cases, the only basis for the decision is relative reliability while the absolute reliability is also very important. This study aimed to measure and calculate the relative and absolute reliability of Sit To sand-5 repetition. 11 community-dwelling older adults 65 years and older (69.64±3.585) and 20 healthy young in the age range 20 to 35 years (28.80±4.15) using Sit to Stand-5repetition were evaluated twice with an interval of 2 to 5 days. The " Minimal Detectable Changes " in seniors was 29.5 seconds and Youth 3.02 seconds and "Coefficient of Variation" were 27% and 19% respectively. The results of this study showed in assessing progress during treatment sessions or judgment about progression or regression, elderly people must more change than young to consider change as a real change not accidentally.

In this paper we have calculated and measured, the value ofProtection Antiquities Tagh Bostan and average willingness to paypeople to visit this location using the Contingent Choice Methodselected Double-bounded Dichotomous choice (DDC) in summer1390.we has been used up logit model To measure willingness to payand Maximum Likelihood method for the estimated model’sparameters. Results show that the average willingness to pay for visitthis place is 460.6 tomans and value of protective is 1,842,400,000tomasn. The results show are effective the proposed amount, incomelevel, number of visit this places, live place upon acceptance orrejection the proposed.

Relative and absolute reliability are psychometric properties of the test that many clinical decisions are based on them. In many cases، only relative reliability takes into consideration while the absolute reliability is also very important. 11 community-dwelling older adults 65 years and older aged (69. 64±3. 585) and 20 healthy young in the age range 20 to 35 years (28. 80±4. 15) using three versions of Timed Up and Go test were evaluated twice with an interval of 2 to 5 days. Generally، the non- homogeneity of the study population was stratified to increase the Intraclass Correlation Coefficient (ICC); this coefficient in elderly people is greater than young people and with a secondary task is reduced. In This study، absolute reliability indices using different data sources and equations lead to in more or less similar results. At general، in test –retest situations، the elderly more than the young people must be changed to be interpreted as a real change، not random. The random error contribution is slightly greater in elderly than young and with a secondary task is increased. It seems، heterogeneity leads to moderation in absolute reliability indices. In relative reliability studies، researchers and clinicians should pay attention to factors such as homogeneity of population and etc. As well as، absolute reliability beside relative reliability is needed and necessary in clinical decision making.

To investigate the effect of Romberg exercise on balance improvement in elderly persons, 70 elderly persons with the history of two or more falling during recent 3 months were selected from Kahrizak nursing home in Tehran (38 as cases and 32 as controls).Methods & Materials: Romberg exercise was done in case group every day (45 minute per day and one time each day) for 3 months. Among all persons, 28 persons in case group and 21 persons in control group were followed for 6 months and incidence and frequency of falling were assessed during this time. The Incidence of one or more falling in case and control groups was 31.3% and 47.6% in men and 57.9% and 27.3% in women, respectively. We found no significant relation between gender and the incidence of falling (P=0.460). Also, no significant relation was found between age and incidence (P=0.554) and frequency of falling (P=0.144) in elderly persons. Although the effect of Romberg exercise on improvement of balance disturbance and falling was not demonstrated, it needs additional studies with larger sample size and longer follow-up.

Falls by elderly people area frequent cause of morbidity and mortality, especially in institutionalized elders. to describe the features of falls among institutionalized elderly people.Methods & Materials: characteristics of falls in the preceding six months (March 2006 - September 2006) that occurred among elder lies (aged over 60years) with normal physical function and cognitive status, who lived at Kahrizak Institute, along term nursing home in Tehran, were surveyed and analyzed. The mean age of the patients with falls was 76.9 yrs. These numbers of falls had occurred among 29 elders that 48.3% were women and 51.7% were men. 57.6% off alls were simple and elders could standup immediately independently. 42.4% of falls needed to help for standup, 2 elder person (2.6%) had sever consequence of fall and had fractures. (Skull fracture, head trauma & hip fracture) 30.3% of falls occurred in yard, 28.9% at room, 18.4%inhallway, 14.5% at WC,. 3.9%at bathroom, and 3.9% at lunch saloon. Analysis of the time of falls showed: 45.3% of falls occurred at 7bl2 am, 13.2% at the lunch time (12bI4), 17% at 14b19, 11.3%at night (19b4 am), and 13.2% at 4b7 am. falls among elder lies occur mainly outside of room. And occur at the time of maximum activities, for example at morning; also falls have been happened more in subjects older, and occasionally result in sever injury such as head trauma, skull fracture, femur and pelvis fracture and cause more mortality and morbidity. Control of environmental risk factors could be protective factors against falls.