Iranian Journal of Public Health
Volume:45 Issue: 7, Jul 2016

Performance is a multi-dimensional and dynamic concept. During the past 2 decades, considerable studies were performed in developing the hospital performance concept. To know literature key concepts on hospital performance, the knowledge visualization based on co-word analysis and social network analysis has been used.
Documents were identified through “PubMed” searching from1945 to 2014 and 2350 papers entered the study after omitting unrelated articles, the duplicates, and articles without abstract. After pre-processing and preparing articles, the key words were extracted and terms were weighted by TF-IDF weighting schema. Support as an interestingness measure, which considers the co-occurrence of the extracted keywords and "hospital performance" phrase was calculated. Keywords having high support with "hospital performance" are selected. Term-term matrix of these selected keywords is calculated and the graph is extracted.
The most high frequency words after “Hospital Performance” were “mortality” and “efficiency”. The major knowledge structure of hospital performance literature during these years shows that the keyword “mortality” had the highest support with hospital performance followed by “quality of care”, “quality improvement”, “discharge”, “length of stay” and “clinical outcome”. The strongest relationship is seen between “electronic medical record” and “readmission rate”.
Some dimensions of hospital performance are more important such as “efficiency”, “effectiveness”, “quality” and “safety” and some indicators are more highlighted such as “mortality”, “length of stay”, “readmission rate” and “patient satisfaction”. In the last decade, some concepts became more significant in hospital performance literature such as “mortality”, “quality of care” and “quality improvement”.

This research aimed to systematically study and outline the methods of hospital performance evaluation used in Iran.
In this systematic review, all Persian and English-language articles published in the Iranian and non-Iranian scientific journals indexed from Sep 2004 to Sep 2014 were studied. For finding the related articles, the researchers searched the Iranian electronic databases, including SID, IranMedex, IranDoc, Magiran, as well as the non-Iranian electronic databases, including Medline, Embase, Scopus, and Google Scholar. For reviewing the selected articles, a data extraction form, developed by the researchers was used.
The entire review process led to the selection of 51 articles. The publication of articles on the hospital performance evaluation in Iran has increased considerably in the recent years. Besides, among these 51 articles, 38 articles (74.51%) had been published in Persian language and 13 articles (25.49%) in English language. Eight models were recognized as evaluation model for Iranian hospitals. Totally, in 15 studies, the data envelopment analysis model had been used to evaluate the hospital performance.
Using a combination of model to integrate indicators in the hospital evaluation process is inevitable. Therefore, the Ministry of Health and Medical Education should use a set of indicators such as the balanced scorecard in the process of hospital evaluation and accreditation and encourage the hospital managers to use them.

Increasing hospital costs and its social and cultural problems has led to the idea of providing healthcare services at home. Because of infrastructural and implementation problems, providing healthcare at home in Iran has not been initiated yet. Therefore, this study set out to elaborate the need for a comprehensive system in order to provide this service in Iran.
All articles published in indexing sites with the defined keywords in English or Farsi were gathered. The indexing websites included Iran Medex, PubMed Central, Elsevier journals, WHO publications and Google scholar from 1985 to 2014 were surveyed. Other documents included the related books and regulations.
Despite of having dominant religious values and constitution laws related to stability of family relations and establishment of clinical services and health care at home in Iran, providing health care services faces some harsh challenges including ignoring entrepreneurship and lack of required infrastructures such as lack of required insurance regulations, the inappropriate and indifferent performance of some activists home services and absence of registration and identification system in this domain.
Because of the increasing number of elderly people in Iran and healthcare costs becoming more and more expensive, establishing a system for providing healthcare at home is inevitable.

Multiple severity scoring systems have been devised and evaluated in adult sepsis, but a simplified scoring model for pediatric sepsis has not yet been developed. This study aimed to develop and validate a new scoring model to stratify the severity of pediatric sepsis, thus assisting the treatment of sepsis in children.
Data from 634 consecutive patients who presented with sepsis at Children’s hospital of Hunan province in China in 2011-2013 were analyzed, with 476 patients placed in training group and 158 patients in validation group. Stepwise discriminant analysis was used to develop the accurate discriminate model. A simplified scoring model was generated using weightings defined by the discriminate coefficients. The discriminant ability of the model was tested by receiver operating characteristic curves (ROC).
The discriminant analysis showed that prothrombin time, D-dimer, total bilirubin, serum total protein, uric acid, PaO2/FiO2 ratio, myoglobin were associated with severity of sepsis. These seven variables were assigned with values of 4, 3, 3, 4, 3, 3, 3 respectively based on the standardized discriminant coefficients. Patients with higher scores had higher risk of severe sepsis. The areas under ROC (AROC) were 0.836 for accurate discriminate model, and 0.825 for simplified scoring model in validation group.
The proposed disease severity scoring model for pediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which has important clinical significance in evaluating the severity of pediatric sepsis and predicting its progress.

The aim of the study was to discuss on the influential factors of the mode of classification of partition management in the emergency triage.
Retrospectively analyzing the effects of emergency triage of 156 cases who adopted the classification partition management mode during Oct 2014 to Oct 2015 in Xuzhou Central Hospital (Xuzhou, Jiangsu Province, China). They were divided into triage success group of 108 cases and triage failure group of 48 cases. Comparing the single factor analysis and multi-factor analysis, and selecting possible influential factors.
According to the single factor analysis, for the patients who came to the doctor in the daytime and working days, the higher education degree and compliance they had, the faster the back-show time of emergency inspect and check came back, the more comprehensive the body examination and disease history taking were done, the simpler the disease condition was, the higher triage success rate they received. Compared to the emergency observation time between two groups, the difference was not statistically significant. According to the multi-factor analysis, the emergency check and examination back-show time, the comprehensive degree of body examination and disease history taking and the complexity degree of disease could be the independent risk factors for triage success.
Simplify the examination procedure, improve the efficiency of back-show and acquire detail disease information are important methods for the improvement of triage success.

Uropathogenic Escherichia coli (UPEC) are major bacterial agent of Urinary Tract Infection (UTI). This infection is more prevalent among women because approximately half of all women will experience a UTI in their life-time and near a quarter of them will have a recurrent infection within 6–12 months. IutA protein has a major role during UPEC pathogenesis and consequently infection. Therefore, the aim of current study was assessment of IutA protein roles as a potential candidate antigen based for vaccine designing.
This survey was conducted during 2014-2015 at the University of Tehran, Iran. Chromosomal DNA extracted from E. coli 35218 and iutA gene amplified by PCR. The amplicon cloned to pVax.1 eukaryotic expression vector and recombinant vector confirmed by sequencing. The iutA gene expression in genetic cassette of pVax/iutA was evaluated in COS7 cell line by RT-PCR. Then, injected to mouse model, which divided to three groups: injected with pVax vector, PBS and pVax/iutA cassette respectively in two stages (d 1 and 14). One week after the second injection, bleeding from immunized mouse was performed and IFN-gamma was measured.
The mice immunized with pVax/iutA showed increased interferon-γ responses significantly higher than two non-immunized groups (P Cellular immune response has a main protective role against UTI. Raising this kind of immune response is important to preventing of recurrent infection. Moreover, the current DNA cassette will be valuable for more trying to prepare a new vaccine against UTI.

This study was done to determine the prevalence of publication misconduct among Iranian authors.
Data were collected through an email survey of corresponding authors of papers published in Iranian journals indexed in Scopus during 2009-2011. Using the double list experiment, these individuals were indirectly questioned about committing one of the five misconducts including duplicate publication, falsification, guest authorship, plagiarism, and fabrication over the past year.
The survey was sent to 2321 individuals; 100 emails bounced, and of the remaining, 813 (36.60%) people responded to the questions. The prevalence rates were 4.15% for fabrication, 4.90% for plagiarism, 18.10% for guest authorship, 12.65% for falsification of the study methods, and -5.40% for duplicate publication. Among respondent 56.50% trusted the method and confidentiality of the survey and 6.50% did not trust the method or confidentiality at all.
We found that the double list experiment method is simple and reliable for use in the academic community, and it can be conducted easily in an e-survey. According to our results, the most common misconducts among Iranian authors are guest authorship and falsification of the methodology. In light of the negative and maleficent impact of publication misconduct in the scientific society, we recommend raising awareness and educating authors and investigators in this regard. To determine the accuracy of the method used in this study, further studies on publication misconduct using a control group and direct questioning, as well as other indirect methods are suggested.

Aflatoxins are the most common mycotoxins that contaminate crops. They are produced by fungi such as Aspergillus flavus and Aspergillus parasiticus. Wheat (Tricitumaestivum) is one of the most important staple foods used in Iran, and the environmental conditions in the north of Iran are favorable to fungal growth. This study was designed in order to determine the aflatoxin concentration in wheat samples from silos in Golestan Province north of Iran.
Samples were collected from three silos of Golestan province. First, aflatoxins were isolated using immunoaffinity chromatography. Then the aflatoxin concentrations were determined by High performance liquid chromatography (HPLC) method and fluorescence detector.
Ten out of 34 samples (29.4% of samples) were contaminated by aflatoxins.No concentration was found above permitted aflatoxin levels in Iran (15 ng/g). In one sample (2.9%), aflatoxin B1 was seen over the permissible limits in Iran. The highest level found in samples for total aflatoxin, aflatoxin B1, aflatoxin B2, aflatoxin G1 and aflatoxin G2 were 7.08 ng/g, 6.91 ng/g, 0.29 ng/g, 1.37 ng/g and 0.23 ng/g, respectively. No correlation was found between humidity levels in wheat samples contained aflatoxin and wheat samples without aflatoxin.
Despite the total aflatoxins determined in samples were below the permissible limits in Iran, the 29% aflatoxin contamination rate can negatively affect health factors and it should not be neglected. So, it is predictable that if the storage duration of samples increases, the aflatoxin contamination levels will increase.

The coccidian protozoa Toxoplasma gondii is an obligate intracellular parasite of humans and other warm-blooded animals. Diagnosis of toxoplasmosis is of considerable medical importance for human, especially pregnant women and immunocompromised individuals. The apply of an Escherichia coli recombinant antigen(s) would be significantly useful in developing standardization of the diagnostic tests and reducing their costs. In this study, immunoreactivity of recombinant SAG3 against sera from immunized mice and human anti-T. gondii IgG positive patients was evaluated by western-blotting and enzyme immunoassay (EIA) in Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences in 2013.
Three inbreed BALB/c female mice were obtained. Two mice were injected with rSAG3 and one was remained untreated, as control. Sera from immunized mice and also pooled sera from IgG positive toxoplasmosis cases were evaluated with western-blotting. IgG antibody responses to recombinant SAG3 was measured by indirect ELISA against the negative control group.
The rSAG3 protein reacted with sera of immunized mice and sera from patients with anti-Toxoplasma IgG antibodies in western-blot analysis. The result of ELISA showed that, there was marked differences in the absorbance values between the recombinant SAG3 immunized mice and control group.
The rSAG3 showed IgG reactivity with sera from immunized mice and anti-Toxoplasma IgG patients.

Since the industrial revolution, the rate of industrialization and urbanization has increased dramatically. Regarding this issue, specific regions mostly located in developing countries have been confronted with serious problems, particularly environmental problems among which air pollution is of high importance.
Eleven parameters, including CO, SO2, PM10, PM2.5, O3, NO2, benzene, toluene, ethyl-benzene, xylene, and 1,3-butadiene, have been accounted over a period of two years (2011-2012) from five monitoring stations located at Tehran, Iran, were assessed by using fuzzy inference system and fuzzy c-mean clustering.
These tools showed that the quality of criteria pollutants between the year 2011 and 2012 did not as much effect the public health as the other pollutants did.
Using the air EPA AQI, the quality of air, and also the managerial plans required to improve the quality can be misled.

Metabolic syndrome (MS) is defined as a pattern of metabolic disorders including central obesity, insulin resistance or hyperglycemia, high blood pressure, and dyslipidemia. Many studies show a clear relationship between diet and components of MS. The aim of the current study was to identify barriers to adherence to dietary recommendations among Iranian MS patients.
The theory of reasoned action (TRA) served as the framework for this qualitative study. Data collection was conducted through six semi-structured focus group discussions, from Apr to Jun 2013. Subjects included 36 married men and women with different levels of education between the ages of 20-50 with MS diagnosed based on IDF’s (International Diabetes federation) criteria. All focus group discussions were audio recorded and transcribed. The thematic content analysis method was used to analyze the study data.
This study identified the most important barriers to adherence to dietary recommendations. MS patients have problems in their attitude toward MS components and their relationship to nutrition. They also had wrong attitudes toward fats and oils, salt, dairy products, cereals, and sugary drinks and sweets. Subjective norms that affects patient eating identifies too.
We identified barriers to adherence to dietary recommendations in MS patients that could be used to prevent MS consequences and provide patients with nutrition education.

Kaposi’s sarcoma is a vascular malignancy, which frequently occurs among immunocompromised individuals such as transplant recipients and patients with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) is considered the etiological agent of all forms of Kaposi’s sarcoma. Though some seroepidemiological studies conducted on the prevalence of HHV-8 in Iran, there are insufficient data on the prevalence of HHV-8 viremia in HIV infected patients. We therefore, aimed to determine the prevalence of HHV-8 viremia in general population and HIV infected patients without Kaposi’s sarcoma in Tehran, Iran.
We conducted a cross sectional survey on 99 patients with HIV infection referred to Iranian Research Center for HIV/AIDS and 40 healthy controls in Tehran, Iran from January to April 2014. The presence of HHV-8 DNA was detected in buffy coat samples of enrolled subjects using nested PCR assay.
A total of 99 HIV infected patients with mean age of 37.9±10 yr and 40 healthy controls with mean age of 39±11.5 yr were enrolled in the study. The mean CD4 count was 410.3± 211.4 cells/mm3. HHV-8 DNA was not detected in both healthy control and HIV patient groups.
This survey showed low rate of HHV-8 DNA in healthy controls and HIV patients. Considering our findings HHV-8 infection does not seem to be widespread in our population. Further studies focusing on different regions of Iran appear to be required to have a more accurate estimation.

Author reports a case of 67- years- old men referred to Donga University Hospital silicosis who had worked in tunnel drilling where presumably had been exposed to high concentration free silica for almost 20 yr. This report is considered the first in Korea to the best of our knowledge since no cases on silicosis could be reported in this occupation in reviewing various literature sources in Korea. The physician's first impression was lung cancer since the CT findings. However, it turned out to be pneumonia and silicosis. It was eventually diagnosed with silicosis and pneumonia, and tuberculosis. The patient is suffering from various clinical courses for long time.

Leishmaniasis is an endemic parasitic disease in Iran. This paper reports the case of a 5-yr-old boy who presented with multiple isolated cervical lymphadenopathy for several months with no history of fever and no signs or symptoms. In an excisional lymph node biopsy, Leishmania parasites were histologically detected. Thus, leishmaniasis should be included in the differential diagnosis of isolated lymphadenitis in immunocompetent patients, even if the K39 and IFA for kala-azar are reported as negative.