Iranian Journal of Public Health
Volume:46 Issue: 2, Feb 2017

Mixed health care systems to work simultaneously on both public and private facilities, is common today. This phenomenon referred to as dual practice (DP), has potential implications for access, quality, cost and equity of health services. This paper aimed to review systematically studies that assess the implications of DP among health workers.
MEDLINE, EMBASE, and The Cochrane library were searched for obtaining published literature between Feb 1990 and May 2014. Google and Google Scholars, organizational websites, and reference lists of relevant papers searched to get grey literature. Only studies concentrated on consequences and impacts of DP among health professionals and conducted using «randomized controlled trials», «non-randomized controlled trials», «controlled before and after studies», or «interrupted time series» were eligible for inclusion.
From 3242 records, we focused on 19 studies, which aimed to assess effects and impacts of dual practice. After that, the current understanding of DP positive and negative implications was categorized and discussed based on two perspectives.
There has been a propensity to over-reliance on theoretical methods in predicting the implications of this phenomenon. Almost all of the mentioned implications are based on theoretical predictions undermined in the broader literature. Furthermore, assessing the current literature showed positive and negative impacts of DP on different parts of the health system and various dimensions of service delivery. These implications are contexted specific and may vary from system to system.

Today, despite the many advances in early detection of diseases, cancer patients have a poor prognosis and the survival rates in them are low. Recently, microarray technologies have been used for gathering thousands data about the gene expression level of cancer cells. These types of data are the main indicators in survival prediction of cancer. This study highlights the improvement of survival prediction based on gene expression data by using machine learning techniques in cancer patients.
This review article was conducted by searching articles between 2000 to 2016 in scientific databases and eJournals. We used keywords such as machine learning, gene expression data, survival and cancer.
Studies have shown the high accuracy and effectiveness of gene expression data in comparison with clinical data in survival prediction. Because of bewildering and high volume of such data, studies have highlighted the importance of machine learning algorithms such as Artificial Neural Networks (ANN) to find out the distinctive signatures of gene expression in cancer patients. These algorithms improve the efficiency of probing and analyzing gene expression in cancer profiles for survival prediction of cancer.
By attention to the capabilities of machine learning techniques in proteomics and genomics applications, developing clinical decision support systems based on these methods for analyzing gene expression data can prevent potential errors in survival estimation, provide appropriate and individualized treatments to patients and improve the prognosis of cancers.

In the majority of countries, active direct euthanasia is a forbidden way of the deprivation of the patients’ life, while its passive form is commonly accepted. This distinction between active and passive euthanasia has no justification, viewed through the prism of morality and ethics. Therefore, we focused on attention on the moral and ethical implications of the aforementioned medical procedures.
Data were obtained from the Clinical Hospital Center in Kragujevac, collected during the first half of the 2015. The research included 88 physicians: 57 male physicians (representing 77% of the sample) and 31 female physicians (23% of the sample). Due to the nature, subject and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis.
A slight majority of the physicians (56, 8%) believe that active euthanasia is ethically unacceptable, while 43, 2% is for another solution (35, 2% took a viewpoint that it is completely ethically acceptable, while the remaining 8% considered it ethically acceptable in certain cases). From the other side, 56, 8% of respondents answered negatively on the ethical acceptability of the physician-assisted suicide, while 33% of them opted for a completely ethic viewpoint of this procedure. Out of the remaining 10, 2% opted for the ethical acceptability in certain cases.
Physicians in Serbia are divided on this issue, but a group that considers active euthanasia and physicianassisted suicide as ethically unacceptable is a bit more numerous.

We aimed to research the value of extended nursing for cerebral stroke patients within a suitable recovery empty period.
Seventy-two cerebral stroke patients were randomized to a control group or treatment group at the recovery period at Xuzhou Recovery Hospital, China in 2016. A recovery guidance exercise was applied to the control group for a set time, while a recovery guidance exercise combined with functional training were applied to the treatment group within the recovery empty period (at 6:00-7:00 a.m. and 7:00-8:00 p.m.). The recovery effect was compared after three months.
Following the three-month intervention, both the control and treatment groups’ scores for the Fugl-Meyer balance evaluation and the Barthel indicator were increased. There was a statistically significant increase in the treatment group (P Extended nursing within a suitable recovery empty period can improve the patient’s prognosis concerning physical activity and mood.

We studied the possible advantages of feed-forward control nursing model in the treatment of placenta previa.
We enrolled 60 pregnant women who were receiving treatment for expectant placenta previa between January 2010 and January 2016 and randomly divided them into the control group and the observation group with 30 cases in each group. In the control group, we offered specialist nursing which included examination, body positioning, vaginal bleeding record, psychological consultation and medication observation. Feed-forward control nursing was applied in the observation group which included establishing feed-forward control nursing improvement team, conducting quality control of nursing defects and putting forward ideas for improvements and verifying improvement outcomes.
The observation group got significantly higher success rate and lower complication rate compared with control group. Gestational age and fetal weights improved apparently in the observation group. When we compared the amount of postpartum bleeding and pregnancy bleeding in two groups we did not find any statistically significant difference (P>0.05). Patients’ satisfaction rate toward our nursing services was much higher in the observation group and the rate of nursing errors was significantly lower in this group. All differences were statistically significant (P Application of feed-forward control nursing model in the expectant treatment of placenta previa can improve treatment success rate, decrease complications and upgrade nursing quality.

Nursing project management is widely used in different aspects of the society. However, whether the nursing project management can control the infections in the operation room (OR) is rarely reported. We evaluated the outcomes of surgical patients after implementing a nursing project management program to provide new scientific ways to manage the OR infections.
Overall, 382 patients, who underwent surgical treatment in Qilu Hospital of Shandong University, Shandong, China from May 2015 to January 2016, were enrolled as observation group. Besides, 347 cases were selected as control group. Patients in the observation group were treated with the nursing project management plan, while patients in the control group were treated with the routine operation-room nursing measures. The infection control rates in the OR, and the patient satisfaction with the nursing team postoperatively were both compared between the two groups of patients.
The OR air, the surgical and personnel’s hands surfaces were sampled for colony forming units, and all were found to be significantly of better quality (indicated by less colony forming units) in the observation group (P It is worth popularizing and applying a good nursing project management plan for surgical patients in hospitals.

Unintended pregnancy (UPr) with high rates of subsequent abortions remains an important problem around the world. Our aim was to determine the prevalence of UPrs in Georgia, their outcomes, and use of modern and traditional methods of contraception in women who terminated their UPrs by induced abortion (IAb) and identify potentially associated factors.
A Cross-sectional study, using stratified multistage sampling design, was conducted from Oct 2010 through Feb 2011. By secondary data analysis in selected group of women (n=2692) association of predictor variables: area of residence, age, level of education, economic status of woman, ethnicity, and religion with independent variables: UPr, termination of UPr by IAb and prior usage of modern and traditional methods of contraception were examined. Descriptive statistics methods and multivariable logistic regression analysis were used.
In Georgia, from the 2692 interviewed women who had a pregnancy, 1068(39.7%) had a UPr in 2005-2010; the majority (n=913; 85.5%) of these UPr ended in an IAb. 31.4% (n=287) of those women used any method of contraception, with the majority (n=213; 74.2%) using a traditional method. With UPr were associated area of residence, level of education and age (P>0.05); with termination of UPr by IAb-ethnic origin (P Low rates of modern contraception use prior UPrs, terminated by IAb demands attention by healthcare providers. Factors associated with these outcomes shall be used to identify target group of women.

To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the National Vision Screening Program for 7 yr old children in Iran.
In this cross-sectional study, eight cities in Iran were selected through multistage cluster sampling. Selected cities were Sari, Birjand, Ardabil, Mashhad, Bandar Abbas, Dezful, Yazd, and Arak, in Iran in 2013. Totally, 4614 schoolchildren were selected, 4106 of which participated in the study. An optometrist at the school site conducted all vision tests. Results were compared against those recorded on each child’s health card. Those with an uncorrected visual acuity worse than 20/25 in at least one eye screened positive for a vision problem.
8.49% [95% confidence interval, 7.65 to 9.39] of the examinees had a vision problem. The sensitivity rate of the school entry screening was 38.15% (95% CI, 33.01 to 43.50) and the specificity rate was 93.11 (95%CI 92.25 to 93.90). The positive and negative predictive values were 33.93 (29.24 to 38.88) and 94.19 (93.39 to 94.93), respectively. Sensitivity and specificity rates did not significantly differ between boys and girls. For the uncorrected visual acuity tested by public health care workers compared to optometrists, the area under the ROC surface was 0.741 (P The validity of the school entry vision screening by health workers is low. To reduce false negative rates, some supplementary examinations such as refraction and near visual acuity measurements as well as further training of screeners should be considered.

The expanse of dendritic cells (DC) differentiation plays an important role in determining immune response. DC-based immunosuppressive drugs have notable side effects in increasing the risk of infectious diseases and cancers. G2013, as a novel anti-inflammatory and immunosuppressive agent, has been tested in experimental model of multiple sclerosis. The aim of this study was to conduct the safety property of G2013 on dendritic cells biology.
The effect of G2013 on differentiation, maturation, and function of dendritic cells was examined at Tehran University in 2014. To investigate how G2013 affects human dendritic cells (DC) in a defined inflammatory environment, human peripheral blood mononuclear cells (PBMC) were isolated from healthy blood. Monocytes were then purified using anti-CD14 microbeads. Monocytes were treated with G2013 in two different doses (6 and 12 μg/well) along with adding granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 for inducing monocytes to immature DC and adding lipopolysaccharide for running DC maturation. Differentiation, maturation, and function of dendritic cells were examined with flow cytometry and ELISA.
G2013 therapy had no significant effect on CD83, CD86 and DR expression, as well as IL-10 and IL-12 cytokine levels and it, has no remarkable side on differentiation, maturation and function of dendritic cells in immature DC and mature DC process in vitro.
G2013 is a safe agent with no adverse effect on differentiation, maturation, and function of dendritic cells. It may be recommended as a novel immunosuppressive agent with no or little side effect in increasing the risk of infectious diseases and cancers.

Expansion of GAA trinucleotide repeats is the molecular basis of Friedreich’s ataxia (FRDA). Precise detection of the GAA expansion repeat in frataxin gene has always been a challenge. Different molecular methods have been suggested for detection of GAA expansion, including; short-PCR, long-PCR, Triplet repeat primed-PCR (TP-PCR) and southern blotting. The aim of study was to evaluate two PCR-based methods, TP-PCR and long-PCR, and to explore the use of TP-PCR accompanying with long-PCR for accurate genotyping of FRDA patients.
Blood samples were collected from six Iranian patients suspected to FRDA, who referred to the Department of Medical Genetics at Tehran University of Medical Sciences during the year 2014. For one of these patients’ four asymptomatic members of the family were also recruited for the analysis. DNA extraction was performed by two different methods. TP-PCR and long-PCR were carried out in all samples. The type of this study is assessment / investigation of methods.
Using a combination of the above methods, the genotypes of all samples were confirmed as five homozygous mutants (expanded GAA repeats), two heterozygous and three homozygous normal (normal repeat size). The results obtained by TP-PCR are consistent with long-PCR results.
The presence or absence of expanded alleles can be identified correctly by TP-PCR. Performing longPCR and Fluorescent-long-PCR enables accurate genotyping in all samples. This approach is highly reliable. It could be successfully used for detection of GAA expansion repeats.

Sodium arsenite (NaAsO2) has potent cytotoxic activity in human cancer cells. Oxidative stress has been suggested as a mechanism for arsenic-induced carcinogenesis. The purpose of the present study was to evaluate the alteration of mRNA levels of catalase (CAT) and superoxide dismutase 2 (SOD2) in MCF-7 and Jurkat cells after exposure to NaAsO2.
Methylthiazol tetrazolium (MTT) viability assay was performed to evaluate cytotoxicity of NaAsO2 in MCF-7 and Jurkat cells. For evaluating the expression levels of the CAT and SOD2, we used two concentrations of NaAsO2 (5 and 15 µM), lower than the concentrations at which 50% of cell viability were lost. The cells were treated with co-treatment of NaAsO2 (15 µM) and N-acetyl-cysteine (NAC; 5 µM) in the media for 24 h. The control cells were maintained in sodium arsenite free growth medium. The experiments were done triplicate. Using quantitative real-time PCR, the expression levels of CAT and SOD2 were quantified. One sample student’s t test was performed for comparisons of mRNA levels between treatment groups and their corresponding untreated control cells.
CAT mRNA level decreased significantly in both cell lines following exposure to NaAsO2 (P After cells exposure to NaAsO2, CAT mRNA level decreased in both examined cell lines but the alterations of SOD2 mRNA level is cell specific. The NAC modulated the NaAsO2 associated alterations of CAT and SOD2 mRNA levels, therefore, the NaAsO2 might act through inducing reactive oxygen species.

Although Candida albicans remains the most common fungal isolate from clinical specimens, many studies have detected a shift towards non-albicans Candida species. Despite worrying clinical pictures associated with latter species, there is little information regarding its susceptibility patterns against currently available antifungal agents, with only a small number of strains having been studied.
We evaluated the in vitro antifungal susceptibilities of clinical isolates of C. orthopsilosis already identified by two-steps PCR-RFLP and reconfirmed by sequence analysis of entire ITS rDNA region, to six antifungal drugs.
The resulting MIC50 and MIC90 for all strains (n=18) were in increasing order, as follows: posaconazole (0.016 & 0.063 μg/ml); itraconazole (0.031 & 0.125 μg/ml); amphotericin B (0.5 & 1 μg/ml); fluconazole (0.25 & 0.5 μg/ml) and caspofungin (4 & 8 μg/ml). A uniform pattern of the MIC ranges was seen for amphotericin B, fluconazole, itraconazole, and posaconazole, while a widest range and the highest MICs were observed for caspofungin.
Although we emphasis on the careful species designation of the clinical isolates of Candida, the antifungal susceptibility patterns of these clinically important organisms may have an application in clinical and epidemiological setting and deserve the implementation of local surveillance programs to monitor.

Despite the importance of the postnatal consultation, in Morocco, only 22% of women attended these consultations. The aim of this study was to identify associated factors with these consultations and offer suggestions to improve their use.
This study was conducted in 2014 in Marrakech. A sample of women in reproductive age (15-49 yr) giving birth during 2013 year was enrolled. They were examined in the public health centers for postnatal consultation or for the BCG. A descriptive and analytic cross-sectional survey was conducted. All participants (n=1029) provided consent before participating in the survey. A questionnaire makes it possible to collect information about socio-demographic, knowledge and perception of women regarding these consultations.
The proportion of women who attended a postnatal consultation was 30.1%. Lack of information (87%), lack of complications (68.6%); health professional poor reception (42%) and financial difficulties (3.3%) were the main reasons that hinder these consultations. In addition, women of rural origin, low education level, and low socioeconomic status are important determinants associated with non-use of postnatal consultation.
This study confirmed the low rate of these consultations. Various determinants explain this fact. The fight against illiteracy, improving household living standards, sensitization of women on the importance of postpartum care, awareness and capacity building of health professionals in the postnatal consultation and communication, and the development of a system of home visits for non-users of postnatal care allow improving the postnatal consultation rate.

Informing plays a prominent role in attracting medical tourists. The enjoyment of proper medical information systems is one of the most important tools for the attraction of medical tourists. Iran''s ability in designing and implementing information networks has remained largely unknown. The current study aimed to explore information needs for designing a medical tourism website.
This qualitative study was conducted in 2015 for designing Hospital Medical-Tourism Website (HMTW). A purposive sampling method was used and data were gathered using a semi-structured questionnaire. Totally, 12 faculty members and experts in the field of medical tourism were interviewed. Data were analyzed using the MAXQDA10 software.
Totally 41 sub-themes and 10 themes were identified. The themes included the introduction of hospital, general guide for patients, tourism information, information related to physicians in hospital, costs, treatment follow-up, online hospital appointment scheduling in website, statistics and news of hospital medical tourism, photo gallery and contacts. Among the themes, the participants highly emphasized four themes including costs (100%), tourism information (91.6%), information related to physicians in hospital, (83.3%) and treatment follow-up (83.3%).
This profitable industry can be developed through considering information requirements for hospital medical tourism website.

Pachydermodactyly is a rare and benign disease that may be idiopathic, genetic, acquired as a response to repetitive trauma, or associated with several other acquired conditions often pushing the health caregiver to do a bunch of costly lab tests and diagnostic workups to rule out other entities. All health care givers must be aware about this disease for reassure the patients and cut unnecessary costs. Moreover, there seems to be an issue of association with certain occupations. A good example might be computer keyboards causing special damages to certain organs like eyes and musculoskeletal system. We have observed deleterious effects of excess work with computer keyboards on fingers in the form of Pachydermodactyly in our case. A 27-yr-old man presented with wider hand span and longer fingers to Dermatology Clinic of Rasoul-E-Akram Hospital in June 2015, especially the ring finger in our case, considered a big symptom who depressed due to their fingers appearance as a rare disease. We gave him an emollient to make his hand smoother. The patient improved both clinically and psychologically on a simple emollient. This disease with its deleterious psychological effects and a simple way of management should be appreciated more by the health care system.

Cutaneous leishmaniasis (CL) is the most common parasitic disease transmitted by vectors in Iran. CL is endemic in many urban and rural parts of Iran and usually caused by two species of Leishmania as L. major and L. tropica transmitted to humans from parasite reservoirs by the bite of female sandflies. We report a case of ocular leishmaniasis with eyelid involvement presentation. The patient was a 70-yr-old housewife woman referred to Health Care Center in city of Kashan, central Iran in 2012. The disease was diagnosed by direct smear, culture, and PCR from the lesion. PCR was positive for L. major. Her lesion was treated with systemic meglumine antimonate (Glucantime) (20 mg/kg/day) for 20 days.