Iranian Journal of Public Health
Volume:46 Issue: 7, Jul 2017

Dietary patterns analysis may provide insights into the influence of overall diet on overweight/obesity. In the past two decades, the relation between dietary patterns and overweight/obesity has been a research focus and a number of results were reported in the research field.
An electronic literature search was conducted in PubMed and Web of Science, to identify human studies published by Mar 2015 and written in English. The following keywords or phrases were involved: dietary patterns, dietary pattern, factor analysis, principal component analysis, diet, obesity, adiposity, overweight and BMI. All the studies were retrieved and prudent/healthy (n=17) and western/unhealthy (n=18) dietary patterns were identified.
When compared with the lowest categories of a prudent/healthy dietary pattern, a reduced overweight/obesity risk was shown in the highest (OR=0.64; 95% CI: 0.52, 0.78; P A prudent/healthy dietary pattern and limit intake of western/unhealthy dietary pattern should be followed, which helps to keep a healthy body mass.

In Iranian traditional medicine (ITM) stomach is the important organ in the body. Its disorders can affect other organs such as liver, heart and also can cause depression. Stomach distemperaments can cause some disorders. The purpose of this study was to provide a diagnostic method of stomach distemperament for clinical practice.
In this study authoritative ITM books such as Canon of Avicenna, Zakhirah-E-Kharazm Shahi by Hakim Esmail Jorjani, Kamel al -Sinaah al- Tibbiyah by Ali ibn al-'Abbas al-Majusi were assessed and symptoms and signs of stomach distemperament were collected.
Stomach has some normal temperament. The imbalance in temperament and humor can cause distemperments. There are 12 types of stomach distemperament and based on symptoms and signs a primary protocol is designed for diagnosis of stomach distemperament.
There is no available guideline for gastric distemperamet diagnosis protocol. As a result, the presented protocol should be considered for use in clinical practice.

Adolescence is an important period since the establishment of dietary pattern can also affect the adulthood. This study aimed to estimate the overall prevalence of skipping breakfast among Iranian students.
The international and national databases, including Medline, Scopus, Science Direct, Embase, Web of sciences, Google Scholar, MagIran, and SID were searched 1945-2016 as per case. All studies addressing the prevalence of skipping breakfast among Iranian students were extracted.
Out of 322 records, 24 articles remained for meta-analysis. The total pooled prevalence of skipping the breakfast was 0.216 (95% CI: 0.213-0.22), the girls had a higher percentage for skipping breakfast compared with boys (26% vs. 18%).
Skipping breakfast is more prevalent in girls. Interventions are required to promote breakfast consumption in the targeted Iranian students, especially the girls.

We aimed to assess what is already known about sexuality education (SE)-related policy or practical issues using review methods to search and critically appraise the existing SE approaches targeting children under age 12 yr.
We completed the data collection by an extensive search of the English and Persian published and unpublished literature, evidence from experts in the topic, and by searching citations. The MeSH-terms were sexuality and training, sexuality education and programs or approaches, sexuality and children, sexuality education and parents, sex or sexuality education, sex education and parents or caregivers. A systematic search of medical and health-related databases, the Cochrane Library and Web of Science was undertaken for the years 1970–2015 together with citation searching, reference list checking and recommendations from stakeholders to identify evidence for SE.
According to the inclusion criteria, 20 documents were identified. They were synthesized into three main categories as sexuality-related knowledge, attitudes, and parents’ skills to manage children's sexual behavior and related education. Employed approaches to children's sexuality were reported to be effective in developing healthy sexual behavior in children. Education was identified as the primary focus of the included packages and guidelines. Parents were recognized as first line educators in SE. However, interventions aiming to improve parent's skills in SE for children were limited. In other words, developing skills in parents, and their competency in children’s sexual behavior management were not specified in the existing programs.
Parents’ skill-building must be the focus of SE programs in order to address children' sexual development goals.

To investigate the interventional efficacy and clinical significance of graded psychological nursing care for patients who have undergone cardiothoracic surgery by providing graded psychological nursing care for these patients according to the results of their psychological evaluation.
In this interventional study, 110 patients who had undergone cardiothoracic surgery between 2014 and 2015 in the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China, were enrolled. We divided them into two groups of 55 patients each, namely, a control group and a treatment group. For patients in the control group, we applied regular psychological nursing care; those in the treatment group were further divided into three different psychological grades after being assessed using Symptom Checklist 90 (SCL-90) and the Pittsburgh Sleep Quality Index (PSQI); patients at each grade were treated by graded psychological nursing care in addition to regular psychological nursing care.
Significant decreases, with statistically significant differences (P Applying graded psychological nursing care in post-operation cardiothoracic patients improved nursing care efficiency and alleviated patients’ negative feelings. Therefore, this type of nursing care should be further promoted and utilized in clinical practice for effective rehabilitation of patients.

In patients with systemic sclerosis, NT-proBNP is a useful diagnostic marker for pulmonary hypertension and ventricular dysfunction, with important prognostic significance. The aim of this study was to assess the relationship between the NT-proBNP levels and the presence and severity of ventricular arrhythmias in patients with scleroderma.
Forty consecutive patients with a diagnostic of systemic sclerosis according to the EULAR criteria admitted at the Rheumatology Clinic of Cluj-Napoca, Romania, from Jan 2014 to Apr 2014 were enrolled. Patients underwent a 12-lead ECG and a 24-hour Holter ECG monitoring for ventricular arrhythmias evaluation. Blood sample testing (including NT-proBNP level measurements), echocardiography, spirometry, chest X-ray and, when considered appropriate, high-resolution chest CT were performed.
Sixty percent of patients (n=24) had abnormal NT-proBNP serum levels (>125 pg/ml) and 10 patients had >100 PVC /24 h. There was a statistically significant correlation between the NT-proBNP levels and the total number of premature ventricular contractions (PVC) (r=0.445, P=0.006), total number of isolated PVC (r=0,493, P=0.002), total number of ventricular couplets (r=0.379, P=0.021) and the number of PVC morphologies (r=0.501, P=0.002). The presence of an NT-proBNP serum level >287 pg/ml had a sensitivity of 55% and a specificity of 93% in predicting the presence of complex ventricular arrhythmias on 24-hour Holter ECG monitoring.
NT-proBNP levels could become a useful ventricular arrhythmia marker for assessing the arrhythmic risk in patients with systemic sclerosis.

Issues of mass screening for prostate cancer rather controversial since 2013 in 11 regions of Kazakhstan introduced a population-based screening for prostate cancer, so we need to evaluate its results.
In different regions of Kazakhstan during 2013-2015, a total of 321548 prostate-specific antigens (PSA) were determined in men aged 50-66 yr, under the Prostate Health Index (PHI) and transrectal ultrasonography (TRUS) guided prostate biopsy with histological examination.
PSA level up to 4 ng/ml in 310870 (96.7%) men, PSA level between 4 and 10 ng/ml in 8 624 (2.7%) men, PSA level above 10 ng/ml in 2054 (0.6%) men. PHI was identified in 5716 (1.8%) men, of which 2867 cases were with PHI ≥ 25 (35.9%). Totally, 3680 biopsies (1.1%) of the prostate were performed. As part of the screening, 2870 cases (0.88%) of benign prostatic hyperplasia and prostatic intraepithelial neoplasia were found. Of 742 cases of prostate cancer (0.23%) were revealed. The stages of prostate cancer screening were as follows: stage I in 172 men (23.2%), stage II in 444 men (59.8%), stage III in 98 men (13.2%) and stage IV in 28 (3.8%) men. The indicators of prostate cancer early diagnosis in the I-II stages were bigger in the “screening regions” than in the “traditional diagnostics” regions: RR 1.35 95% CI (1.24 – 1.46), OR 1.84 95% CI (1.58–2.15). Prostate cancer was detected at I-II stages in the "screening" regions only by screening vs traditional diagnostics, with RR 1.64 95% CI (1.56 – 1.73), OR 4.77 95% CI (3.87–5.87).
Implementation of screening can improve the diagnosis of prostate cancer in the early stages.

We analyzed the effect of comprehensive care on the patients who received minimally invasive percutaneous nephrolithotomy (MPCNL).
Patients hospitalized from 2013-2014 in Zhumadian Central Hospital (n=124) were enrolled and divided into two groups on random basis. The control group was treated with routine nursing model while the observation group was given comprehensive care additionally. The surgery time, degree of comfort, complications and successful cases, hospitalization time, sleep quality, nursing satisfaction and changes of systolic pressure, pulse and respiratory at different time were observed and analyzed.
The surgery time of the control group was significantly longer than that of observation group (P The comprehensive care on the patients undergoing MPCNL was effective, and it can dramatically shorten surgery time, improve the success rate, improve the sleep quality of patients, keep life sign stable and minimize the complications.

This study aimed to determine the efficient factors that potentially lead to the barriers of developing medical tourism in South Korea.
To explore the current medical tourism trend, a qualitative procedure was adopted. Besides analyzing the current situation of medical tourism in Korea through a systematic searching on the available information and publications, in-depth-interviews were conducted to collect data from relevant authorities and representatives of medical tourism associations in this country.
The result revealed, although government have supported this industry, that lack of specialty and expertise among the health care practitioners in the scope of cross cultural communication, seems to be the core barrier to development of medical tourism in Korea. Demands for convenient promotional activities, policy making and action regulation are the other effective factors.
Several strategies are required in order to address and combat these barriers, such as governmental support for cultural training, cooperative efforts to encourage health practitioners involved to enhance their cultural and linguistic competence in international scale.

This study aimed to investigate food experts’ views on important nutrition and food systems knowledge issues for education purposes at schools in Iran.
In 2012, semi-structured, face-to-face or telephone interviews were conducted with twenty-eight acknowledged Iranian experts in food and nutrition fields. Participants were selected from four major provinces in Iran (Tehran, Isfahan, Fars and Gilan). Open-ended interview questions were used to identify nutrition and food systems knowledge issues, which experts considered as important to be included in school education programs. Qualitative interviews were analyzed thematically using NVivo.
A framework of knowledge that would assist Iranian students and school-leavers to make informed decisions in food-related areas was developed, comprising five major clusters and several sub-clusters. Major knowledge clusters included nutrition basics; food production; every day food-related practices; prevalent nutritional health problems in Iran and improvement of students’ ethical attitudes in the food domain.
These findings provide a guide to curriculum developers and policy makers to assess current education curricula in order to optimize students’ knowledge of nutrition and food systems.

The hematologic response to hydroxyurea (HU) is varied among β-thalassemia (BT) patients. The BCL11A and SOX6 genes are involved in response to HU. This study aimed to investigate the in-vitro responsiveness of HU among BT major patients homozygote for IVSII-1G>A mutation and XmnI single nucleotide polymorphism (SNP) in order to find whether the in-vitro Hb concentration is a predictor of clinical (HU) responsiveness.
In this case-control study, twenty BT patients homozygote for IVSII-1G>A mutation and XmnI SNP from Thalassemia Research Center, Sari, Iran in 2015 were selected and categorized into two groups of 10 Responder (R) and 10 Non-Responder (NR) according to their clinical HU response. Ten healthy individuals as a control group were also selected. Hematopoietic erythroid progenitors were expanded from peripheral blood. Hb concentration was measured using photometry method. The flow cytometry and real-time PCR methods were applied for the analysis of cell surface markers (CD71 and CD235a) and gene expression (BCL11A and SOX6), respectively.
R and NR groups produced higher amount of Basic Hb than C group in cell culture medium at day 14 (P Since different factors including wide networks of intracellular factors and individual differences between patients can affect response to HU in patients, the increasing Hemoglobin on culture medium alone cannot predict clinical responsiveness to that drug.

Adolescent and young adults are at increased risk of psychiatric distress and serious disability. We estimated the prevalence and associated risk factors of psychiatric distress among the college students of Hamadan University of Medical Sciences, Iran.
We performed this cross-sectional study, from Jan to May 2016 at Hamadan University of Medical Sciences, Hamadan, Iran. Students filled out voluntarily an anonymous self-administered questionnaire, including demographic characteristics, personal information, behavioral risk factors, and a validated Persian version of the GHQ-28 questionnaire, including somatic symptoms (items 1-7), anxiety/insomnia (items 8-14), social dysfunctions (items 15-21), and severe depression (items 22-28).
Of 1259 participants, 518 (41.1%) had psychiatric distress, 166 (13.2%) had heterosexual intercourse, 100 (8.0%) had homosexual intercourse, 204 (16.2%) were smokers (31.6% in males and 6.3% in females), 124 (9.9%) reported a history of using opium/psychedelic substances, 204 (16.2%) reported suicide thought, and 103 (8.2%) had attempted suicide at least once in the past. After adjusting odds ratio (95% CI) for age and sex, psychiatric distress were significantly associated with emotional breakdown 2.67 (2.09, 3.40), heterosexual intercourse 2.56 (1.82, 3.62), homosexual intercourse 2.42 (1.57, 3.71), smoking 3.19 (2.29, 4.45), substance abuse 5.03 (3.26, 7.76), suicide thought 7.81 (5.42, 11.27), suicide attempt 5.64 (3.49, 9.12), uninterested in the discipline 2.29 (1.70, 3.07), and non-optimistic about future 2.16 (1.63, 2.86).
A majority of college students had psychiatric distress and a substantial number of them reported one or more high-risk behaviors that if neglected, may severely impair the student's function and influence their subsequent development and productive lives.

Chronic pain is associated with increased stress in families and has its own impact on the relationship between members of the family. Among couples, if one of them suffers from chronic pain, this may influence marital satisfaction in both of them and given the importance of marital satisfaction in the prediction of successful treatment outcome, it is important to investigate pain and personality-related factors contributing to inter-individuals variation in marital satisfaction.
Participants in this study were recruited from Atieh Hospital and Rasa Pain Clinic, Tehran, Iran in the year 2013. Chronic pain patients and their spouses were asked to complete a battery of questionnaires including measures on pain cognition and marital satisfaction. Using correlation and regression analysis factors with the highest level of contribution to marital satisfaction were investigated.
Spouses’ level of rumination about patients’ pain has been found to be positively correlated with marital satisfaction in patients. In addition, patients’ depression has been found to be the best predictor of level of marital satisfaction in patients. In addition, patients’ level of depression, disability and perceived helplessness has been found to be the best predictors of marital satisfaction in their spouses.
To improve marital satisfaction among chronic pain patients, their support-seeking needs should be satisfied through involvement of their spouses in the process of treatment. To improve marital satisfaction among patients’ spouses, we should help patients regain their ability, improve their mood, and make patients believe that they have access to the support of their caregivers.

High rate of unintended pregnancies in Iran is one of problems in family planning. The main goal of this study was to determine the rate of unintended pregnancies and to examine factors among married women in Shiraz City, Iran. It also discusses the possible effects of new population policies on the rate of unintended pregnancy.
In this quantitative and survey study, data were collected by researcher-made questionnaire with interviewer from 400 pregnant women in Shiraz City referred to public and private health centers for prenatal care in 2013. Data were analyzed by SPSS both descriptively and analytically.
Overall, 17% of total pregnancies were unintended. The highest rate occurred among couples whose level of education was under diploma. In addition, women above 39 yr old experienced a higher rate of unintended pregnancy. The most popular methods were pills, withdrawal, and condom. The highest rate of unintended pregnancy was related to withdrawal. Knowledge about modern contraceptives particularly emergency contraceptives was low. Age, residence place, use of traditional contraception methods, knowledge about contraceptives, fear of side effects and couple agreement on contraception method were the main predictors of unintended pregnancy.
There is still unmet need in family planning. The main predictors of unintended pregnancies are high prevalence of traditional contraception methods and insufficient knowledge about modern contraception methods. Policymakers should pay more attention to these issues. Furthermore, although Iranian policy makers are worried about low fertility, they need to be aware that new population policy through restriction of access to family planning services is effective, but also may exacerbate the problem by leading to a higher chance of unintended pregnancy.

Treatment of major depression is crucial to decrease the burden of disease. Hence, in this study, the efficacy of Botox was compared with placebo for treatment of patients with major depression.
In this randomized clinical trial, 28 consecutive patients with major depression were enrolled. The patients were randomly assigned to receive either Botox or placebo and the scores of Beck Depression Inventory were determined and compared at baseline and after two and six weeks in the groups and between the groups. In addition, the drug adverse effects were compared between groups. This study had been registered in TCTR with TCTR20170409001 code.
There was a statistically significant difference two group for 6th week Beck Score (P=0.004), but at baseline and after two weeks, there was no significant difference (P>0.05). None of the patients experienced side effects.
Finally, Botox is effective for treatment of patients with major depression and it has a high safety.

Priapism is well-defined by persistent, painful penile erection which happens without sexual stimulation. Currently, the hirudotherapy is practiced to treat venous congestion and subsequent compartment syndrome. Here we will report a case of a male with priapism treated by leeches. The case was a 26 yr old young single male referred to the Razi Hospital Emergency Department, Guilan University of Medical Sciences, Rasht, Iran due to long-time spontaneous erections. The patient had no history of mental disorders, trauma or sickle cell anemia. we insert two leeches in each side of penile shaft for two hours, after a one hour break we insert do in same manner for another cycle. At follow-up two days later he had significantly decreased pain, though still had cavernosal swelling and tenderness to palpation. The patient was subsequently discharged after three days of admission. The pain and perineal swelling completely resolved over the course of one month. In this case, chronology indicates that leech therapy was possibly treatment option for priapism. This procedure seems to be non-invasive treatment strategy worth to discussing in such patients.