kamran yazdani

Alzheimer’s is a chronic disease that causes cognitive disabilities, thinking, personality changes and disruptions in daily activities. Due to these disorders, patients need long-term care. Most care for Alzheimer’s patients is done at home by family members, which makes home caregivers mentally, physically, emotionally, socially and financially vulnerable. Health personnel have a key role to play in providing information and guidance and helping the family control these conditions. The purpose of this study was to examines the level of knowledge and attitude of health workers and determines the related factors. 

This research is a cross-sectional study to evaluate the level of knowledge and attitude of health workers about Alzheimer’s disease and its related factors. All 260 health workers of Gorgan and Kordkuy districts were studied by census method to assess their knowledge and attitude about Alzheimer’s disease and its related factors. ANOVA and T-tests were used to determine the relationship between the independent variables and the dependent variable. Variables whose significant level of correlation with response variable was less than 0.2 in bivariate analysis were entered into the regression model and finally multiple linear regression was used to determine the factors related to level of knowledge and attitude.

The mean level of knowledge was 46.73% (95% CI, 45.46 to 48.16) and the mean level of attitude was 55.61% (95% CI, 54.63 to 56.74). The results show that those with a history of previous education, a history of caring for Alzheimer’s patients, a higher level of work experience in the health care system, and having a female gender and be married have higher levels of knowledge and those with a history of previous education and Sistani descent had a higher attitude.

In general, the mean level of knowledge was 46.73(0-100) and the mean level of attitude was 55.61(0-100). Factors such as: gender, work history in the health system, history of participating in educational workshops, history of caring for sick patients, and marital status were related to the level of knowledge and factors such as ethnicity and history of participating in the training workshop were related to the level of attitude of the health care providers.

The aim of this study was to estimate the effect of smoking on metabolic syndrome (MS) and its components applying inverse probability‑of‑treatment weighting (IPTW) and propensity score (PS) matching.

Using data from Tehran Lipid and Glucose Study, 4857 participants aged over 20 years with information on smoking and confounders in the third phase (2005–2008) were included, and the MS was assessed in the fifth phase (2011–2014). IPTW and PS matching were used to adjust for confounders.

Based on average treatment effect (ATE) estimates, smoking decreased the risk of hypertension (RR: 0.62; 95% CI: 0.43, 0.88), but increased the risk of low HDL cholesterol (1.20; 0.98, 1.48). Similarly, the average treatment effect in the treated (ATT) estimates using IPTW and PS matching suggested that smoking decreased the risk of hypertension (0.63; 0.52, 0.76, and 0.68; 0.54, 0.85), and increased the risk of low HDL cholesterol (1.24; 1.07, 1.43, and 1.28; 1.06, 1.54), respectively.

Smoking seems to increase the risk of low HDL cholesterol but decreases the risk of hypertension.

This qualitative study was undertaken with the aim to identify the reasons for sharing syringes or needles among people who inject drugs (PWID) in Iran.

We used purposive sampling to recruit 4 groups of participants, male PWID (n = 14), female PWID (n = 6), service providers (n = 8), and human immunodeficiency virus (HIV)/addiction experts (n = 9). Data were collected through 2 focus group discussions (FGDs) among male PWID, and semi-structured interviews with female PWID, service providers, and HIV/addiction experts. Using conventional content analysis, themes were extracted for reasons for sharing needles to inject drugs.

We found 13 themes for barriers such as low perceived risk of HIV, high stigma around drug injection and use, low access to harm reduction education and prevention services due to their limited working hours as a well as uneven geographical distribution of services, some structural barriers like incarceration, poverty, and homelessness, and several competing survival needs beyond the injection-related safe behaviors.

Our study was able to provide the perspectives of both PWID and health care authorities and providers towards several barriers to accessing HIV prevention services that lead to needle sharing among PWID in Iran. These barriers need to be addressed to achieve the target of HIV epidemic contro

The current study aimed at determining the pattern of drug dependence and its related factors in mid-term residential treatment centers (MTRCs). The current cross-sectional study was conducted on all drug dependent people residing in MTRCs of Tehran, Iran, who were voluntarily seeking treatment from April to August, 2018. Required data were collected through face-to-face interviews. Drug dependence was categorized into four groups: soft opioids, hard opioids, methamphetamine, and combination of hard opioids and methamphetamine. The association of potential risk factors with drug dependence was measured using chi-square test and multinomial logistic regression. Out of 1868 participants in the current study, 97% were male. Mean age (SD) of the participants was 38.1 (9.9). The different types of drug dependence were hard opioids (43.0%),soft opioids (29.5%), methamphetamine (15.4%), and a combination of hard opioids and methamphetamine (12.1%). The prevalence of injecting drug use was 2.7%. In comparison with the reference group (soft opioids), being un-married and unemployment, significantly increased the risk of using the three groups of drugs (odds ratios [ORs]: 1.5-3.34, P values: <0.001-0.033).Age ≥30 years at the initiation of drug use, and using current drug for more than 10 years, significantly increased the risk of using hard opioids and a combination of hard opioids and methamphetamine (ORs: 1.65-2.31, P values: <0.001-0.030). Age ≥50 years significantly decreased the risk of using the three groups of drugs (ORs: 0.21-0.43, P≤0.001). Different pattern of drug dependence found in MTRCs, they were mostly hard opioid users, lower injecting drug use and higher mean of age.

Skin biometrology is a useful method for evaluation of inflammatory skin disorders such as dermatitis, psoriasis, and lichen planus. The current study tries to compare the biophysical features of skin in dermatitis, psoriasis, and lichen planus. By a convenient sampling method, 22 mild to moderate chronic dermatitis, 26 psoriasis, and 21 lichen planus patients were recruited in the study. Stratum corneum (S.C.) hydration, Transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, elasticity parameters (R0, R2, and R5), skin temperature, skin thickness, and echo-density of epidermis and dermis were measured on the lesional (selected active lesion), uninvolved perilesional, and uninvolved symmetrical skin. The average of perilesional and symmetrical uninvolved parameters was used as control, while the percentage change of each parameter [(lesion – control / control) ×100] was calculated, and compared among three diseases by ANOVA test using SPSS software version 18. The significance level was set at α=0.05. Comparison of percentage changes showed that the changes in TEWL, friction index, sebum content, R2 (gross elasticity), R5 (net elasticity), skin temperature, dermal thickness, and epidermal density are not significantly different among three skin diseases. But there were significant differences in three diseases considering the decrease in S.C. hydration (p<0.001), R0 (opposed to firmness) (p<0.001), and dermal density (p<0.001) compared to control skin. Moreover, the increase in skin pH (p<0.001), melanin content (p=0.048), erythema (p=0.023), and epidermal thickness (p <0.001) significantly differed among these diseases. Dermatitis, psoriasis and lichen planus lesions had specific biophysical changes. It may be helpful in their differential diagnosis.

Self-regulated learning (SRL) is highly task and context dependent. Microanalytic assessment method measures students’ SRL processes while performing a particular learning task. The present study aimed to design a microanalytic SRL assessment protocol for biomedical science learning.
This mixed method study was conducted in Tehran University of Medical Sciences, Iran, in 2013. The data collection tool was a microanalytic SRL assessment protocol that was designed based on the literature review, expert opinion, and cognitive interview with medical students, and then, piloted. The participants consisted of 13 second year medical students. The subjects were interviewed while conducting a biomedical science learning task. Interviews were recorded, transcribed and coded based on a predetermined coding framework. Descriptive statistics were used to analyze the data.
The microanalytic SRL assessment protocol was developed in three parts; interview guide, coding framework, and biomedical science learning task. An interview guide was designed consisting of 6 open-ended questions aimed at assessing 5 SRL sub-processes of goal setting, strategic planning, meta-cognitive monitoring, causal attribution, and adaptive inferences and a close-ended question regarding self-efficacy. Based on the pilot study, most participants reported task-specific and task-general processes for the sub-processes of strategic planning (92%), meta-cognitive monitoring (77%), causal attribution (85%), and adaptive inferences (92%).
The developed protocol could capture the fine-grained nature of the self-regulatory sub-processes of medical students for biomedical science learning. Therefore, it has the potential application of modifying SRL processes in early years of medical school.

Overweight and obesity in children are a serious problem. They are increasingly prevalent and associated with a wide range of health problems in adulthood. Monitoring their status is essential for effective planning in the health system.. This study aimed to assess the prevalence of overweight and obesity in children below 5 years in Tehran in 2012.Patients and This cross-sectional study employed data provided by the urban health equity assessment in Tehran. The sample comprised a total of 4656 children under 5 years, recruited via multistage sampling. Data were collected through questionnaires and anthropometric measures of height and weight. The WHO child growth standards were used to determine overweight and obesity. Data were analyzed using chi-square tests, with SPSS version 11.5. The prevalence of overweight and obesity in children were 12% and 23.7% respectively. The prevalence of overweight was significantly higher in girls than boys and the prevalence of obesity was significantly higher in boys than girls (P = 0.001). Obesity was more prevalent in children from high economic percentiles, but this finding was not statistically significant. The prevalence of overweight and obesity in children under 5 years is high. Overweight and obesity should be considered an epidemic and serious health problem in Tehran. They certainly require more attention and intervention.

Alterations in p53 and p27KIP1 have been documented as important events in the carcinogenesis of various cancers, but their prognostic role in oral squamous cell carcinoma (OSCC) remains controversial.. The present investigation aimed to evaluate the clinicopathologic and prognostic significance of p53 and p27KIP1 expression in a group of Iranian patients with OSCC..Patients and In this analytical cross-sectional study, medical records of patients with primary OSCC, diagnosed from 1994 to 2004 were reviewed and 28 subjects were selected based on the inclusion/exclusion criteria. Immunohistochemical staining using monoclonal antibodies against p53 and p27KIP1 was performed on representative archival paraffin blocks. Demographic data along with information on p53 and p27KIP1 expression, recurrence, and tumor grade was statistically analyzed using the Fischer exact test. Prognostic factors for overall survival were determined by Cox regression analysis (P < 0.05).. p53 and p27KIP1 expression were found in 28.57% (8 positive versus 20 negative) and 67.85% (19 positive versus 9 negative) of OSCC cases, respectively. There was no significant association between these two proteins (P = 0.371), and neither of them showed a significant relationship with the studied clinicopathologic variables (P > 0.05). In survival analysis, only histopathologic differentiation (17 low and moderate, 11 poor) demonstrated a significant correlation with overall survival (P = 0.048).. Despite the fact that abnormalities in p53 and p27KIP1 may be involved in the development of OSCC, their clinical significance in the studied population seems limited. Further investigation on the combined p53/p27KIP1 expression may be helpful in predicting the biologic behavior of this tumor.

Few studies use modern approaches to develop a quality of life (QOL) questionnaire with acceptable construct validity, especially in Iran. Our main objective was to construct a new validated and uni-dimensional questionnaire, based on WHOQOL-100, using the Rasch analysis. In a population-based, cross-sectional study in 2007, 500 Tehran residents aged≥18 were randomly sampled. The Persian version of WHOQOL-100 was used to measure the participants'' QOL. After using targeting and person fit analysis, we performed category/threshold ordering, item fit, and differential item functioning analyses, in succession. We used outfit or infit statistics>1.5 and <0.5 for detecting underfit and overfit items/persons, respectively. We also deleted items with disordered category and/or threshold. Person Separation Index and test reliability were also calculated in the datasets. Male to female ratio was 0.98 and the mean age (SD) of participants was 35.1 (12.8) years. Initial analyses showed significant differences in quality of life between age groups (P=0.002), educational levels (P=0.001), and current health status groups (P<0.001). We eliminated 67 persons for under-fitting, 38 items for category and/or threshold disordering, 6 items for under-fitting, and 26 items for item bias. Test reliability for the final 30-item scale was 0.89. We prepared a shortened version of the WHOQOL-100 that is single construct, uni-dimensional and free of item bias or any disordering, according to the Rasch model.

Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced. This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers. The medians of the numbers of papers and books during a 5-year period were 150. 5 and 2. 5 respectively. The median of the «articles per researcher» was 19. 1. Based on multiple linear regression, younger age centers (p=0. 001), having a separate budget line (p=0. 016), and number of research personnel (p<0. 001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0. 004). The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers.

Given the importance of measuring quality of life, as an important outcome for evaluating the health status of individuals as well as assess response to interventions, the need to examine the psychometric characteristics of this questionnaire is evident. In this study the structural validity of the WHOQOL-100 questionnaire, using Rasch analysis has been studied. Population examined in this study included 500 people from physically- movement disabled community that has been selected of Crescent Comprehensive Rehabilitation Center of Tehran. Participants in this study received the WHOQOL-100 questionnaire, which contain 6 subscales, and completed it. Then analysis was performed using Rasch analysis. On each of the dimensions one model of Rasch family models, which is called partial credit model, was fitted and then suitability of the items was considered with using of standard item fit statistics and analysis of differential item functioning. After removing four overall items and then fitting the models separately on each dimension, four items of 12 items of physical health dimension, 14 items of 24 items of mental health dimension, 11 items of 16 items of independence dimension, 7 items of 12 items of social communication dimension, 7 item of 27 items of health environment dimension and 2 items of 4 items of religion, mental status and personal beliefs dimension diagnosed improper and excluded of questionnaire. Reliability indices, including Psi and Cronbach's alpha, were respectively in (0.900, 0.644) and (0.576, 0.878) intervals. The remaining items in each of the dimensions of the WHOQOL-100 questionnaires have been correctly fitted model So they can measure only one aspect of quality of life. For all dimensions, the reliability index PSI, was larger than Cronbach's alpha index.

Calculation of burden of diseases and risk factors is crucial to set priorities in the health care systems. Nevertheless, the reliable measurement of mortality rates is the main barrier to reach this goal. Unfortunately, in many developing countries the vital registration system (VRS) is either defective or does not exist at all. Consequently, alternative methods have been developed to measure mortality. This study is a subcomponent of NASBOD project, which is currently conducting in Iran. In this study, we aim to calculate incompleteness of the Death Registration System (DRS) and then to estimate levels and trends of child and adult mortality using reliable methods. In order to estimate mortality rates, first, we identify all possible data sources. Then, we calculate incompleteness of child and adult morality separately. For incompleteness of child mortality, we analyze summary birth history data using maternal age cohort and maternal age period methods. Then, we combine these two methods using LOESS regression. However, these estimates are not plausible for some provinces. We use additional information of covariates such as wealth index and years of schooling to make predictions for these provinces using spatio-temporal model. We generate yearly estimates of mortality using Gaussian process regression that covers both sampling and non-sampling errors within uncertainty intervals. By comparing the resulted estimates with mortality rates from DRS, we calculate child mortality incompleteness. For incompleteness of adult mortality, Generalized Growth Balance, Synthetic Extinct Generation and a hybrid of two mentioned methods are used. Afterwards, we combine incompleteness of three methods using GPR, and apply it to correct and adjust the number of deaths. In this study, we develop a conceptual framework to overcome the existing challenges for accurate measuring of mortality rates. The resulting estimates can be used to inform policy-makers about past, current and future mortality rates as a major indicator of health status of a population.

This study aims to introduce an appropriate instrument for measurement of smoking stages in adolescents and to examine its validity using latent class analysis (LCA) model. We designed an algorithm to measure the smoking stages. The relevancy and clarity of the algorithm was examined by experts and lay experts. We assessed the reliability of our algorithm using test-retest method. Moreover, using the LCA, we studied the validity of the stages measured by the designed algorithm in 4903 students (ages 14-19), who were randomly selected from grade 10 high school students in Tabriz (North-West of Iran). The algorithm content validity indicates high relevancy and clarity percentages. Intra-class correlation of 0.929 was found in the assessment of the reliability of smoking stages (9 stages) in 154 students within a two-week interval. The LCA model revealed nine interpretable classes (G2 = 0.051, df = 1, P = 0.821) for the measurement of smoking stages. Examination of the smoking cessation stages in a sample of 218 students in the cessation stage demonstrated that the results for five classes could be interpreted (G2 = 0.001, df = 1, P = 0.975). The results suggested that this algorithm is clear, valid, and reliable.

The aim of this study is determining the prevalence of smoking stages in adolescents of Tabriz city (northwest of Iran) and identifying the personal, environmental, and psychological factors relating to cigarette smoking. Fifty-seven high schools were randomly selected, and 4903 students were completed a self-administered questionnaire about cigarette smoking and the related risk factors. The association of independent variables with cigarette smoking was evaluated using the ordinal logistic regression model. In total, 17.3% of the participants were experimenters (95% CI: 15.8-18.9) and 5.0% were regular smokers (95% CI: 3.7-6.2). The results showed that the male gender (OR=2.92; CI: 1.94-4.77), age (OR=1.27; CI: 1.02-1.64), having general risk taking behavior (OR=1.50; CI: 1.02-2.21), presence of a cigarette smoker in the family (OR=1.78; CI: 1.23-2.54), friendship with close cigarette smoker friends (OR=2.52; CI: 1.65-3.86), substance abuse experience (OR=8.27; CI: 2.61-25.61), attitude toward cigarette smoking (OR=1.22; CI: 1.10-1.27) and positive thinking about cigarette smoking (OR=1.05; CI: 1.01-1.14) are associated to cigarette smoking in adolescents. The cigarette smoking prevalence is minimal in Tabriz city adolescents, especially in girls; but the experimenter prevalence is considerable. Findings of this study justifies adopting more serious measures in the pre-adolescence and adolescence period.

Intention to smoking is a strong predictor of future smoking behavior. The aim of this study is identifying the personal, environmental, and psychological factors relating to intention to smoking in adolescents of Tabriz city (Northwest of Iran). Four thousand nine hundred and three (4903) students were randomly selected and completed a self‑administered questionnaire about cigarette smoking, intention to smoking, and the related risk factors through multi‑stage sampling. The association of independent variables with intention to smoking was evaluated using the multi‑variable logistic regression model. The mean age of student was 15.7 ｱ 0.73 years, and 42.9% of the samples were male. The results showed that 95.0% of students were in committer stage (students who had never smoked and were sure never start smoking). Having general risk‑taking behavior (OR = 2.90; 95% confidence interval [CI]: 1.21‑6.97), smoker in the family (OR = 2.60; 95% CI: 1.20‑5.61), and positive attitude towards cigarette smoking (OR = 1.30; 95% CI: 1.18‑1.43) had statistically significant association with intention to start smoking in future. Majority of non‑smokers have firm decision to not start smoking in the future. Having general risk‑taking behavior, smoker in the family, and positive attitude towards smoking are associated with intention to smoking in adolescents.

During recent years there have been many discussions about the meaning of accreditation and the steps for establishing an accreditation system in our country. It is worth to mention that in the third national economic, social and cultural development plan, the process of accreditation of medical education programs and its reinforcement has been mentioned. Simply, accreditation can be defined as granting of approval to an institution, which according to the judgment of experts in the field of study has met the predetermined requirements. In medicine, accreditation of educational programs signifies that national standards for structure, function and efficacy are met by a medical education institution’s program leading to the MD degree (undergraduate medical education) or one of the recognized medical specialties (postgraduate training). Similar to the other parts of the world in the second half of the twentieth century, the situation of medical education in our country faced a rapid and imbalanced growth in medical education (especially for general medicine) during the last twenty years. Therefore recognition and applying the methods, useful in quality improvement of medical education, is of utmost importance. In this regard, establishment of accreditation system will be very effective, and in the third national development plan a lot of attention has been paid to the issue of establishing and upgrading the evaluation and accreditation systems of educational institutions and programs. In this article, we will overview the basics of accreditation, steps to establish an accreditation system, the process of review and accreditation of programs and a brief description of well-known accreditation systems in different parts of the world.

Anethum is an herbal medicine composed of the three plants species Anethum, Fumaria and Cichorium, and has been widely marketed and prescribed as lipid-lowering agent in Iran in recent years. No controlled clinical trial of this medicine has so far been carried out, however. We studied the efficacy and short-term side effects of Anethum in patients with isolated hypertriglyceridaemia.
151 people (54 men and 97 women) with serum triglyceride ≥250mg/dl and serum cholesterol Four months after treatment was started, serum triglyceride had decreased 12.5% in the Anethum group and 6.8% in the placebo group (p=0.999). During the same period, serum triglyceride had decreased 48.8% in the nicotinic acid group and 54.4% in the clofibrate group (p=0.006 with respect to both placebo and Anethum). Furthermore, the nicotinic acid group showed a 7.8% decrease in serum total cholesterol (p=0.009 with respect to the other three groups). HDL-C decreased 9.8% in the Anethum group, 17.5% in the nicotinic acid group, 8.1% in the clofibrate group, and 9.1% in the placebo group (p=0.149 between first three groups and placebo). 81.8% of the nicotinic acid, 57.1% of the clofibrate, 8.0% of the Anethum and 30% of the placebo group experienced side effects during the same period. The most common complaints in the Anethum were actually non-specific ones.
We conclude that Anethum does not exert any therapeutic effect on isolated hypertriglyceridaemia.

Anethum is an herbal medicine composed of the three plants species Anethum, Fumaria and Cichorium, and has been widely marketed and prescribed as lipid-lowering agent in Iran in recent years. No controlled clinical trial of this medicine has so far been carried out, however. We studied the efficacy and short-term side effects of Anethum in patients with isolated hypertriglyceridaemia. 151 people (54 men and 97 women) with serum triglyceride ≥250mg/dl and serum cholesterol <240mg/dl were enrolled in this study. Participants were randomly assigned to one of four treatment groups: Anethum, nicotinic acid, clofibrate, and placebo. They were seen at the Doctor Shariati University Hospital lipid clinic once every two weeks. Serum lipid profile was measured at 2 and 4 months after start of therapy. Relevant patient details, including sex, body mass index, mean total cholesterol and high-density lipoprotein, cigarette smoking, previous myocardial infarction, physical activity, and oral contraceptive use were recorded before enrolment. Four months after treatment was started, serum triglyceride had decreased 12.5% in the Anethum group and 6.8% in the placebo group (p=0.999). During the same period, serum triglyceride had decreased 48.8% in the nicotinic acid group and 54.4% in the clofibrate group (p=0.006 with respect to both placebo and Anethum). Furthermore, the nicotinic acid group showed a 7.8% decrease in serum total cholesterol (p=0.009 with respect to the other three groups). HDL-C decreased 9.8% in the Anethum group, 17.5% in the nicotinic acid group, 8.1% in the clofibrate group, and 9.1% in the placebo group (p=0.149 between first three groups and placebo). 81.8% of the nicotinic acid, 57.1% of the clofibrate, 8.0% of the Anethum and 30% of the placebo group experienced side effects during the same period. The most common complaints in the Anethum were actually non-specific ones. We conclude that Anethum does not exert any therapeutic effect on isolated hypertriglyceridaemia.