فهرست مطالب

  • Volume:30 Issue: 1, 2016
  • تاریخ انتشار: 1394/10/11
  • تعداد عناوین: 161
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  • Mehdi Adavi, Masoud Salehi, Masoud Roudbari* Pages 1-5
    Background
    Diabetes and hypertension are important non-communicable diseases and their prevalence is important for health authorities. The aim of this study was to determine the predictive precision of the bivariate Logistic Regression (LR) and Artificial Neutral Network (ANN) in concurrent diagnosis of diabetes and hypertension.
    Methods
    This cross-sectional study was performed with 12000 Iranian people in 2013 using stratified-cluster sampling. The research questionnaire included information on hypertension and diabetes and their risk factors. A perceptron ANN with two hidden layers was applied to data. To build a joint LR model and ANN, SAS 9.2 and Matlab software were used. The AUC was used to find the higher accurate model for predicting diabetes and hypertension.
    Results
    The variables of gender, type of cooking oil, physical activity, family history, age, passive smokers and obesity entered to the LR model and ANN. The odds ratios of affliction to both diabetes and hypertension is high in females, users of solid oil, with no physical activity, with positive family history, age of equal or higher than 55, passive smokers and those with obesity. The AUC for LR model and ANN were 0.78 (p=0.039) and 0.86 (p=0.046), respectively.
    Conclusion
    The best model for concurrent affliction to hypertension and diabetes is ANN which has higher accuracy than the bivariate LR model.
    Keywords: Artificial neutral Network, Joint logistic regression, Prediction, Diabetes, Hypertension
  • Satar Rezaei, Razieh Fallah, Ali Kazemi Karyani, Rajabali Daroudi, Hamed Zandiyan, Mohammad Hajizadeh* Pages 6-14
    Background
    A dramatic increase in healthcare expenditures is a major health policy concern worldwide. Understanding factors that underlie the growth in healthcare expenditures is essential to assist decision-makers in finding best policies to manage healthcare costs. We aimed to examine the determinants of healthcare spending in Iran over the periods of 1978-2011.
    Methods
    A time series analysis was used to examine the effect of selected socio-economic, demographic and health service input on per capita healthcare expenditures (HCE) in Iran from 1978 to 2011. Data were retrieved from the Central Bank of Iran, Iranian Statistical Center and World Bank. Autoregressive distributed lag approach and error correction method were employed to examine long- and short-run effects of covariates.
    Results
    Our findings indicated that the GDP per capita, degree of urbanization and illiteracy rate increase healthcare expenditures, while physician per 10,000 populations and proportion of population aged&ge 65 years decrease healthcare expenditures. In addition, we found that healthcare spending is a “necessity good” with long- and short-run income (GDP per capita), elasticities of 0.46 (p
    Conclusion
    Our analysis identified GDP per capita, illiteracy rate, degree of urbanization and number of physicians as some of the driving forces behind the persistent increase in HCE in Iran. These findings provide important insights into the growth in HCE in Iran. In addition, since we found that health spending is a “necessity good” in Iran, healthcare services should thus be the object of public funding and government intervention.
    Keywords: Healthcare expenditures, Autoregressive distributed lag approach, Error correction method, Time series analysis, Iran
  • Mahmood Karimy, Ahmad Reza Abedi *, Hamid Abredari, Mohammad Taher, Fatemeh Zarei, Zahra Rezaie Shahsavarloo Pages 15-25
    Background
    The horror of HIV/AIDS as a non-curable, grueling disease is a destructive issue for every country. Drug use, shared needles and unsafe sex are closely linked to the transmission of HIV/AIDS. Modification or changing unhealthy behavior through educational programs can lead to HIV prevention. The aim of this study was to evaluate the efficiency of theory-based education intervention on HIV prevention transmission in drug addicts.
    Methods
    In this quasi-experimental study, 69 male drug injecting users were entered in to the theory-based educational intervention. Data were collected using a questionnaire, before and 3 months after four sessions (group discussions, lecture, film displaying and role play) of educational intervention.
    Results
    The findings signified that the mean scores of constructs (self-efficacy, susceptibility, severity and benefit) significantly increased after the educational intervention, and the perceived barriers decreased (p
    Conclusion
    The present research offers a primary founding for planning and implementing a theory based educational program to prevent HIV/AIDS transmission in drug injecting addicts. This research revealed that health educational intervention improved preventive behaviors and the knowledge of HIV/AIDS participants.
    Keywords: Drug abusers, Addiction, Substance, Preventive Health Education
  • Ali Aboutorabi, Maryam Ghiasipour, Aziz Rezapour *, Abolghasem Pourreza, Ali Sarabi Asiabar, Asghar Tanoomand Pages 26-35
    Background
    Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences.
    Methods
    In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests.
    Results
    The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals’ housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status.
    Conclusion
    Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals’ staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments.
    Keywords: Informal payment, Corruption, Iran, Under the table payment
  • Bahram Nabilou, Hassan Yusefzadeh, Aziz Rezapour, Farbod Ebadi Fard Azar, Parviz Salem Safi, Ali Sarabi Asiabar, Nahal Ahmadzadeh* Pages 36-43
    Background
    Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study.
    Methods
    In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, input-oriented and variable return to scale assumptions were applied and Deap2.1 software was used.
    Results
    The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked.
    Conclusion
    Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful.
    Keywords: Hospital, Productivity, Efficiency, Malmquist index
  • Seyed Alireza Hosseini, Fatemeh Rajabi *, Ali Akbari Sari, Mohsen Ayati, Saeed Heidari, Fawzieh Ghamary Pages 44-57
    Background
    Hormone therapy is currently the mainstay in the management of locally advanced and metastatic prostate cancer. We performed a systematic review to compare safety, efficacy and effectiveness of degarelix, a new gonadotropin-releasing hormone (GnRH) antagonist (blocker), versus gonadotropin-releasing hormone (GnRH) agonists.
    Methods
    MEDLINE, Web of Science and the Cochrane library were searched to identify all of the published Randomized Controlled Trials (RCTs) that used degarelix versus gonadotropin-releasing hormone agonists with or without anti-androgen therapy for the treatment of prostate cancer. We performed meta-analysis of extracted data on safety and efficacy of the target medication.
    Results
    Six studies were included. They involved a total of 2296 patients which were used in the meta-analysis. Follow-up times after treatment were between 12 weeks and 12 months. Three of six RCTs compared degarelix with goserelin and the others compared it with leuprolide.Meta-analysis on safety outcomes revealed that the only statistically significant difference between the degarelix treated group and GnRH agonists treated group was complication in the injection site which was higher in degarelix-treated group (OR= 46.34, 95% CI: 15.79 to 136, p
    Conclusion
    Our meta-analysis indicates that, compared with GnRH agonists, degarelix has significantly more effects on lower urinary tract symptoms and also Prostate Specific Antigen (PSA) and testosterone reduction in the first month of the treatment. Except minor complications in the injection site like pain, erythema and swelling, there is no increase in major side effects and mortality due to degarelix. This is while the effect on testosterone and PSA after the first month of treatment is not statistically different between the two groups.
    Keywords: Prostate cancer, Degarelix, Leuprolide, Goserelin, Meta, analysis, GnRH Agonists, Safety, Efficacy
  • Jalal Arabloo, Pejman Hamouzadeh, Seyedeh Maryam Mousavinezhad, Mohammadreza Mobinizadeh *, Alireza Olyaeemanesh, Morvarid Pooyandjoo Pages 58-65
    Background
    Image-guided radiotherapy used multiple imaging during the radiation therapy course to improve the precision and accuracy of health care provider's treatment.
    Objectives
    This study aims to assess the safety, effectiveness and economic aspects of image-guided radiation therapy for decision-making about this technology in Iran.
    Methods
    In this study, the most important medical databases such as PubMed and Cochrane Library were searched until November 2014. The systematic reviews, health technology assessment reports and economic evaluation studies were included. The results of included studies were analyzed via the thematic synthesis.
    Results
    Seven articles were included in the study. The results showed that image-guided radiation therapy, regardless of the imaging technique used in it, is associated with no major toxicity and has the potential to reduce the symptoms of poisoning. Using image-guided radiation therapy for prostate cancer resulted in substantial improvement in the quality of the received dose and optimal therapeutic dose of radiation to the targeted tumor while the radiation dose to the surrounding healthy tissues was minimal. Additionally, image-guided radiation therapy facilitated the diagnosis and management of exception deviations, including immediate changes and gross errors, weight loss, significant limbs deformity, systematic changes in the internal organs and changes in respiratory movements. Usage of image-guided radiation therapy for prostate cancer was associated with increased costs.
    Conclusion
    Current available evidence suggests that the image-guided radiation therapy can reduce the amount of radiation to healthy tissue around the tumor and the toxicity associated with it. This can enhance the safe dose of radiation to the tumor and increase the likelihood of destruction of tumor. The current level of evidence required conducting further studies on the costs and effectiveness of this technology compared with conventional technology.
    Keywords: Image, Guided Radiotherapy, Health Technology Assessment, Systematic Review
  • Jalal Arabloo, Serajaddin Grey, Mohammadreza Mobinizadeh, Alireza Olyaeemanesh *, Pejman Hamouzadeh, Kiumars Khamisabadi Pages 66-72
    Background
    Maggot therapy has recently attracted considerable attention as an emerging debridement technique for wound healing. This study aimed to review the safety, effectiveness and economic evaluations of Maggot Debridement Therapy for wound healing.
    Methods
    To retrieve the relevant evidences, the Cochrane Library (until September 2014) was searched by appropriate keywords, using free text and Mesh. Systematic reviews, HTA reports and economic evaluation studies that compared larval therapy with other debridement therapies, such as hydrogel in patients with various kinds of ulcers in terms of side effects, the wound healing rate, the healing time, and cost per QALY, were included.
    Results
    Five studies met the inclusion criteria which showed that healing with larval therapy happened a little earlier than the usual methods and that pain perception in larval therapy was a little more than usual methods (as by anesthetic conventional methods). However, the quality of life of those patients who received larval therapy was better and they showed a greater tendency to larval therapy as it was relatively safe and had a low rate of side effects.
    Conclusion
    It seems that larval therapy has several advantages such as rapid wound debridement, infection elimination, pain control and ulcer healing. The use of larval therapy has the potential to reduce side effects and decrease the need for amputation.
    Keywords: Larval Therapy, Wound Debridement, Ulcer HealingMedian Nerve, Electromyography, Ulnar Nerve, Ulnar, to, Median Nerve Anastomosis, Nerve Injury
  • Mohammad Sadegh Fazeli, Mohammad Reza Keramati *, Azam Rahimi, Alireza Kazemeini, Mohammad Mehdi Banoei, Habibollah Dashti, Amir Reza Fazeli Pages 73-76
    Background
    Visfatin is an adipocytokine secreted by visceral adipose tissue. It has been shown that adipocytokines may contribute to the induction of carcinogens and progression of tumors. Previously, we found a significant increase in the visfatin serum level in colorectal cancer patients. Herein, we investigated if this cytokine increases in patients with colorectal adenoma as a precursor of colorectal cancer.
    Methods
    In this case-control analytic study, a total of 34 patients diagnosed with colorectal adenoma and 35 disease-free controls were included. Adenomas were also categorized based on their location within the colon. Visfatin serum levels were measured in all cases and controls using enzyme-linked immunosorbent assay kits. In order to compare visfatin levels between groups a two-tailed t-test was considered. Pearson correlation was also used to assess the relationship between visfatin levels and other measured variables.
    Results
    Patients included 18 male (53%) and 16 female (47%) with a mean±SD age of 48.3±10.96 years and controls were 18 male (51%) and 17 female (49%) with a mean±SD age of 51.6±12.52 years. There were no significant difference in terms of the visfatin level between the two groups (6.7±3.01 ng/ml for patients and 6.8±2.49 ng/ml for controls, p>0.05). Except for a significant correlation between the BMI and visfatin level (p=0.041), no other correlation was detected. We found no significant difference between the levels of visfatin in each location of adenoma comparing the healthy controls (p>0.05 in all comparisons). There was no statistical difference between the locations groups in terms of visfatin level as well (p>0.05).
    Conclusion
    Visfatin serum level does not significantly increase in patients with colorectal adenoma. Site of adenoma within the colon or rectum does not seem to play an important role in this regard as well.
    Keywords: Colorectal adenoma, Visfatin, Adipocytokine, Colon, Rectum
  • Farideh Mohtasham, Bahareh Yazdizadeh *, Zahra Zali, Reza Majdzadeh, Sima Nedjat Pages 77-84
    Background
    Health technology assessment (HTA) is a tool utilized for efficient dissemination of technology. For the purpose of encouraging decision-makers to utilize this tool, at first, we need to identify the obstacles in the processes of preparation, utilization, and implementation of HTAs. This study aims to define these barriers and offer solutions for effective utilization of HTA reports produced in Iran.
    Methods
    This qualitative content analysis determines the various beneficiaries of HTA, and utilizes a semi-structured interview with the participants who are all involved in the HTA.
    Results
    Nine out of ten people invited for the interviews accepted the researchers’ invitation. An analysis of barriers and solutions for improving the utilization of HTA reports was conducted in three levels of policy makers (policy level), specialists in healthcare (professional level), and ordinary people (public level). The barriers in the policy level include unsuitability of reports for their audience, incompatible views toward the definition and necessity of health technology assessment, lack of financial resources for report preparation, and limitations in large-scale policymaking in Ministry of Health. Barriers in the professional level include lack of knowledge on HTA among service-providers. Barriers in the public level consist of information asymmetry.
    Conclusion
    There are various barriers toward accurate utilization of HTAs in Iran. Thus, a systematic approach which involves people, brings about culture, improves infrastructures, and boosts supervision on the performance is recommended.
    Keywords: Health Technology Assessment, Developing country, Qualitative Study
  • Vahdat Poortahmasebi, Mohammad Sajad Emami Aleagha, Mehdi Amiri, Mostafa Qorbani, Mohammad Farahmand, Hamid Asayesh, Seyed Moayed Alavian* Pages 85-92
    Background
    Hepatic steatosis is commonly observed in patients with chronic hepatitis C (CHC). Many studies indicate a relationship between steatosis and fibrosis progression. The aim of this study was to analyze the prevalence of hepatic steatosis and related factors in Iranian CHC patients.
    Methods
    One hundred and fifteen consecutive patients with CHC were enrolled which were treatment-naïve. The patients were divided into groups with and without steatosis according to the result of liver biopsy (58.3% and 41.7%, respectively). Demographic, histological, biochemical and virological factors were examined and compared in all patients.
    Results
    In terms of host factors, body mass index (BMI), triglyceride, fasting blood glucose (FBG), necroinflammatory activity and severity in fibrosis of CHC patients with steatosis was significantly higher than the patients without steatosis. Of viral factors, HCV viral load was not significantly altered in patients with steatosis. Moreover, HCV genotypes did not meet such association. Using multivariate regression analysis, parameters of BMI values, FBG level and stage of fibrosis were independently associated with steatosis.
    Conclusion
    Our data indicate that CHC patients are more susceptible to development of hepatic steatosis. Based on our results, grade of steatosis appears to be associated with hepatic fibrosis progression rate in CHC patients.
    Keywords: Chronic hepatitis C, Steatosis, Fibrosis, Necroinflammatory activity
  • Behzad Damari, Sahand Riazi, Isfahani* Pages 93-104
    Background
    According to national laws and world experiences; provision, maintenance, and improving citizens’ health are considered to be the essential functions of municipalities as a “social institute”. In order to equitably promote health conditions at urban level, particularly in marginal areas, since 2004 targeted efforts have been implemented in the municipality of Tehran metropolis. This study was intended to identify and analyze these targeted measures and tries to analyze health interventions in a conceptual framework and propose a future path.
    Methods
    This is a qualitative study with content analysis approach. Reviewing documents and structured interviews with national health policy making and planning experts and executive managers of 22-region municipalities of Tehran metropolis were used to collect data. The data were analyzed on the basis of conceptual framework prepared for urban health in 4 domains including municipal interventions, goal achievements, drivers and obstacles of success, and the way forward.
    Results
    From the viewpoint of interviewees, these new health actions of Tehran municipality are more based on public participation and the municipality was able to prioritize health issue in the programs and policies of Tehran city council. Tehran municipality has accomplished three types of interventions to improve health, which in orders of magnitude are: facilitative, promotional, and mandatory interventions. Development and institutionalization of public participation is the greatest achievement in health-oriented actions; and expansion of environmental and physical health-oriented facilities and promoting a healthy lifestyle are next in ranks.
    Conclusion
    Since management alterations seriously challenges institutionalization of actions and innovations especially in the developing countries, it is suggested that mayors of metropolitan cities like Tehran document and review municipal health measures as soon as possible and while eliminating overlapping of interventions with other sectors, design and approve the charter of “health promoting municipality”. The most important role of municipalities in this charter would be coordinating health improvement of citizens. This charter, when approved as a national policy could be used for other cities too.
    Keywords: Tehran Municipality, Urban health, Tehran metropolis, future path
  • Tannaz Ahadi, Gholam Reza Raissi *, Masood Yavari, Lobat Majidi Pages 105-109
    Background
    Two main muscles studied in the hand for evaluation of median nerve injuries are opponens pollicis (OP) and abductor pollicis brevis (APB). However, Riché-Cannieu communicating branch (RCCB) may limit the use of these muscles in electrodiagnosis. This condition is confusing in the case of median nerve injuries. This study was conducted to evaluate the prevalence of RCCB.
    Methods
    Twenty-three consecutive cases of complete median nerve injury were studied. Evoked responses via stimulation of median and ulnar nerves in the wrist and recording with needle in the thenar area were studied.
    Results
    Of the patients, 82.6% exhibited RCCB. In 14 (60.8%) cases the OP and in 19(82.6%) cases APB was supplied by the ulnar nerve.
    Conclusion
    RCCB was detected to be 60.8% in OP and 82.6% in APB, so OP is preferable to APB in the study of median nerve.
    Keywords: Median Nerve, Electromyography, Ulnar Nerve, Ulnar, to, Median Nerve Anastomosis, Nerve Injury
  • Golandam Rezaei, Seyed Alireza Hosseini *, Ali Akbari Sari, Alireza Olyaeemanesh, Mohammad Hassan Lotfi, Mojtaba Yassini, Reza Bidaki, Bijan Nouri Pages 110-121
    Background
    The aim of this study was to directly compare efficacy of atomoxetine and methylphenidate in treatment of children and adolescents 6- 18 years.
    Methods
    All published, randomized, open label or double blind trials, comparing the efficacy of methylphenidate with atomoxetine in treatment of children diagnosed with ADHD, using DSM-IV criteria were included in this study; ADHD Rating Scale–IV–Parent Version: Investigator Administered and Scored (ADHDRS) scores was used. The standardized mean difference (SMD) was used as a measure of effect size.
    Results
    Eleven studies were included with a total of 2,772 participants. The meta-analysis did not find a significant difference in the efficacy between methylphenidate and atomoxetine (SMD= 0.09, 95% CI -0.06, 0.25) (Z= 1.18, p= 0.24). Sub group analysis showed a significant standardized mean difference favoring OROS methylphenidate (SMD= 0.31, 95% CI 0.16, 0.47 (Z= 3.91, p
    Conclusion
    Atomoxetine and methylphenidate showed comparable efficacy in the treatment of children and adolescents with ADHD. However, Osmotic (Controlled) Release Oral (Delivery) System (OROS) methylphenidate is more effective than atomoxetine in treatment of ADHD in children and adolescents that is suggested as a first-line treatment in ADHD. Moreover, comparing the immediate release (IR) methylphenidate to atomoxetine did not lead to the benefit of IR methylphenidate.
    Keywords: Atomoxetine, ADHD, Child, Adolescents, Meta, analysis, Methylphenidate
  • Behzad Najafi, Farshad Farzadfar, Hossein Ghaderi *, Mohammad Hadian Pages 122-130
    Background
    Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically.
    Methods
    We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond’s checklist for appraising the quality of studies.
    Results
    The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies.
    Conclusion
    A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening.
    Keywords: Cost effectiveness, Diabetes, Screening, Economic evaluation
  • Alireza Mazdaki, Hesam Ghiasvand, Ali Sarabi Asiabar, Seyran Naghdi, Aidin Aryankhesal* Pages 131-145
    Background
    Helicobacter pylori may cause many gastrointestinal problems in developing countries such as Iran. We aimed to analyze the cost- effectiveness and cost- utility of the test-and-treat and empirical treatment strategies in managing Helicobacter pylori infection.
    Methods
    This was a Markov based economic evaluation. Effectiveness was defined as the symptoms free numbers and QALYs in 100,000 hypothetical adults. The sensitivity analysis was based on Monte Carlo approach.
    Results
    In the test- and- treat strategy, if the serology is the first diagnostic test vs. histology, the cost per symptoms free number would be 291,736.1 Rials while the cost per QALYs would be 339,226.1 Rials. The cost per symptoms free number and cost per QALYs when the 13 C-UBT was used as the first diagnostic test vs. serology was 1,283,200 and 1,492,103 Rials, respectively. In the empirical strategy, if histology is used as the first diagnostic test vs. 13 CUBT, the cost per symptoms free numbers and cost per QALYs would be 793,234 and 955,698 Rials, respectively. If serology were used as the first diagnostic test vs. histology, the cost per symptoms free and QALYs would be 793,234 and 368941 Rials, respectively.
    Conclusion
    There was no significant and considerable dominancy between the alternatives and the diagnostic tests.
    Keywords: Cost, Effectiveness Analysis, Cost, Utility Analysis, Gastric Acid Anti, Secretory Treatment, Helico, bacter Pylori Infection
  • Mohammadreza Mobinizadeh, Pouran Raeissi *, Amir Ashkan Nasiripour, Alireza Olyaeemanesh, Seyed Jamaleddin Tabibi Pages 146-162
    Background
    In the recent years, using health technologies to diagnose and treat diseases has had a considerable and accelerated growth. The proper use of these technologies may considerably help in the diagnosis and treatment of different diseases. On the other hand, unlimited and unrestricted entry of these technologies may result in induced demand by service providers. The aim of this study was to determine the appropriate criteria used in health technologies priority-setting models in the world.
    Methods
    Using MESH and free text, we sought and retrieved the relevant articles from the most appropriate medical databases (the Cochrane Library, PubMed and Scopus) through three separate search strategies up to March 2015. The inclusion criteria were as follows: 1) Studies with specific criteria; 2) Articles written in English; 3) Those articles conducted in compliance with priority setting of health technologies. Data were analyzed qualitatively using a thematic synthesis technique.
    Results
    After screening the retrieved papers via PRISMA framework, from the 7,012 papers, 40 studies were included in the final phase. Criteria for selecting health technologies (in pre assessment and in the assessment phase) were categorized into six main themes: 1) Health outcomes; 2) Disease and target population; 3) Technology alternatives; 4) Economic aspects; 5) Evidence; 6) and other factors. “Health effects/benefits” had the maximum frequency in health outcomes (8 studies); “disease severity” had the maximum frequency in disease and target population (12 studies); “the number of alternatives” had the maximum frequency in alternatives (2 studies); “cost-effectiveness” had the maximum frequency in economic aspects (15 studies); “quality of evidence” had the maximum frequency in evidence (4 studies); and “issues concerning the health system” had the maximum frequency in other factors (10 studies).
    Conclusion
    The results revealed an increase in the number of studies on health technologies priority setting around the world, and emphasized the necessity of application of a multi- criteria approach for appropriate decision making about healthcare technologies in the health systems.
    Keywords: Priority Setting, Priority Setting Criteria, Health Technology, Health Systems, Health Technology Assessment
  • Hesam Ghiasvand, Mohammad Moradi, Joo, Nazanin Abolhassani, Hamid Ravaghi *, Seyed Mansoor Raygani, Sahar Mohabbat, Bahar Pages 163-174
    Background
    It is estimated that major depression disorders constitute 8.2% of years lived with disability (YLDs) globally. The repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT) are two relative common interventions to treat major depressive disorders, especially for treatment resistant depression. In this study the cost- effectiveness and cost-utility of rTMS were compared with ECT in Iranian population suffering from major depressive disorder using a decision tree model.
    Methods
    A decision tree model conducted to compare the cost-effectiveness ratio of rTMS with ECT in a health system prospective and 7 months’ time horizon. The outcome variables were: response rate, remission rate and quality-adjusted life-years (QALYs) of the rTMS and ECT as primary and secondary outcomes extracted from systematic reviews and randomized control trials. The costs were also calculated through a field study in one clinic and one hospital; the direct costs have only been considered.
    Results
    The total cost for rTMS and ECTstrategieswere11015000Rials (373US$) and 11742700 Rials (397.7US$), respectively. Also the rTMS/ECT ratio of costs per improved patients was 1194410Rials (40.5 US$); the ratio for costs per QALYs utility was 21017139 Rials (711.72 US$). The incremental cost- effectiveness ratio of rTMS versus ECT was 1194410 Rials (40.44 US$) after treatment and maintenance courses.
    Conclusion
    Given the current prevalence of depressive disorders in Iranian population, the ECT is more cost-effective than TMS. The sensitivity analysis showed that if the prevalence of major depressive disorders declines to below 5% or the costs of rTMS decrease (rTMS provided by public sector), then the rTMS becomes more cost-effective compared with ECT. However, efficacy of rTMS depends on the frequency of pulsed magnetic field, the location of rTMS on the head, the number of therapeutic sessions and the length of each session.
    Keywords: Major Depressive disorders, Electroconvulsive Therapy, repetitive Transcranial Magnetic Stimula, tion, Decision tree
  • Alireza Mahboub, Ahari, Sakineh Hajebrahimi, Mahmoud Yusefi, Ashraf Velayati * Pages 175-182
    Background
    EOS is a 2D/3D muscle skeletal diagnostic imaging system. The device has been developed to produce a high quality 2D, full body radiographs in standing, sitting and squatting positions. Three dimensional images can be reconstructed via sterEOS software. This Health Technology Assessment study aimed to investigate efficacy, effectiveness and cost-effectiveness of new emerged EOS imaging system in comparison with conventional x-ray radiographic techniques.
    Methods
    All cost and outcome data were assessed from Iran's Ministry of Health Perspective. Data for clinical effectiveness was extracted using a rigorous systematic review. As clinical outcomes the rate of x-ray emission and related quality of life were compared with Computed Radiography (CR) and Digital Radiography (DR). Standard costing method was conducted to find related direct medical costs. In order to examine robustness of the calculated Incremental Cost Effectiveness Ratios (ICERs) we used two-way sensitivity analysis. GDP Per capita of Islamic Republic of Iran (2012) adopted as cost-effectiveness threshold.
    Results
    Review of related literature highlighted the lack of rigorous evidence for clinical outcomes. Ultra low dose EOS imaging device is known as a safe intervention because of FDA, CE and CSA certificates. The rate of emitted X-ray was 2 to 18 fold lower for EOS compared to the conventional techniques (p
    Conclusion
    EOS imaging technique might not be considered as a cost-effective intervention in routine practice of health system, especially within in-patient wards. Scenario analysis shows that, only in an optimum condition such as lower assembling costs and higher utilization rates, the device can be recruited for research and therapeutic purposes in pediatric orthopedic centers.
    Keywords: EOS imaging, Radiography, Health Technology Assessment, Cost, effectiveness
  • Saeideh Jafari Andarian, Alireza Olyaeemanesh *, Seyed Alireza Hosseini, Ali Akbari Sari, Shahram Firoozbakhsh, Mojtaba Nouhi Jadesi, Mohammadreza Mobinizadeh Pages 183-198
    Background
    Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease, which reduces the lung function and causes respiratory symptoms over time, and it is primarily associated with shortness of breath, cough and sputum production. Roflumilast, which is a long-acting selective inhibitor, reduces the anti-inflammatory effect of the main symptoms of COPD. The aim of this study was to compare the clinical effectiveness of adding roflumilast to the current treatment regimen of patients with severe COPD.
    Methods
    To retrieve the marker studies, medical databases were searched up to February 2014. We included studies, which compared the clinical effectiveness and safety of roflumilast as concomitant to Long-acting ß2-agonist/Long-acting muscarinic antagonist (LABA/LAMA) regimen, in adult patients with severe COPD. The number of exacerbations, changes in the lung function FEV1, FEV1/FVC and quality of life were the major predefined outcomes. Meta-analysis of outcomes was performed by the RevMan software, with I2> 50%, representing considerable heterogeneity.
    Results
    Seven randomized controlled trials and two systematic reviews were included. In terms of safety, participants were likely to experience more side effects from roflumilast compared to placebo, particularly gastrointestinal effects (diarrhea, nausea, vomiting), headache and weight loss. There was no significant difference in the risk of cardiac complications or flu-like symptoms or upper respiratory tract infection in the two groups. In terms of effectiveness, only a small improvement was observed in SGRQ (St George’s Respiratory Questionnaire) index. Roflumilast reduced moderate to severe attacks, and caused significant improvements in the lung function regardless of the severity of the disease and the concurrent use of other standard COPD therapies.
    Conclusion
    Roflumilast anti-inflammatory therapy reduces the chronic bronchitis symptoms in patients with moderate to severe COPD, and it can be safely used with other drugs simultaneously.
    Keywords: Roflumilast, COPD, Safety, Effectiveness
  • Malek Amini, Afsoon Hassani Mehraban *, Hamid Haghni, Ali Asghar Asgharnezhad, Mohammad Khayatzadeh Mahani Pages 199-209
    Background
    Participation is mostly cultural and familial based, and there is not any assessment scales for evaluating kids’ participation in Iranian context, therefore the purpose of this study was developing children’s participation assessment scale for Iranian children.
    Methods
    Development of this scale occurred in two phases; phase I: planning: following reviewing the literature and adopting and compiling some items of available evaluation tools in the area (such as CAPE, CPQ, CLASS, Life-H) and receiving advice from two expert panels, the preliminary94-item questionnaire was prepared. Phase II: construct: the survey study was carried out on40 children and 21 of their parents to assess the popularity of the activity in Iran; thus, the items of the questionnaire reduced to 92 and after face and content validity, the final version prepared with 71 items.
    Results
    The final 71-item questionnaire was developed in two parent-report and child-report versions. The 71 items based on the literature and expert panels’ advice were categorized in 8 areas of occupation according to Occupational Therapy Practice Framework (ADL, IADL, Play, leisure, social participation, education, work, and sleep/rest).
    Conclusion
    Iranian children’s participation assessment is a useful and culturally relevant tool to measure participation of Iranian children. It can be used in rigorous clinical and population-based research.
    Keywords: Scale development, Participation, Children, Outcome measure
  • Mojtaba Malek, Fatemeh Esfehanian, Atieh Amouzegar, Farzaneh Sarvghadi, Zohreh Moossavi, Mohammad R. Mohajeri, Tehrani, Mohammad E. Khamseh *, Alireza Amirbaigloo, Ameneh Ebrahim Valojerdi Pages 210-216
    Background
    Cushing's disease is the most prevalent cause of endogenous adrenocorticotrophic hormone hypersecretion. The aim of this study was to document the current clinical practice pattern in the management of Cushing's disease by Iranian Endocrinologists to determine their opinions and compare them with the current clinical practice guidelines.
    Methods
    An eight-item questionnaire dealing with diagnosis, treatment and follow up of patients with Cushing's disease was developed, piloted, and sent to the members of Iranian Endocrinology Society.
    Results
    Among 90 endocrinologists invited to participate in the survey, 76 replied. Most respondents selected overnight dexamethasone suppression test (ONDST) and assessment of 24-hour urinary free cortisol (UFC) as the best screening tests followed by midnight serum cortisol and midnight salivary cortisol. Classic high dose dexamethasone suppression test and measurement of serum ACTH were selected for localization of the primary lesion by 64.5%. The primary choice of treatment was trans-sphenoidal pituitary surgery (86.8%). For the recurrence of Cushing's disease, the preferred treatment modality was medical therapy followed by bilateral adrenalectomy, and pituitary re-surgery. In case of treatment failure after the first pituitary surgery and ketoconazole treatment, 51% chose bilateral adrenalectomy, while36.8% selected pasireotide only.
    Conclusion
    ONDST and UFC are two most common tests used to screen an index case with signs and symptoms of hypercortisolism. The primary choice of treatment in Cushing's disease is pituitary surgery. However, medical treatment by ketokonazol is preferred for the recurrences. Pasireotide is the second alternative after bilateral adrenalectomy in case of treatment failure after pituitary surgery and ketoconazole.
    Keywords: Cushing\'s disease, Diagnosis, Management, Clinical Practice
  • Mona Ebrahimipour Ebrahimipour *, Mohammad Reza Motamed, Hassan Ashayeri, Yahya Modarresi, Mohammad Kamali Pages 217-224
    Background
    Finding the right word is a necessity in communication, and its evaluation has always been a challenging clinical issue, suggesting the need for valid and reliable measurements. The Homophone Meaning Generation Test (HMGT) can measure the ability to switch between verbal concepts, which is required in word retrieval. The purpose of this study was to adapt and validate the Persian version of the HMGT.
    Methods
    The first phase involved the adaptation of the HMGT to the Persian language. The second phase concerned the psychometric testing. The word-finding performance was assessed in 90 Persian-speaking healthy individuals (20-50 year old; 45 males and 45 females) through three naming tasks: Semantic Fluency, Phonemic Fluency, and Homophone Meaning Generation Test. The participants had no history of neurological or psychiatric diseases, alcohol abuse, severe depression, or history of speech, language, or learning problems.
    Results
    The internal consistency coefficient was larger than 0.8 for all the items with a total Cronbach’s alpha of 0.80. Interrater and intrarater reliability were also excellent. The validity of all items was above 0.77, and the content validity index (0.99) was appropriate. The Persian HMGT had strong convergent validity with semantic and phonemic switching and adequate divergent validity with semantic and phonemic clustering.
    Conclusion
    The Persian version of the Homophone Meaning Generation Test is an appropriate, valid, and reliable test to evaluate the ability to switch between verbal concepts in the assessment of word-finding performance.
    Keywords: Homophone Meaning Generation Test, Language, Naming, Neuropsychological Assessment, Verbal Fluency
  • Alireza Olyaeemanesh, Mahbobeh Rahmani *, Reza Goudarzi, Abulghasem Rahimdel Pages 225-235
    Background
    Intravenous immunoglobulin (IVIG) is an established treatment of immune mediated demyelinating neuropathy including Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Recent trials suggest its efficacy in treating relapsing- remitting multiple sclerosis. IVIG exerts a number of effects, which may be beneficial in treating multiple sclerosis (MS): Reduction of inflammation, inhibition of macrophages, and promotion of remyelination. The aim of this study was to provide an overall assessment of the existing trials of safety and effectiveness of IVIG in relapsing- remitting MS compared to other drugs currently available for the treatment of disease activity in MS.
    Methods
    A systematic search strategy was applied to MEDLINE (PubMed and Ovid Medline (1990- Nov 2014)), Cochrane Library 2014, and Trip Database 2014, CRD. The reference lists from the identified trials, MS clinical handbooks and guidelines for the use of IVIG were studied. This article was conducted without language restrictions. Randomized controlled trials of IVIG in MS were selected. Sixteen double-blinded trails were randomly selected. Ten trials were excluded and we performed a meta-analysis on the six trials (537 participants) of IVIG in comparison to placebo. The methodological quality of the trials was assessed using Jadad checklist.
    Results
    The meta-analysis showed a significant beneficial effect on proportion of relapse-free patients (OR: 1.693; 95% CI-1.205-2.380), on the proportion of patients who improved (OR:2.977; 95% CI 1.769-5.010; p=0.0001) and deteriorated (OR:0.522; 95% CI0.330-0.827; p=0.006) between placebo and IVIG-treated patients. In addition, there was a reduction in the annual relapse rate in the IVIG group compared to placebo, which was statistically significant (SMD=-0.218; 95% CI-0.412 to -0.024; p=0.028). The results of the meta-analysis did not show significant differences between Expanded Disability Status Scale (EDSS) changes from baseline (SMD,-0.025; 95% CI,-0.211 to 0.161; p=0.860).
    Conclusion
    IVIG can be considered as an alternative therapeutic option, second-line therapy or adjuvant therapy, considering its beneficial effects (high tolerance, need to be injected with longer intervals, etc.) for treating relapsing–remitting MS patients.
    Keywords: Multiple sclerosis, Relapsing–remitting Multiple Sclerosis, Intravenous Immunoglobulin, Meta, analysis
  • Vitorino Modesto Dos Santos* Pages 236-237
  • Reza Tabrizi, Farzaneh Zolala, Maryam Nasirian, Mohammad Reza Baneshi, Abbas Etminan, Eghbal Sekhavati, Mahmoud Khodadost, Ali Akbar Haghdoost* Pages 238-245
    Background
    Chronic kidney disease is asymptomatic until its last stages and though it is increasing globally, we are faced with paucity of a population-based model to assess this disease, particularly in developing countries. Therefore, the aim of this study was to estimate the prevalence and trends of CKD according to a new estimation method.
    Methods
    Using multiplier method, we estimated the numbers of different stages of CKD based on the number of patients with end stage renal failure from 2006 to 2016. The required multipliers were extracted from a simulation of the disease in Kerman following a dynamic model. The 95% uncertainty interval was computed using Monte-Carlo technique with 10,000 iterations.
    Results
    The prevalence of CKDA (GFR
    Conclusion
    This study predicted an increase in the prevalence of CKD in the future. This may be due to the increasing life expectancy of the population, the increase in the prevalence of non- communicable diseases such as hypertension and diabetes, or patients’ survival due to receiving better support. Therefore, the policymakers should be concerned and well informed about this increase.
    Keywords: Chronic Renal Failure, Chronic Kidney Disease, Multiplier Method, Prediction in Iran
  • Mohsen Yaghoubi *, Maziar Moradi, Lakeh, Mohammad Moradi, Joo, Vafa Rahimi, Movaghar, Neda Zamani, Ahmad Naghibzadeh, Tahami Pages 246-258
    Background
    The present study aims to evaluate the cost-effectiveness of Dynamic Interspinous Spacer (Coflex®) and Static Spacer (X-STOP ®) compared to Laminectomy (LAMI) in patients with lumbar spinal stenosis.
    Methods
    A decision-analysis model was developed to estimate the cost-effectiveness. The effectiveness parameters were obtained from a systematic literature review in relevant databases including PUBMED and EMBASE. A meta-analysis was performed using the STATA statistical package and a random model was used to collect measures of mean difference of visual analogue scale (VAS) pain score before and after intervention in X-stop, Coflex and LAMI (95% confidence intervals). Cost data were obtained from provider and associated literature based on health care provider prospective. We assumed that the probability of the success rate of surgery in each intervention from associated literature and calculated Incremental cost effectiveness ratio. A one-way sensitivity analysis was also carried out.
    Results
    Twenty-four out of 294 studies are included in the Meta-analysis. The overall pooled estimate of the mean difference of VAS pain score were 3.49 (95% CI 3.7-4.2) and 4.14 (95% CI 3.09-5.19) for X-stop and Coflex, respectively. In addition, we assumed the overall pooled estimate of 5.3 (95% CI 2.15-7.4) on the basis of literature for LAMI. The average cost per LAMI surgery, X-stop and Coflex was US$ 3019, US$ 2022 and US$ 2566, respectively. Incremental cost effectiveness ratio of X-stop and Coflex versus LAMI was US$ 665.9 and US$ 780.7, respectively.
    Conclusion
    Static Interspinous Spacer (X-stop) appears to be the most cost-effective treatment strategy in base case scenario with success rate of LAMI (range between (55%-70%). A sensitivity analysis shows that the increase probability of success rate of LAMI was more than 70 % and less than 55% which lead to the cost effectiveness of the Coflex intervention.
    Keywords: laminectomy, interspinous, spinal stenosis, cost, effectiveness, lumbar vertebrae
  • Morteza Abdollahi, Forouzan Salehi, Naser Kalantar, Mohsen Asadilari, Mohammad Reza Khoshfetrat, Marjan Ajami* Pages 259-265
    Background
    The consumption of low quality foods is common in low socioeconomic areas; and according to epidemiological studies, the density of nutrients often proves the quality of diet. This study aimed to compare the density of macronutrients and micronutrients in various parts of Tehran.
    Methods
    This was a cross-sectional study performed from September to December 2007 in all the 22 districts of the municipality of Tehran including 1,807 households. Experienced interviewers completed a 24-hour recall questionnaire. To estimate the nutrient densities, nutrient intake (grams or milligrams) was calculated per 1,000 kcal energy intake. To calculate the density of energy intake, energy intake (kcal) was divided by 100 g of foodstuff. The 22 districts of Tehran were divided into five zones of north, center, east, west and south. ANOVA and Tukey tests were used.
    Results
    The highest density of protein and fat intake was observed in the north of Tehran, while carbohydrate density was highest in the west, east and south zones, and energy density was highest in the south zone (p
    Conclusion
    Despite the high density of energy in the south of Tehran, a deficiency of micronutrient intake was obvious, reflecting the importance of the impact of socioeconomic factors.
    Keywords: Energy Density, Macronutrients Density, Micronutrients Density, Socioeconomic Status
  • Behnam Hajiaghaei, Ismail Ebrahimi, Mojtaba Kamyab, Hassan Saeedi *, Maryam Jalali Pages 266-272
    Background
    Creating a socket with proper fit is an important factor to ensure the comfort and control of prosthetic devices. Several techniques are commonly used to cast transtibial stumps but their effect on stump shape deformation is not well understood. This study compares the dimensions, circumferences and volumes of the positive casts and also the socket comfort between two casting methods. Our hypothesis was that the casts prepared by air pressure method have less volume and are more comfortable than those prepared by weight bearing method.
    Methods
    Fifteen transtibial unilateral amputees participated in the study. Two weight bearing and air pressure casting methods were utilized for their residual limbs. The diameters and circumferences of various areas of the residual limbs and positive casts were compared. The volumes of two types of casts were measured by a volumeter and compared. Visual Analogue Scale (VAS) was used to measure the sockets fit comfort.
    Results
    Circumferences at 10 and 15 cm below the patella on the casts were significantly smaller in air pressure casting method compared to the weight bearing method (p=0.00 and 0.01 respectively). The volume of the cast in air pressure method was lower than that of the weight bearing method (p=0.006). The amputees found the fit of the sockets prepared by air pressure method more comfortable than the weight bearing sockets (p=0.015).
    Conclusion
    The air pressure casting reduced the circumferences of the distal portion of residual limbs which has more soft tissue and because of its snug fit it provided more comfort for amputees, according to the VAS measurements.
    Keywords: Transtibial prosthesis, Weight bearing, Cast, Air pressure
  • Elahe Shojaei, Hassan Ashayeri *, Zahra Jafari, Mohammad Reza Zarrin Dast, Koorosh Kamali Pages 273-279
    Background
    Speech perception ability depends on auditory and extra-auditory elements. The signal-to-noise ratio (SNR) is an extra-auditory element that has an effect on the ability to normally follow speech and maintain a conversation. Speech in noise perception difficulty is a common complaint of the elderly. In this study, the importance of SNR magnitude as an extra-auditory effect on speech perception in noise was examined in the elderly.
    Methods
    The speech perception in noise test (SPIN) was conducted on 25 elderly participants who had bilateral low–mid frequency normal hearing thresholds at three SNRs in the presence of ipsilateral white noise. These participants were selected by available sampling method. Cognitive screening was done using the Persian Mini Mental State Examination (MMSE) test.
    Results
    Independent T- test, ANNOVA and Pearson Correlation Index were used for statistical analysis. There was a significant difference in word discrimination scores at silence and at three SNRs in both ears (p≤0.047). Moreover, there was a significant difference in word discrimination scores for paired SNRs (0 and , 0 and , and and (p≤0.04)). No significant correlation was found between age and word recognition scores at silence and at three SNRs in both ears (p≥0.386).
    Conclusion
    Our results revealed that decreasing the signal level and increasing the competing noise considerably reduced the speech perception ability in normal hearing at low–mid thresholds in the elderly. These results support the critical role of SNRs for speech perception ability in the elderly. Furthermore, our results revealed that normal hearing elderly participants required compensatory strategies to maintain normal speech perception in challenging acoustic situations.
    Keywords: Word Discrimination Score, Signal to Noise Ratio, Elderly
  • Rasoul Yarahmadi, Parvin Moridi, Yarallah Roumiani* Pages 280-288
    Background
    Research project risks are uncertain contingent events or situations that, if transpire, will have positive or negative effects on objectives of a project. The Management of Health and Safety at Work (MHSW) Regulations 1999 require all employers and the self-employed persons to assess the risks from their work on anyone who may be affected by their activities. Risk assessment is the first step in risk-management procedure, and due to its importance, it has been deemed to be a vital process while having a unique place in the research-based management systems.
    Methods
    In this research, a two-pronged study was carried out. Firstly, health and safety issues were studied and analyzed by means of ISO 14121. Secondly, environmental issues were examined with the aid of Failure Mode and Effect Analysis. Both processes were utilized to determine the risk level independently for each research laboratory and corrective measure priorities in each field (laboratory).
    Results
    Data analysis showed that the total main and inherent risks in laboratory sites reduced by 38% to 86%. Upon comparing the average risk levels before and after implementing the control and protective actions utilizing risk management approaches which were separate from health, safety and environmental aspects, a highly effective significance (p
    Conclusion
    The large number of engineering measures was attributed to the employment of a variety of time-worn machinery (old technologies) along with using devices without basic protection components.
    Keywords: Total risk, Laboratory site, Risk management
  • Masoumeh Hosseini, Alireza Olyaeemanesh, Batoul Ahmadi *, Saharnaz Nedjat, Faranak Farzadi, Mohammad Arab, Arash Rashidian Pages 289-298
    Background
    Gender inequality harms the health of millions of women and girls in all over the world. This study aimed to identify the state of gender equity in the health sector of the Islamic Republic of Iran.
    Methods
    This study was based on the secondary analysis of the available data in four provinces. The research team held three sessions to select the appropriate indicators for measuring gender equity in Iran. Moreover, using the data of different sources, the indexes were evaluated by applying the brain storming method.
    To demonstrate the difference between females and males, the ratio of females to males was measured in each indicator. The confidence intervals were used to show significant differences in the gap between men and women. Educational indicators were analyzed using the appraisal framework of UNESCO and International Institute for Education Planning.
    Results
    Findings revealed gender equality in the indicators of education and under–five underweight in all the provinces. However, the indicator of information on the mild psychological diseases showed inequality in favor of males. Infants’ mortality, under-five mortality, crude death, drug abuse and smoking showed inequality in favor of females in all the four provinces. The incidence of tuberculosis, severe psychological diseases, and basic and supplementary insurance coverage was equal in all provinces except Tehran.
    Conclusion
    This study revealed gender inequality in many indicators among the provinces. Therefore, improving this condition requires policymaking, planning, and conducting appropriate strategies with proper gender approaches.
    Keywords: Equity in Health, Gender Equality, Gender Equity in Health, Women's Health
  • Reza Dehnavieh, Nadia Mirshekari, Sara Ghasemi, Reza Goudarzi, Ali Akbar Haghdoost, Mohammad Hossain Mehrolhassani, Zahra Moshkani, Somayeh Noori Hekmat* Pages 299-309
    Background
    Every year millions of dollars are expended to equip and maintain the hospital sterilization centers, and our country is not an exception of this matter. According to this, it is important to use more effective technologies and methods in health system in order to reach more effectiveness and saving in costs. This study was conducted with the aim of evaluating the technology of regional sterilization centers.
    Methods
    This study was done in four steps. At the first step, safety and effectiveness of technology was studied via systematic study of evidence. The next step was done to evaluate the economical aspect of off-site sterilization technology using gathered data from systematic review of the texts which were related to the technology and costs of off-site and in-site hospital sterilization. Third step was conducted to collect experiences of using technology in some selected hospitals around the world. And in the last step different aspects of acceptance and use of this technology in Iran were evaluated.
    Results
    Review of the selected articles indicated that efficacy and effectiveness of this technology is Confirmed. The results also showed that using this method is not economical in Iran.
    Conclusion
    According to the revealed evidences and also cost analysis, due to shortage of necessary substructures and economical aspect, installing the off-site sterilization health technology in hospitals is not possible currently. But this method can be used to provide sterilization services for clinics and outpatients centers.
    Keywords: Health technology assessment, Off, site sterilization, In, house sterilization
  • Mahnaz Sanjari, Fatemeh Jafaraghayee, Maryam Aalaa, Neda Mehrdad* Pages 310-312
    Précis: This debate article highlights some questions from critics of qualitative research. Planning for proper design, philosophical background, researcher as a research instrument in the study, trustworthiness and application of findings are main debates in this field. One of the issues that have been received little attention is report of qualitative inquiry. A qualified report can answer the critics. This requires that the qualitative articles cover all points about the selected method and rigourness of study conduct to convince policy makers, managers and all readers in different level.
    Keywords: Quality improvement, Health care field, Qualitative research
  • Zahra Kavosi, Maryam Sarikhani Khorrami, Khosro Keshavarz, Abdosaleh Jafari, Amir Hashemi Meshkini, Hamid Reza Safaei, Shekoufeh Nikfar* Pages 313-326
    Background
    Prevention of catheter-related infection is of prime importance,. However, because of the risks caused by the leakage of circulating antibiotics and development of resistance to antibiotics, they are replaced by lock solutions. The aim of this study was to evaluate the efficacy and cost- effectiveness of taurolidine-citrate as a hemodialysis catheter lock solution compared to other common alternatives in Iran.
    Methods
    To evaluate the efficacy of taurolidine-citrate, a systematic review was conducted by searching electronic databases. The outcomes of interest for cost-effectiveness analysis were as follows: “Catheter-related bacteremia episodes”; “catheter-related bacteremia-free survival”; “catheter thrombosis rate” for efficacy evaluation and "reduction of catheter-related infection". For evidence synthesis, a meta-analysis was conducted on the extracted efficacy data. To evaluate the cost of treatments, direct medical costs were included, and the incremental cost-effectiveness ratio was calculated for each comparison. The payers’ (patients and insurance companies) perspectives were used for cost analysis.
    Results
    After carrying out the systematic process, three articles were included in the analysis. Considering 95% confidence interval, the relative difference was -0.16 (-0.25 to -0.07) for catheter-related bacteremia episode, indicating that the rate of catheter-related infections in hemodialysis patients who used taurolidine-citrate was 16% less than in those hemodialysis patients who received heparin. Considering 95% confidence interval, the relative difference was 0.13 (-0.06 0.32) for catheter thrombosis, showing that the rate of catheter-related thrombosis in hemodialysis patients who used taurolidine-citrate was 13% more than in hemodialysis patients who received heparin. The results of this analysis indicated that taurolidine-citrate, compared to heparin, was more effective in preventing catheter-related infection; therefore, it could be considered as a superior strategy. Nevertheless, compared to heparin-gentamicin combination, taurolidine-citrate is an inferior strategy because of its higher cost and lower infection prevention.
    Conclusion
    Compared to heparin, taurolidine-citrate is a superior option, but it is an inferior strategy compared to heparin-gentamicin combination. The clinical evidences on taurolidine-citrate, heparin and gentamicin/heparin are not sufficient for making confident decisions.
    Keywords: Taurolidine, Citrate, Taurolock, Health Technology Assessment, Cost, effectiveness
  • Marzieh Nojomi, Maziar Moradi, Lakeh, Ashraf Velayati, Ahmad Naghibzadeh, Tahami, Haleh Dadgostar, Gholamhossein Ghorabi, Mohammad Moradi, Joo, Mohsen Yaghoubi* Pages 327-340
    Background
    The burden of obesity and diet-related chronic diseases is increasing in Iran, and prevention and treatment strategies are needed to address this problem. The aim of this study was to determine the outcome, cost, safety and cost-consequence of non-invasive weight loss interventions in Iran.
    Methods
    We performed a systematic review to compare non-invasive interventions (cryolipolysis and radiofrequency/ ultrasonic cavitation) with semi-invasive (lipolysis) and invasive (liposuction). A sensitive electronic searching was done to find available interventional studies. Reduction of abdomen circumference (cm), reduction in fat layer thickness (%) and weight reduction (kg) were outcomes of efficacy. Meta-analysis with random models was used for pooling efficacy estimates among studies with the same follow-up duration. Average cost per intervention was estimated based on the capital, maintenance, staff, consumable and purchase costs.
    Results
    Of 3,111 studies identified in our reviews, 13 studies assessed lipolysis, 10 cryolipolysis and 8 considered radiofrequency. Nine studies with the same follow-up duration in three different outcome group were included in meta-analysis. Radiofrequency showed an overall pooled estimate of 2.7 cm (95% CI; 2.3-3.1) of mean reduction in circumference of abdomen after intervention. Pooled estimate of reduction in fat layer thickness was 78% (95% CI; 73%-83%) after Lipolysis and a pooled estimate of weight loss was 3.01 kg (95% CI; 2.3-3.6) after lipousuction. The cost analysis revealed no significant differences between the costs of these interventions.
    Conclusion
    The present study showed that non-invasive interventions appear to have better clinical efficacy, specifically in the body shape measurement, and less cost compared to invasive intervention (liposuction).
    Keywords: Radiofrequency, Cryolipolysis, Lipolysis, Liposuction, Cost, Consequence, Systematic review, Meta, analysis
  • Farzaneh Maleki, Zahra Hosseini Nodeh, Zahra Rahnavard *, Masoume Arab Pages 341-349
    Background
    Since type-2 diabetes is the most common chronic disease among Iranian female adolescents, we applied theory of planned behavior to examine the effect of training to intention to preventative nutritional behaviors for type-2 diabetes among female adolescents.
    Methods
    In this experimental study 200 (11-14 year old) girls from 8 schools of Tehran city (100 in each intervention and control group) were recruited based on cluster sampling method during two stages. For intervention group, an educational program was designed based on the theory of planned behavior and presented in 6 workshop sessions to prevent type-2 diabetes. The data were collected before and two months after the workshops using a valid and reliable (α=0.72 and r=0.80) author-made questionnaire based on Ajzens TPB questionnaire manual. The data were analyzed using t-test, chi-square test and analysis of covariance.
    Results
    Findings indicate that the two groups were homogeneous regarding the demographic characteristics before education, but the mean score of the theory components (attitudes, subjective norms, perceived behavioral control, and intention) was higher in the control group. Also, results showed all of the theory components significantly increased after the education in the intervention group (p=0.000).
    Conclusion
    Training based on the theory of planned behavior enhances the intention to adherence preventative nutritional behaviors for type-2 diabetes among the studied female adolescents.
    Keywords: Health education, Theory of planned behavior, Diabetes Mellitus Type 2, adolescents
  • Esmaeil Rezaei, Hadi Sedigh Ebrahim, Saraie, Hamid Heidari, Parichehr Ghane, Khadijeh Rezaei, Jamal Manochehri, Mohsen Moghadami, Parvin Afsar, Kazerooni, Ali Reza Hassan Abadi, Mohammad Motamedifar* Pages 350-355
    Background
    The human immunodeficiency virus (HIV) is one of the most life- threatening human infections. The advent of highly active antiretroviral therapy (HAART) has dramatically changed the course of HIV infection and patient's quality of life. In addition to the benefits, HAART can have numerous side effects and toxicities. Therefore, we aimed to assess the impact of short-term vitamins treatment on hematological parameters of HIV infected patients receiving HAART.
    Methods
    This cross-sectional study was conducted on 100 confirmed HIV positive patients who referred to Shiraz HIV/AIDS research center in southwest of Iran. The first-line of HAART regimen contained Zidovudine, Lamivudine, and Efavirenz. The studied population received vitamin B12 weekly and folic acid daily for at least one month.
    Results
    After receiving HAART for at least 6 months with adherence above 90%, significant differences (p
    Conclusion
    Combined administration of B12 and folate supplements is a beneficial adjuster on hematologic status of HIV infected persons receiving HAART. However, future research with larger studied population and longer follow-up periods is required. Moreover, especial attention should be given to gender because the effect of vitamins was significantly different on some hematologic parameters between different genders.
    Keywords: HIV, HAART, Vitamin B12, Folic acid, Hematology
  • Ali Sheidaei, Alireza Abadi *, Farid Zayeri, Fatemeh Nahidi, Nafiseh Gazerani, Anita Mansouri Pages 356-363
    Background
    Infantile colic, cry-fuss and sleep problems are transient in the initial months of life, but they contribute to maternal depression, parenting stress and family mental health problems. In this randomized clinical trial, we aimed to explore the efficacy of massage therapy compared to rocking in reducing infantile colic symptoms including duration and number of cries, sleep duration and severity of infant colic.
    Methods
    This was a single blind RCT study with a one-week follow-up. One hundred colicky infants aged younger than 12 weeks old were randomly assigned into massage and rocking groups. Infants in the massage group received a massage for 15-20 minutes once during a day and once at night before sleeping for a week. In the control group, mothers rocked their infants gently for 5-25 minutes when the symptoms of colic appeared. Parents recorded the details of the colic symptoms in a diary every day. A GEE approach was applied to explore the effect of the intervention.
    Results
    Efficiency of massage therapy was significantly higher than rocking. At the end of the study, the mean number of daily cries was 4.26±1.40 in the massage and 6.9±2.14 the rocking groups (p
    Conclusion
    Massaging significantly improved colic symptoms during a one-week intervention for all outcomes. In addition, significant differences were found between the intervention and control groups in favor of massaging. Therefore, massage therapy is more effective than rocking for treating infant colic symptoms.
    Keywords: Colic, Massage, Clinical Trial, Pediatrics
  • Mansoureh Vahdat, Elaheh Sariri, Maryam Kashanian, Zahra Najmi*, Alireza Mobasseri, Mahjabin Marashi, Behnaz Mohabbatian, Shideh Ariana, Yousef Moradi Pages 364-367
    Background
    Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard for evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about the accuracy of these tests. The aim of this study was to evaluate the accuracy of the combination of TVS and HSG with hysteroscopy as the gold standard.
    Methods
    Medical records of infertile women who were undertaken all three diagnostic modalities were reviewed to analyze their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
    Results
    Ninety-nine infertile women were assessed with a mean±SD age of 29.1±6.47 years, mean±SD duration of themarriage of 8.9±10.28 years, and mean±SD duration of infertility of 5.6± 4.16 years. The sensitivity, specificity, PPV, and NPV of TVS were 98.55%, 30%, 76.4%, and 90%, respectively. HSG had a sensitivity of 95.6%, specificity of 60%, PPV of 84.62%, and NPV of 85.71%.When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 94.2, 66.67, 86.67, and 83.33%, respectively. The diagnostic accuracy of single TVS, HSG or combined techniques was statistically similar that was equal to 77.7, 84.8 and 85.8 % respectively.
    Conclusion
    The accuracy of combination of two diagnostic modalities, 2D TVS and HSG is not higher than HSG alone for assessing uterine malformation in infertile women.
    Keywords: Ultrasound, Hysterosalpingography, Hysteroscopy, Müllerian anomaly, Accuracy, Infertility
  • Koorosh Etemad, Parvin Ebrahimi, Hassan Azimi, Mansoureh Lotfi, Marzieh Nojomi* Pages 368-376
    Background
    Media advertisements especially radio and TV are one of the most important and effective ways for health promotion and consumption of healthy productions worldwide. Ministry of Health and some other ministries in Iran agreed to control and restrict the advertising of unhealthy products and services. Therefore, adequate supervision and monitoring should be done in this field. A content analysis of Health-related Advertisements was done in Islamic Republic of Iran Broadcasting (IRIB)
    Methods
    This study was a cross-sectional research and collecting of data was carried out in 2012. Ten selected TV and radio channels were recorded from 6 a.m. to 12 p.m. for two successive months in the special weekdays. Broadcasted advertisements data were extracted by the trained observers according to a checklist and analyzed using SPSS 18 software and described with descriptive statistics.
    Results
    The percentage of different types of advertising were including 73.9% unrelated to health, 21.9% harmless health related, 2.9% less healthy, 1.3% harmful or harmful with a probability of abuse. Non-harmful to health advertisements included 95.86% of total advertisements out of ten TV and radio channels; and the remained advertisements (4.14%) were related to the harmful, less healthy foodstuff and detrimental services and products. Also, 0.8% of the advertisements were shown during children programs.
    Conclusion
    The main findings of the current study revealed that majority of the advertisements of Islamic Republic Broadcasting were unrelated to health. It seems advertising of harmful for health in IRIB was less than 5%, and the levels of these type ads were less than the other countries. Even so, the policymakers need to pass and enforce some executive and governing law for the prevention of broadcasting unhealthy advertisements to increase the society health level and prevent the diseases resulted from unhealthy products causing the considerable damages in a long time.
    Keywords: Advertisements, Health, Television, Radio
  • Fateme Arabi Basharic, Alireza Olyaee Manesh*, Mohammad Ranjbar Ezzat Abadi, Seyed Mostafa Shiryazdi, Hussein Shabahang, Ali Jangjoo Pages 377-384
    Background
    Prevalence of obesity in the world, in both developed and developing countries, is growing rapidly. Bariatric surgery is now accepted as the treatment for morbid obesity.
    Objective
    This study compares laparoscopic sleeve gastrectomy's effectiveness (LSG) with the most common bariatric surgery, laparoscopic Roux-en-Y (LRYGB) gastric bypass.
    Methods
    A systematic review was performed using relevant search data bases, including Cochrane library, PubMed, Magi ran, Iranmedex, SID and Trip database, with no time limit. Data bases were searched until July 2014 for randomized control trials. The studied population included people aged between 18–60 years, with BMI≥35 and at least one obesity-related disease, or people with BMI≥40. BMI change, as the research outcome, was investigated at least in one-year follow-up period. Cochrane criteria were used to assess quality of studies. The results were extracted from the articles.
    Results
    In total, 384 articles were obtained in the search; six RCTs were included in this study. There was no significant difference between the two laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass procedures in BMI, and both groups were similar in weight loss CI [-.1.31, 0.43], p=0.32.
    Conclusion
    The two procedures of bariatric surgery are effective and reliable treatments. Performing more trial studies with greater sample size and longer follow-up period for making final decision in selecting a certain surgical procedure is essential.
    Keywords: Sleeve gastrectomy, Roux, en, Y gastric bypass, Morbid obesity
  • Kamyar Mansori, Hamid Soori *, Fariba Farnaghi, Sohila Khodakarim, Shiva Mansouri Hanis, Mahmoud Khodadost Pages 385-391
    Background
    Poisoning is a major public health problem and is one of the most frequent causes of emergency hospital admissions. The aim of this study was to identify the main risk factors for unintentional childhood poisoning in Tehran, Iran and to suggest possible causes and preventative measures.
    Methods
    In this case-control study (case, n=140; control, n=280), two controls were selected for every case. Controls were matched by age, sex, and date of hospital attendance. All children and their guardians were then interviewed by the same person using a standard questionnaire that covered the demographic, behavioral, and risk factors associated with accidental poisonings.
    Results
    The most common type of poisoning was related to narcotics (58.6%); and among the narcotics, methadone was the most prevalent poisoning agent (74.7%). Multivariate conditional logistic regression model revealed that addiction in the family (OR=14.6; 95% CI:6.2-34.6), previous poisoning (OR=7; 95% CI:2.4-20.2), maternal occupation (OR=4; 95% CI:1.3- 12.3), and inaccessibility of poisoning products (OR=0.03; 95% CI:0.01- 0.12) were the main risk factors in unintentional childhood poisoning.
    Conclusion
    Addiction in the family as a risk factor and inaccessibility of poisoning products as a protecting factor were recognized to have the highest correlation with the unintentional child poisoning. These two factors were considered as priorities in health education programs.
    Keywords: Risk Factors, Unintentional Childhood Poisoning, Case, Control, Hospital
  • Mansoureh Ashghaly Farahani, Fatemeh Oskouie *, Fatemeh Ghaffari Pages 392-394
  • Farzad Ashrafi, Behdad Behnam, Mehran Arab Ahmadi, Morteza Sanei Taheri, Hamid Reza Haghighatkhah*, Hossein Pakdaman, Seyed Mohammad Hadi Kharrazi Pages 395-400
    Background
    Magnetic resonance imaging (MRI) has improved the diagnosis and management of patients with multiple sclerosis (MS). Montreal Cognitive Assessment (MoCA) is a brief, sensitive test that has been recommended by National Institute of Neurological Diseases and Stroke and Canadian Stroke Network (NINDS-CSN) as a reliable tool to detect mild cognitive impairments. This study aimed to evaluate the relationship between MoCA test and its sub-items with brain abnormalities in MRI of MS patients.
    Methods
    Based on MRI scans of 46 MS patients, third ventricle and white matter lesions volumes were measured. Disease duration and expanded disability status scale (EDSS) were recorded in each patient. In addition, cognitive domains of the patients were evaluated by Montreal cognitive assessment (MoCA) test. We analyzed data using t-test or Mann-Whitney U test, Pearson correlation coefficient, and non-parametric Spearman test. Furthermore, multiple linear regression model was applied to evaluate the association between cognitive indices and MRI characteristics.
    Results
    Among MRI indices, only severity of atrophy showed a significant difference between cognitively impaired and cognitively preserved patients. Third ventricular volume was significantly correlated with total MoCA score (p=0.003, r=-0.42), but none of the juxtacortical or periventricular lesions volume revealed significant relation with total MoCA score. However, using multivariate linear regression after adjustment for educational level and disease duration, there was a significant negative association between juxtacortical lesions volume and total MoCA score as well as naming and attention sub-items. Also, memory score was adversely associated with the third ventricular volume (p=0.03, r=0.31).
    Conclusion
    Cognitive disturbances detected by MoCA, may be associated with some pathological changes including atrophy, third ventricular volume, and juxtacortical lesion. MoCA, as a brief test, is not correlated with brain lesions volume in MS patients.
    Keywords: Multiple Sclerosis, MRI, Cognitive Function, Lesions Volume, MoCA
  • Noushin Jalayer Naderi*, Farrokh Tirgari, Zahra Keshavarz Pages 401-406
    Background
    New blood vessels formation is a critical step in tumor progression. Vascular density affects the clinical outcome and prognosis of malignant tumors. The aim of this study was to investigate the relation between the Vascular Endothelial Growth Factor (VEGF) expression and vascular density with the clinical and histopathologic features in oral squamous cell carcinoma (OSCC).
    Methods
    In this retrospective study, 22 paraffin embedded block of well-differentiated OSCC were examined immunohistochemically for VEGF expression. Vascular density was determined by counting the blood vessels in 6 fields with 100 (HPF) on hematoxylin-eosin stained slides. The relation between the VEGF expression and vascular density with clinical and histopathologic features were analyzed by t-test, ANOVA, and Chi-square tests.
    Results
    A significant relation between gender (P=0.06) and tumor size (p=0.05) with vascular density was obtained. The relation between VEGF expression and gender (p=0.41), age (p=0.35), lymph node involvement (p=0.38), tumor size (p=0.15) and tumor differentiation (p=0.34) was not significant. The relation between vascular density and age (p=0.55), lymph node involvement (p=0.20), and tumor differentiation (p=0.80) was not significant.
    Conclusion
    Blood vessels formation relates to tumor size. Controlling the tumor size by manipulating the blood vessels formation may contribute to the inhibition of tumor progression in malignant tumors.
    Keywords: Oral, Squamous Cell Carcinoma, Vascular Endothelial Growth Factor, Microvessel density
  • Mohammad Rezapour, Somayeh Taran, Mahmood Balin Parast, Morteza Khavanin Zadeh* Pages 407-414
    Background
    Vascular Access (VA) is an important aspect for blood circulatory in Hemodialysis (HD). Arteriovenous Fistula (AVF) is a suitable procedure to gain VA. Maturation of the AVF is a status of AVF, which can be cannulated for HD. This study aimed to discover the parameters that effectively reduce the duration between VA and start of HD, which symbolizes the maturation time (MT).
    Methods
    Ninety-six patients who underwent AVF creation were selected for this study. The decision tree method was used based on CART/C4.5 algorithm, which is one of the data mining approaches for data classification. Vascular diameter ratio (VDR) coefficient was obtained (VDR=Artery/Vein diameters).
    Results
    We investigated the relationship between the VDR and MT in this study and found that MT is reversely related to VDR in elderly patients, while this relation was direct in younger patients.
    Conclusion
    The analysis revealed a Spearman's correlation coefficient for Vein diameter with MT. MT decreases when diameters of vein and artery are close to one another. This study can help the surgeons to identify high- risk patients who elongate MT for HD.
    Keywords: Data Mining, Hemodialysis, Maturation Time, Vascular Diameter Ratio, Thermodynamics
  • Mohsen Bayati, Sajad Vahedi, Firooz Esmaeilzadeh, Zahra Kavosi, Zahra Jamali, Abdolhalim Rajabi, Yousef Alimohamadi* Pages 415-420
    Background
    As one of the main criteria of health outcomes, maternal mortality indicates the socioeconomic development level of countries. The present study aimed at identifying and analyzing the effective factors on maternal mortality in Eastern Mediterranean Region (EMR) of the World Health Organization (WHO).
    Methods
    Analytical model was developed based on the literature review. Panel data of 2004-2011 periods for 22 EMR countries was used. Required data were collected from WHO online database. Based on results of diagnostic tests for panel data model, parameters of model were estimated by fixed effects method.
    Results
    Descriptive statistics demonstrated the large disparities in social, economic, and health indicators among EMRO countries. Findings obtained from evaluating the model showed a negative, significant relationship between GDP per capita (β=-0.869, p
    Conclusion
    Improved income and economic development, increased resources allocated to the health sector, improved delivery services particularly the increased use of trained staff in the delivery, improve quality of primary care centers, mitigating the risks of marginalization and its dangers, and especially improving the level of women's education and knowledge are the key factors in policy making related to maternal health promotion.
    Keywords: Maternal mortality rate, Maternal health, Panel data model, EMRO
  • Seyyed Hasan Karbasy, Pooya Derakhshan* Pages 421-425
    Background
    The administration of opioids before induction of general anesthesia can be considered as a problem in cesarean section. The aim of this study was to compare the effects of intravenous Fentanyl as a premedication before induction of general anesthesia versus placebo on maternal hemodynamic parameters and on the first and fifth minutes Apgar score in the neonates in elective cesarean delivery.
    Methods
    This double- blinded, randomized, clinical trial study was conducted in 2014-2015 at Vali-e-Asr hospital, Birjand, Iran. Ninety full term pregnant women undergoing elective cesarean section delivery under general anesthesia were selected. The participants were randomly classified into two groups: The Fentanyl group and the placebo. Iintravenous Fentanyl 1μg/kg was administrated three minutes before anesthesia induction for the Fentanyl group, and 2 milliliter normal saline was administered for the placebo group. Maternal mean arterial pressure, heart rate before the start of anesthesia induction and thirty seconds after intubation were measured. Also, the first and fifth minutes Apgar scores of the neonates were evaluated and recorded by a blinded anesthesiologist. The clinical trial registration number was IRCT2015010320112N3.
    Results
    Maternal mean arterial pressure was significantly lower in the Fentanyl group than the placebo group after intubation. Heart rate was significantly higher in the placebo group before the start of anesthesia induction and after intubation compared to the Fentanyl group. The first and fifth minutes’ Apgar scores of the neonates were not statistically different between the two groups.
    Conclusion
    Administration of 1μg/Kg intravenous Fentanyl before the induction of anesthesia for cesarean section delivery decreases maternal hemodynamic changes after intubation. In addition, it does not have any effect on Apgar scores of the neonate in the 1st and 5th minutes after birth.
    Keywords: Fentanyl, Apgar score, Cesarean section, Anesthesia, Neonates
  • Alireza Shams Moattar, Fariba Asghari, Reza Majdzadeh* Pages 426-431
    Background
    Dealing with ethical considerations is a major component of Health Technology Assessment (HTA) definitions.
    Objectives
    Present study aimed to explore and describe the manner of ethical analyses in HTA reports and the effects it had on HTA-related decision making around the world.
    Methods
    By considering the contextual milieu of reports and searching for ethical themes and subjects in HTA full reports, a descriptive analysis of HTA report's contents and related processes was conducted. The review focused on all English HTA reports issued in a year. All ethical aspects, criteria, approaches, and also decision-making related ethical issues were described and summarized in retrieved reports. The inclusion of ethical aspects in final decision-making criteria of HTA reports was also considered.
    Results
    Eighty-nine HTA reports issued in one year were included in this review and analyzed for ethical considerations. There was no trace of any ethical issues in 60.7% of retrieved HTA reports. Dimensions of equity in resource distribution, stakeholder engagement, social values, essence and nature of technology, and ethical issues about the method of assessment for decision making, and physician-patient relationship were raised and discussed in 38.2%, 3.4%, 3.4%, 3.4%, 34.8% and 3.4% of reports respectively. Those issues were also included in 44.1, 5.9, 2.9, 2.9, 0 and 2.9% of final reports, respectively. In overall, only in 16 cases (17.9%) of all 89 reports, ethical issues were included in HTA decision-making orientations.
    Conclusion
    This review shows that ethical issues are occasionally raised and discussed in HTA reports. More importantly, the inclusion of ethical concerns as a decision criterion in HTAs is few and insufficient.
    Keywords: Health Technology Assessment, Ethical considerations, Ethical analysis, Decision process
  • Masoud Mehrpour *, Mohammad Mehrpour Pages 432-436
    Background
    Hemorrhagic Transformation (HT) of Ischemic Stroke (IS) is a detrimental complication. This study investigated the association between serum ferritin level and HT in patients with massive IS of middle cerebral artery.
    Methods
    Thirty patients with massive IS of middle cerebral artery were enrolled in this prospective cohort study. They were divided into two groups based on the serum ferritin level, lower or greater than 164.1ng/ml at the first 24 hours after admission. To investigate the incidence of HT in the two groups, we observed them for two weeks.
    Results
    During the two- week observation, the incidence of HT was two persons (13.3%) in the group with the serum ferritin level of lower than 164.1ng/ml, and eight persons (53.3%) in the other group. This difference was statistically significant between the two groups (p=0.02). The relative risk of HT was 4 (95% CI: 1.012-15.8) in the patients with massive IS of middle cerebral artery and the serum ferritin level greater than 164.1ng/ml.
    Conclusion
    This study revealed that the serum ferritin level greater than 164.1ng/ml in the first 24 hours after admission is a reasonably important predictor for HT of IS. Conducting studies on factors affecting the serum ferritin level are suggested.
    Keywords: Stroke, Hemorrhagic Transformation, Ferritin
  • Mahmud Badiei, Mitra Gharib*, Mitra Zolfaghari, Rita Mojtahedzadeh Pages 437-443
    Background
    Training methods that enhance nurses’ learning and retention will increase the quality of patient care. This study aimed to compare the effectiveness of electronic learning and educational booklet on the nurses’ retention of diabetes updates.
    Methods
    In this controlled trial study, convenience sampling was used to select 123 nurses from the endocrinology and internal medicine wards of three hospitals affiliated to Tehran University of Medical Sciences (Tehran, Iran). The participants were allocated to three groups of manual, electronic learning, and control. The booklet and electronic learning groups were trained using educational booklet and electronic continuous medical education (CME) website, respectively. The control group did not receive any intervention. In all the three groups, the nurse's knowledge was measured before the intervention, and one and four weeks after the intervention. Data were collected by a questionnaire.
    Results
    Significant differences were observed between the mean scores of the three groups one and four weeks after the intervention (F=26.17, p=0.001 and F=4.07, p=0.020, respectively), and post hoc test showed that this difference was due to the higher score in e-learning group. Both e-learning and booklet methods could effectively improve nurse's knowledge (χ²=23.03, p=0.001 and χ²=51.71, p=0.001, respectively).
    Conclusion
    According to the results of this study, electronic learning was more effective than booklet in enhancing the learning and retention of knowledge. Electronic learning is suggested as a more suitable method as it provides appropriate interactions and attractive virtual environments to motivate the learners and promote retention.
    Keywords: Knowledge, Nursing Care, Distance Education, Booklet, Continuing Medical Education
  • Zahra Meidani, Mehrdad Farzandipour*, Alireza Farrokhian, Masomeh Haghighat Pages 444-453
    Background
    Considering the role of laboratory tests as a central part of controlling health expenditure, this study intends to investigate laboratory tests overutilization in Iran to pave the way for future interventions.
    Methods
    Inappropriate laboratory utilization was reviewed in a cross-sectional survey through the retrospective analysis of 384 medical records at a tertiary center. To pave the way for future intervention, overutilization tests were classified into two categories, inappropriate and inefficient, and then they were analyzed. Frequency analysis was used to analysis patient’s age, gender, hospital wards, length of stay, and diagnosis as well as inappropriate test and inefficient tests.
    Results
    A total of 143 (1.50 %) of the tests were inefficient and was ordered due to laboratory errors including hemolysis, inefficient sampling, or absurd results. 2522 (26.40%) of the tests were inappropriate and stem from failure to meet medical/clinical appropriateness criteria.
    Conclusion
    Whereas, inappropriate test ordering was more frequent than inefficient tests, the initial improvement strategy should focus on physicians’ test ordering behavior through conducting proper teaching strategies, ongoing audit and educational feedback, implementing health information technology tools and employing laboratory practice guidelines (LPGs) and testing algorithms. Conducting continuous quality improvement cycle for laboratory services and training of personnel involved in blood sampling is recommended for inefficient tests.
    Keywords: Health Expenditures, Laboratories, Utilization review, Hemolysis, Quality Improvement, Algorithms
  • Maryam Mousavinezhad, Reza Majdzadeh*, Ali Akbari Sari, Alireza Delavari, Farideh Mohtasham Pages 454-468
    Background
    After lung and prostate cancers, colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women after breast cancer worldwide. Every year, more than one million people are diagnosed with colorectal cancer worldwide and half of these patients die from this disease, making it the fourth leading cause of death in the world. This systematic review aimed to assess the effectiveness of the two colorectal diagnostic tests of FOBT (fecal occult blood test) and FIT (fecal immunochemical test)) in terms of technical performance.
    Methods
    To retrieve the relevant evidence, appropriate medical databases such as Cochrane library, NHSEED, Scopus and Google scholar were searched from February 2013 to July 2014, using free-texts and Mesh. In this study, inclusion/exclusion criteria of the papers, randomized controlled trials, economic evaluations, systematic reviews, meta-analyses and meta-syntheses of the effectiveness of FIT versus FOBT tests in moderate-risk populations (age: 50 to 70 years), which had reported the least of such outcomes as sensitivity, specificity and clinical outcomes were reviewed. The analyses of the effectiveness outcomes were performed in the form of meta-analysis.
    Results
    Five papers were eligible to be included in the final phase of the study for synthesis. FIT showed a better performance in participation and positivity rate. Moreover, in terms of false positive and negative rate, FIT showed fewer rates compared to FOBT (RR:-4.06; 95% CI (-7.89-0.24), and NN-scope (Number need to scope) (2.2% vs. 1.6%), and NN-screen (Number need to screen) (84% vs. 31-49% in different cut off levels) showed significant differences in FOBT vs. FIT, respectively.
    Conclusion
    In the five included studies (3, 11-14), the acceptability of FIT was more than FOBT. However, in our meta-analysis, no difference was found between the two tests. FIT was significant in positivity rate and had a better performance in participation rate, and a fewer false negative numbers compared to FOBT.
    Keywords: Neoplasm, FOBT, FIT
  • Aram Rostami, Seyed Akbar Moosavi, Vahid Changizi *, Ali Abbasian Ardakani Pages 469-475
    Background
    Critical macromolecules of cells such as DNA are in exposure to damage of free radicals that induced from the interaction of ionizing radiation with biological systems. Selenium and vitamin-E are natural compounds that have been shown to be a direct free radical scavenger. The aim of this study was to investigate the radioprotective effect of selenium and vitamin-E separately and synergistically against genotoxicity induced by 6MV x-rays irradiation in blood lymphocytes.
    Methods
    Fifteen volunteers were divided into three groups include A, B and C. These groups were given selenium (800IU), vitamin-E (100mg) and selenium (400IU) vitamin-E (50mg), respectively. Peripheral blood samples were collected from each group before (0hr) and 1, 2 and 3hr after selenium and vitamin-E administration (separately and synergistically). Then the blood samples were irradiated to 200cGy of 6MV x-rays. After that lymphocyte samples were cultured with mitogenic stimulation to determine the chromosomal aberrations with micronucleus assay in cytokinesis-blocked binucleated cells.
    Results
    The lymphocytes in the blood samples collected at one hr after ingestion selenium and vitamin-E, exposed in vitro to x-rays exhibited a significant decrease in the incidence of micronuclei, compared with control group at 0hr. The maximum protection and decrease in frequency of micronuclei (50%) were observed at one hr after administration of selenium and vitamin-E synergistically.
    Conclusion
    The data suggest that ingestion of selenium and vitamin-E as a radioprotector substance before exposures may reduce genetic damage caused by x-rays irradiation.
    Keywords: 6MV, X, rays, Selenium, Vitamin, E, Lymphocyte, Micronucli
  • Mahmood Karimy, Marzieh Araban, Iraj Zareban*, Mohammad Taher, Ahmadreza Abedi Pages 476-483
    Background
    Self-care is an essential element in treating a person with diabetes; and managing diabetes is of prime importance. The aim of this study was to investigate the predictors of adherence to self-care behavior among women with Type 2 diabetes.
    Methods
    This cross-sectional study was conducted on 210 female patients aged 30 to 60. Data collection tool was an anonymous valid and reliable questionnaire designed based on the Health Belief Model (HBM), which acquired information about the followings: Perceived susceptibility, severity, benefits, barriers, self-efficacy and diabetes self-care behavior. Data were analyzed by t-test, chi-square and regression analysis.
    Results
    The multiple regression models revealed 59.9% of the variance of self-care behavior with self-efficacy, perceived barrier, benefit and susceptibility. Additionally, the highest weight for β (β=0.87) was found for self-efficacy. Self-care behavior was positively correlated with all HBM variables except for perceived barriers showing a negative correlation.
    Conclusion
    The Health Belief Model may be used as a framework to design intervention programs in an attempt to improve adherence to self-care behaviors of women with diabetes. In addition, the results indicated that self-efficacy might play a more crucial role in developing self-care behaviors than t other HBM components. Therefore, if the focus is placed on self-efficacy when developing educational programs, it may increase the likelihood of adherence to self-care behavior.
    Keywords: Diabetes, Health Beliefs Model, Self, Care, Self, Efficacy, Iran
  • Amir Mehrgou, Mansoureh Akouchekian* Pages 484-495
    Many factors including genetic, environmental, and acquired are involved in breast cancer development across various societies. Among all of these factors in families with a history of breast cancer throughout several generations, genetics, like predisposing genes to develop this disease, should be considered more. Early detection of mutation carriers in these genes, in turn, can play an important role in its prevention. Because this disease has a high prevalence in half of the global population, female screening of reported mutations in predisposing genes, which have been seen in breast cancer patients, seems necessary. In this review, a number of mutations in two predisposing genes (BRCA1 and BRCA2) that occurred in patients with a family history was investigated. We studied published articles about mutations in genes predisposed to breast cancer between 2000 and 2015. We then summarized and classified reported mutations in these two genes to recommend some exons which have a high potential to mutate. According to previous studies, exons have been reported as most mutated exons presented in this article. Considering the large size and high cost of screening all exons in these two genes in patients with a family history, especially in developing countries, the results of this review article can be beneficial and helpful in the selection of exon to screen for patients with this disease.
    Keywords: BRCA1 gene, BRCA2 gene, Mutations, Breast cancer
  • Mohammadhosain Afrand, Saeed Hossein Khalilzadeh, Ahmad Shojaoddiny, Ardekani *, Mohammad Afkhami, Ardekani, Azita Ariaeinejad Pages 496-503
    Background
    Metabolic syndrome (MS) is a cluster of metabolic disturbances, and its prevalence is increasing worldwide. MS exhibits variations among ethnic groups. Zoroastrianism is an ethnic minority which has maintained its isolation and endogamy up to now. So, we evaluated the frequency of MS in Zoroastrians of Yazd, Iran.
    Methods
    In this cross-sectional study, participants aged ≥30 years were selected using a systematic random sampling. Weight, height, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR) and blood pressure (BP) were measured using standard methods. Also, blood levels of glucose, triglycerides (TG), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), urea, creatinine and uric acid (UA) were measured. Both revised National Cholesterol Education Program Adult Treatment Panel III (ATPIII) and Joint Interim Statement (JIS) criteria were used to diagnose the MS.
    Results
    The mean±SD age of the participants (n=403) was 56.9±12.8 years. The frequency of MS was 69.7% and 74.9% based on JIS and ATPIII criteria, respectively; this was significantly different by age, marital status, job, educational level, and menopausal status (p
    Conclusion
    This study showed a high frequency of MS in Zoroastrians of Yazd, Iran.
    Keywords: Metabolic syndrome, Minority, Frequency, Zoroastrian
  • Shohreh Movahedi, Leili Safdarian, Marzieh Agahoseini, Ashraf Aleyasin, Sepideh Khodaverdi, * Sara Asadollah, Ali Kord Valeshabad, Parvin Fallahi, Zahra Rezaeeian Pages 504-510
    Background
    Release of vascular endothelial growth factor (VEGF) by ovaries in response to HCG administration is one of the main mechanisms of ovarian hyper stimulation syndrome. Since Dopamine/dopamine receptor2 (Dp-r2) pathway activity -mediated by VEGF/ Vascular endothelial growth factor receptor 2 (VEGFR-2) signaling-, is associated with angiogenic events, dopamine agonists were used for the management of severe forms of OHSS. In order to assess the effects of Cabergoline on angiogenesis in the human endometrium, and subsequently its impacts on the implantation rate this study was conducted.
    Methods
    This historical cohort study was conducted based on existing data of 115 patients (20-40 years) whom underwent assisted reproductive treatment (ART) and with a high probability for developing OHSS between March 2007 and September 2008. Forty five cases received Cabergoline were compared to 70 control subjects. The statistical methods used were: Unpaired t-test for continuous variables and the chi-square test (or Fisher’s exact test if required) for categorical variables.
    Results
    None of the patients (treatment or control group) developed OHSS. The etiologies of infertility and administration of GnRH agonist or antagonist protocols were similar in two groups (p>0.2). Number of transferred embryos and zygote intra-fallopian transfer (ZIFT) did not differ between the two groups (p≥0.06). Implantation rate in treatment (3.1%) and control (6.6%) subjects was similar (p=0.4). No significant difference was observed in fertilization rate, chemical, clinical and ongoing pregnancies between the two groups (p>0.5).
    Conclusion
    Cabergoline can be safely administered in ART protocols to prevent OHSS, without compromising ART outcomes.
    Keywords: Cabergoline, Ovarian Hyper stimulation Syndrome, Dopamine agonist, OHSS, Implantation rate
  • Malek Amini, Aryan Shamili*, Bijan Frough, Marzieh Pashmdarfard, Abolghasem Fallahzadeh Abarghouei Pages 510-517
    Background
    Spasticity is one of the problems after a stroke. Due to this increase in muscle tone, patients are confronted with problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of the simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period.
    Methods
    In this study a comparison was done between three groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about three months and the evaluations were done monthly. Goniometry was the method to measure the range of motion, and Modified Ashworth Scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer Assessment. Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times. Significance was set at 0.05.
    Results
    All outcome measures were improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during the 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p>0.05). The results also showed that the changes in elbow`s spasticity (p=0.05) and wrist`s spasticity (p=0.007) and upper extremity function (p=0.04) were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin, and the splint was more than other groups.
    Conclusion
    In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.
    Keywords: Splinting, Botulinum toxin, Stroke, Hand function
  • Nasim Vahabi, Anoshirvan Kazemnejad *, Ramazan Fallah Pages 518-525
    Background
    Growth failure in children less than five years old can lead to the serious complications such as increased mortality, learning difficulties or physical disability. The aim of this study was to investigate the non-organic factors affecting the growth trend in less than two years children living in Zanjan, Iran.
    Methods
    This longitudinal study was conducted on a sample of 3566 children less than two years old in Zanjan. Weight and length growth trends were recorded as ordinal variables and analyzed by longitudinal marginal model.
    Results
    About 12% (n=289) and 8% (n=212) of children had at least one decline/stagnation in the weight and length growth curve, respectively. Based on the marginal model, the effect of the child’s age and residence area on the weight and length growth trends were statistically significant (p
    Conclusion
    Given the relatively high prevalence of growth failure among studied children less than two years old in rural areas of Zanjan, raising the awareness of parents in rural areas about feeding and nutritional behaviors of children seems an important issue. Additionally, healthcare providers should mostly focus on monitoring the growth of children older than 12 months.
    Keywords: Weight growth trend, length growth trend, longitudinal data, marginal model
  • Ghobad Moradi, Reza Majdzadeh, Kazem Mohammad, Hossein Malekafzali, Saeede Jafari, Kourosh Holakouie, Naieni* Pages 526-533
    Background
    About 80% of deaths in 350 million cases of diabetes in the world occur in low and middle income countries. The aim of this study was to determine the status of diabetes socioeconomic inequality and the share of determinants of inequalities in Kurdistan Province, West of Iran, using two surveys in 2005 and 2009.
    Methods
    Data were collected from non-communicable disease surveillance surveys in Kurdistan in 2005 and 2009. In this study, the socioeconomic status (SES) of the participants was determined based on the residential area and assets using principal component analysis statistical method. We used concentration index and logistic regression to determine inequality. Decomposition analysis was used to determine the share of each determinant of inequality.
    Results
    The prevalence of diabetes expressed by individuals changed from 0.9% (95% CI: 0.6-1.3) in 2005 to 3.1% (95% CI: 2-4) in 2009. Diabetes Concentration Index changed from -0.163 (95% CI: -0.301- -0.024) in 2005 to 0.273 (95% CI: 0.101-0.445) in 2009. The results of decomposition analysis revealed that in 2009, 67% of the inequality was due to low socioeconomic status and 16% to area of residence; i.e., living in rural areas.
    Conclusion
    The prevalence of diabetes significantly increased, and the diabetes inequality shifted from the poor people to groups with better SES. Increased prevalence of diabetes among the high SES individuals may be due to their better responses to diabetes control and awareness programs or due to the type of services they were provided during these years.
    Keywords: Inequality, Diabetes, SES, Concentration Index, Decomposition, Iran
  • Mohammadreza Vafa*, Sepideh Soltani, Farid Zayeri, Mahtab Niroomand, Azadeh Najarzadeh Pages 534-542
    Background
    The results of the studies on the effects of sodium on bone metabolism have been inconsistent. There is no definitive answer to the question of whether sodium restriction can be associated with a lower incidence of osteoporosis. What reinforces the necessity of designing this study is the lack of findings with the approach of examining the effects of sodium on bone in our country.
    Methods
    This was a cross-sectional study conducted on 185 retired female teachers aged 45 to 70. Sodium intake was evaluated using two
    Methods
    A 24-hour recall and a 12-hour urine sample. To assess bone health, ORAI index was calculated for each individual. Urinary calcium, phosphorus, potassium and serum vitamin D and PTH were measured as laboratory variables. To compare the general characteristics of the participants across tertiles of urinary sodium, the analysis of variance (ANOVA) was used for quantitative variables and the Chi-square test for categorical variables.
    Results
    Phosphorous, calcium and potassium urinary excretion rate increased with the increase in urinary sodium (p
    Conclusion
    Although urinary calcium and potassium increased with the increase in sodium intake, no relationship was found between sodium and ORAI.
    Keywords: Urinary Sodium, Urinary Calcium, ORAI, Bone Health
  • Mansoureh Akouchekian*, Simin Hemati, Davood Jafari, Nazanin Jalilian, Masoumeh Dehghan Manshadi Pages 543-550
    Background
    Li-Fraumeni syndrome (LFS) is one of the most serious hereditary cancer syndromes with a high risk of malignancy in childhood. This syndrome is an autosomal dominant cancer predisposing syndrome due to a germline mutation in the TP53 tumor suppressor gene.
    Methods
    In this study, a representative family case of Li-Fraumeni syndrome is described. The proband of this family was a 43-year-old male who had osteosarcoma of the mandible and a positive family history of cancer. His mother died at the age of 29 of brain cancer; his sister died at the age of 18 of breast cancer; his brother died at the age of 36 of liver cancer; and another sister of his died at the age of 16 of leukemia. Complete sequence analysis of the TP53 and PTEN genes was performed in this family. We used standard diagnostic tools such as sequencing and multiplex ligation-dependent probe amplification (MLPA) to analyze these two genes in this family. The exons and flanking exon-intron junctions of the TP53 and PTEN genes were sequenced.
    Results
    We detected a germline mutation in the TP53 gene in this family that was previously reported as somatic mutation in LFS in the catalogue of somatic mutations in cancer (COSMIC). In addition, according to the International Agency for Research of Cancer (IARC) database, a 19-year-old male patient with sarcoma was recently reported to have this germline mutation. We also found two new IVS variations in the PTEN gene, one of which can be a suggestive evidence of an effect on the splicing of PTEN.
    Conclusion
    Genomic modifications for tumor risk and genotype-phenotype correlations in LFS are still to be identified. We believe every new finding in this area can provide new insights into the pathogenesis and progression of Li-Fraumeni syndrome.
    Keywords: PTEN Gene, Li, Fraumeni Syndrome, Germline Mutation
  • Maryam Jalessi, Mohammad Farhadi, Alimohamad Asghari, Maryam Hosseini, Elahe Amini, Seyyed Behzad Pousti Pages 551-556
    Background
    Nose is used as a corridor in endoscopic endonasal transsphenoidal approach (EETSA) for pituitary adenoma. Thus, it may affect the nasal airway patency, function and sinonasal-related quality of life. The aim of this study is to objectively and subjectively evaluate these effects.
    Methods
    In this prospective study, 43 patients with pituitary adenoma who were candidates for EETSA from March 2012 to October 2013 were enrolled. The patients were evaluated preoperatively using acoustic rhinometry and rhinomanometry (with/without the use of decongestant drops) and asked to complete the 22-Item Sino-nasal Outcome Test (SNOT-22) questionnaire. The tests were repeated at one and three months postoperatively. The preoperative data were compared with the first and second postoperative ones using paired-sample t-test.
    Results
    Without the use of decongestant drops, the total airway resistance increased significantly (p=0.016), and the nasal airflow decreased significantly (p=0.031) in the first postoperative evaluation. However, in the 3rd postoperative month, the difference was not significant. With the use of decongestant drops, the objective parameters showed no significant changes compared to preoperative data even at the first evaluation. The SNOT-22 scores also did not differ significantly in 1st and 3rd postoperative months. The first postoperative SNOT-22 showed a strong correlation with the second minimal cross-sectional area on simultaneous evaluation, and with the preoperative total airway resistance.
    Conclusion
    EETSA has a transient adverse effect on the nasal patency that quickly improves, making it a safe approach for the sinonasal system. Rhinomanometry is the most sensitive test for detecting these nasal functional changes objectively.
    Keywords: Pituitary adenoma, Endoscopy, Skull base, Rhinomanometry, Acoustic rhinometry
  • Leila Yazdanpanah, Zamzam Paknahad, Ali Javad Moosavi, Mohammad Reza Maracy, Mohammad Masoud Zaker Pages 557-569
    Background
    Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. Smoking is the number one cause of COPD; however, genetic, environmental and dietary factors contribute to the etiology of this disease. In this study, we assessed the association between three diet quality indices -the Healthy Eating Index-2005 (HEI-2005), the Healthy Eating Index-2010 (HEI-2010), and Mediterranean Diet Score (MED)- and the severity of disease in COPD patients.
    Methods
    This cross-sectional study was performed at Rasul-e-Akram Hospital in Tehran on 121 COPD patients with the mean age of (SD) of 66.1(10.9) years. A pulmonary specialist diagnosed all participants based on a spirometry test. They were categorized into four groups (1, 2, 3, 4 stages of disease). Three diet quality indices, spirometry test and determination of disease severity were performed for all the participants. ANCOVA and Kruskal-Wallis test were used to assess the relationship between dietary quality indices and severity of the disease. The relationship between HEI-2010, HEI-2005, MED score, their components and lung function was assessed using a multiple linear regression analysis. All analyses were done using SPSS 18.
    Results
    Reduction of the Healthy Eating Index-2010 and MED score were observed along with the increase in disease severity, but they were not significant. The relationship between the three diet quality indices and lung function showed a significant association between MED score and Forced expiratory volume in one second (FEV1), The Forced Vital Capacity (FVC) (β=2.9, 95% CI (1.1, 4.8), p=0.002), (β=2.8, 95% CI (0.9, 4.8), p=0.007), respectively.
    Conclusion
    Mediterranean dietary pattern and obtaining a better score on HEI-2010 diet were associated with a better lung function test.
    Keywords: COPD, Diet Quality Index, nutrition, Mediterranean Diet
  • Mohammad Reza Honarvar, Shahryar Eghtesadi *, Pooria Gill, Shima Jazayeri, Mohammad Ali Vakili, Mohammad Reza Shamsardekani, Abdollah Abbasi Pages 570-579
    Background
    Acceleration in sputum smear conversion helps faster improvement and decreased probability of the transfer of TB. In this study, we aimed to investigate the effect of green tea extract supplementation on sputum smear conversion and weight changes in smear positive pulmonary TB patients in Iran.
    Methods
    In this double blind clinical study, TB patients were divided into intervention, (n=43) receiving 500 mg green tea extract (GTE), and control groups (n=40) receiving placebo for two months, using balanced randomization. Random allocation and allocation concealment were observed. Height and weight were measured at the beginning, and two and six months post-treatment. Evaluations were performed on three slides, using the ZiehlNeelsen method. Independent and paired t test, McNemar’s, Wilcoxon, Kaplan-Meier, Cox regression model and Log-Rank test were utilized. Statistical significance was set at p
    Results
    The interventional changes and the interactive effect of intervention on weight were not significant (p>0.05). In terms of shortening the duration of conversion, the case to control proportion showed a significant difference (p=0.032). Based on the Cox regression model, the hazard ratio of the relative risk of delay in sputum smear conversion was 3.7 (p=0.002) in the higher microbial load group compared to the placebo group and 0.54 (95% CI: 0.31-0.94) in the intervention compared to the placebo group.
    Conclusion
    GTE decreases the risk of delay in sputum smear conversion, but has no effect on weight gain. Moreover, it may be used as an adjuvant therapy for faster rehabilitation for pulmonary TB patients.
    Keywords: Body Weight, Dietary Supplements, Humans, Sputum, Tea, Tuberculosis, Pulmonary
  • Edris Abdifard, Sudabe Amini, Sattar Bab, Nasim Masroor, Alice Khachian, Mohammad Heidari* Pages 580-586
    Background
    As the third leading cause of death, cancers have a special place in the Iranian health system. Several studies have been done in some regions of the country with few years of follow-ups, but this was the first standardized study to investigate the incidence trends of colorectal cancer in Iran in a one-decade period.
    Methods
    The registered data for colorectal cancer cases in National Cancer Registry System were extracted from the Center for Disease Control & Management of Ministry of Health. The codes from 18 to 21 among cancers were selected for colon and rectum cancers. Incidence rates were directly standardized, using WHO population. The significance of incidence rate trends was tested through Poisson regression.
    Results
    In this study, 36,650 cases of colorectal cancer were observed for 10 years in Iran, which increased from 813 cases in 2000 to 6,210 cases in 2009. Gender ratio of men to women was 1.39. Significant increasing trends of colorectal cancer were observed during the period of the study. The standardized incidence rate increased from 1.6 per 100,000 persons per year in 2000 to 11.3 in 2009 in males (p
    Conclusion
    Colorectal cancer has an increasing trend in Iran. The rising trend of colorectal cancer as well as other types of cancers is partially due to improvement in cancer registry systems in the early years of registry. Moreover, westernized lifestyle and an increase in environmental risks could explain this rising trend.
    Keywords: Incidence Trend, Colorectal, Cancer, Iran
  • Enayatollah Homaie Rad, Zahra Kavosi, Masoud Arefnezhad* Pages 587-592
    Background
    Health utilization inequality is a major concern for health policymakers. Equality in utilization of services is very important for having a healthy society. The aim of this study was to describe inequality in dental care utilization in Iran, Therefore, concentration index, its curve, and the predictors of inequality in utilization of dental services and their spending were calculated.
    Methods
    Data of a health utilization survey which previously had been gathered in Shiraz, Iran were used for this study. Tobit and Poisson estimators were used to estimate utilization and out of pocket models. Furthermore, concentration index and curve was calculated to show inequality in dental care utilization.
    Results
    High inequalities was found in dental care utilization in Iran (concentration index=0.19). In the utilization model, the relationship between income and utilization was positive. People with higher income could utilize more services. Being covered by insurance increased the probability of dental care utilizations too.
    Conclusion
    Policy makers must find solutions like increase the coverage of dental insurances to decrease inequality in dental care utilization.
    Keywords: Dental Services, Inequality, Concentration index, Concentration curve, Shiraz
  • Fereshteh Eftekharizadeh, Reza Dehnavieh, Somayeh Noori Hekmat, Mohammad Hossein Mehrolhassani* Pages 593-604
    Background
    Super oxidized water (SOW), as a novel antiseptic solution, is used with claims of effectiveness and cost effectiveness in healing chronic wounds such as diabetic foot, infectious post-operative ulcers and burn ulcers. We conducted a health technology assessment to evaluate the clinical evidence from clinical and randomized trials for this disinfection. This study aims to evaluate the safety, effectiveness and cost-effectiveness of this technology in Iran, for using as a wound disinfectant.
    Methods
    Systematic literature searches were conducted from October 2013 to March 2014 for the following medical databases: OVID MEDLINE, CINAHL, the Cochrane Library and the PICO terms were included and then analyzed by Cochrane assessment criteria.
    Results
    Out of 705 articles, twelve potentially relevant trials were identified. Others that didn’t come with the PICO criteria were excluded. 5 randomized controlled trials, 5 clinical trials, a rapid HTA and a case series that had studied the effectiveness of super oxidized water on patients with different chronic wounds, were included. Most of these trials were assessing similar sets of outcomes as the Safety and Effect on Healing days to re-epithelization, healing rate, effect on Infection bacterial counts and infection rates.
    Conclusion
    Super oxidized water is a safe, effective and cost effective irrigation and cleansing agent due to the performed analysis in comparison with current treatment as povidone iodine for treating wound infections.
    Keywords: Super oxidized water (SOW), Betadine, Chronic wound, Cost, Antiseptic
  • Farnoosh Safavifar, Mehrdad Eftekhar*, Kaveh Alavi, Reza Negarandeh, Amir Hossein Jalali, Maryam Eftekhar Pages 605-611
    Background
    Gender identity disorder and its treatment with sex reassignment surgery is a profound experience, which can affect the mental, interpersonal, social and religious aspects of one’s life.
    Methods
    This was a qualitative content analysis study focusing on the various dimensions of the experiences of seven patients suffering from gender identity disorder in a female-to-male subgroup. This study presents a report concerning the religious aspects of their experience.
    Results
    The findings of this study were categorized into the four following conceptual categories: sense of guilt; accomplishing a sense of submission to God’s will as well as God’s pleasing; practical commitment to religion; and rejection by the religious communities.
    Conclusion
    Diminishing religion to spirituality comprised the core experiences of these patients having intimate relations with such concepts as secularism, stigma, and technocracy.
    Keywords: Transsexualism, Sex Reassignment Surgery, Religious Experience, Qualitative
  • Batoul Bagheripour, Mojtaba Kamyab*, Fatemeh Azadinia, Ali Amiri, Mohammad Akbari Pages 612-619
    Background
    Traction has been suggested to be an effective treatment for symptoms of neck disorder in patients with no contraindications. However, according to previous researches, the effectiveness of traction is controversial, particularly compared to other conservative treatments. This trial was conducted to evaluate the effect of sustained traction, using an over-the-door home cervical traction unit in combination with routine physical therapy on reducing cervical osteoarthrosis symptoms including neck pain, medication use and disability level compared to routine physical therapy alone.
    Methods
    In this double- blinded pilot study with a pre-post test design and a control group, 20 women with mild to moderate osteoarthrosis were systematically assigned to the over-the-door home cervical traction (mean±SD age: 50.5±4.45yrs) or control groups (mean±SD age: 55.6±7.34yrs). Pain, level of disability, and drug consumption were evaluated before and after 10 sessions of intervention. Data were analyzed using parametric or non-parametric statistic including the paired-sample t-test, independent sample t-test, and Wilcoxon and Mann-Whitney u test for intra and inter groups comparison based on the Kolmogorov-Smirnov test results.
    Results
    Patients in both groups showed a significant decrease in pain intensity and disability level (p0.05). No significant differences were found in terms of drugs consumption within and between the groups at the end of the treatment (p>0.05).
    Conclusion
    The results revealed that applying sustained traction using an over-the-door home cervical traction unit was not significantly superior to the routine physical therapy and ergonomic training to manage symptoms including neck pain and disability in a small group of mild to moderate cervical osteoarthrosis patients.
    Keywords: Osteoarthritis, Neck, Pain, Traction
  • Farid Najafi, Behzad Karami, Matin, Satar Rezaei, Nader Rajabi, Gilan, Moslem Soofi* Pages 620-626
    Background
    Responsiveness is one of the three main goals of the health system introduced by World Health Organization. This study aimed at examining health system responsiveness after Health Sector Evolution Plan in Kermanshah, Western Iran.
    Methods
    A sample of 335 hospitalized patients was selected using proportionate allocation to population size method in the city of Kermanshah (Iran) in 2015. World Health Survey (WHS) questionnaire was used to collect data. Data were analyzed using descriptive statistics and principal component analysis by STATA 12.
    Results
    The overall health system responsiveness score was 72.6. The best and worst performance for domains of dignity and autonomy were 82.2 and 62.5, respectively. Socio-demographic variables of the patients had no significant effect on the total health system responsiveness score. The principal component analysis findings indicated that 68% of the variance of the overall responsiveness score was explained by four components.
    Conclusion
    The overall responsiveness score of each of the domains was higher than that of other similar previous studies in Iran. Although it is difficult to reach a conclusion, our findings may show better responsiveness of the health system compared to the previous reports.
    Keywords: Health System Responsiveness, Health Sector Evolution, Inpatient Care, Iran
  • Ali Gholami, Shaker Salarilak, Pegah Lotfabadi, Fereshte Kiani, Abdolhalim Rajabi, Kamyar Mansori, Zahra Moosavi Jahromi* Pages 627-633
    Background
    Epilepsy is a common chronic neurological disorder that has a great impact on people’s lives. Patients with epilepsy are at increased risk for poor Quality of Life (QoL). The objective of this study was to evaluate the QoL of epileptic patients in comparison to healthy persons.
    Methods
    This cross-sectional study was conducted on 52 epileptic patients from Golbu region in Neyshabur (a city in northeast of Iran). Using Short Form Health Survey (SF-36) scale, the data were collected between April and Jun 2012. Every patient were compared with two healthy persons. Epileptic and healthy persons were similar for age, sex and local residence. Pearson’s correlation coefficient and t-independent test applied for data analysis through SPSS v. 16 software.
    Results
    Of 52 epileptic patients, 24 were female (46.2%) and 28 were male (53.8%). The mean±SD age of epileptic patients was 40.92±20.33yr (Rang: 15-86yr). The total mean score of SF-36 in patient group was 55.88 and in healthy group 68.52and this difference was statistically significant (p
    Conclusion
    The study showed that epilepsy disease has an important role in QoL of patients, thus some interventional programs are necessary to improve their QOL.
    Keywords: Epilepsy, Quality of life, SF, 36, Neyshabur
  • Adebimpe Wasiu Olalekan, Akanni Olufemi Emmanuel Pages 634-639
    Background
    Diagnosis of anemia is challenging in resource-poor settings due to inadequate laboratory resources. This study assessed the validity of the Tallquist haemoglobinometer in assessing anemia among pregnant women in Osogbo, Southwestern Nigeria.
    Methods
    This was a cross - sectional study, in which 200 pregnant women of reproductive age were selected using multistage sapling method. A checklist was used to collect socio-demographic data and the results of the screening test. Blood collection and analysis were carried out using standardized referenced methods.
    Results
    Mean±SD age of the respondents was 28.9.9 yrs.; and 62 (62.6%) had up to primary level education. When Tallquist and Haematocrit methods were compared, there was 68.4%, 83.5% and 100% likelihood of Tallquist method (TM) diagnosing severe, moderate and mild anemia, respectively. The validity indices of the TM versus Haematocrit method as the gold standard revealed the sensitivity of 97.9%, specificity of 92.1%, positive predictive value of 92.4%, and negative predictive value of 97.9% and diagnostic accuracy of 95.0%. When compared to the Haemoglobin Cyanide method, the Tallquist method showed a calculated sensitivity of 96.6%, specificity of 87.4%, positive predictive value of 86.0%, and negative predictive value of 97.0% and diagnostic accuracy of 91.5%.
    Conclusion
    The TM is a valid tool in screening anemia among pregnant women in resource- poor settings and rural primary health care centers in Southwestern Nigeria; therefore, its use should be encouraged, particularly to assess mild to moderate anemia.
    Keywords: Anemia, Tallquist method, Validity, Pregnant women, Southwestern Nigeria
  • Safiye Yaghoubi Fard, Reza Goudarzi, Abbas Etminan, Mohammad Reza Baneshi, Mohsen Barouni*, Mohammad Jafari Sirizi Pages 640-646
    Background
    This cross-sectional study was conducted to compare the cost-effectiveness of three therapeutic methods of long-term hemodialysis, kidney transplant from a living person and kidney transplant from a cadaver utilizing Disability Adjusted Life Years (DALY) using data from the records of patients referred to Afzalipour Hospital of Kerman in 2012.
    Methods
    This cross-sectional study utilizing Disability Adjusted Life Years (DALY) as outcome measure, used data from the records of patients referred to Afzalipour Hospital of Kerman in 2012. The decision tree model and decision tree software (Tree Age pro 11) were used for data analysis. In this research, costs and effects were studied from the patients and healthcare providers’ perspective.
    Results
    In the patient’s perspective, the CER of dialysis was 5.04 times greater than transplant from a living person and 6.15 times higher than transplant from a cadaveric donor. In the hospital’s perspective, the average cost-effectiveness ratio of dialysis was 8.4 times greater than transplant from a living person and 14.07 times higher than transplant from a cadaver. The smaller the C-E ratio, the greater was the cost-effectiveness. In both perspectives, the order of effectiveness of treatment methods were transplant from a cadaver, transplant from a living person and dialysis.
    Conclusion
    Considering the results obtained in this study, measures should be taken to increase the desire for organ donation from brain-dead patients, living people and patients’ relatives.
    Keywords: Cost, Effectiveness, DALY, Chronic Dialysis, Kidney Transplant
  • Mahdi Goudarzvand, Samira Rasouli Koohi, Zohreh Khodaii, Somayeh Soleymanzadeh Moghadam* Pages 647-653
    Background
    Multiple Sclerosis (MS) is a disease of the immune system that creates damage of Learning and memory in that. Using probiotic supplements is recommended for preventing MS disease and improving memory. This study aimed to investigate the effect of Lactobacillus Plantarum (LP) and bifidobacterium B94 (BB94), on acquisition phase of spatial memory in the local demyelination of rats` hippocampus.
    Methods
    In this study, 32 male Wistar rats were divided into control, damage group and treatment groups. Treatment groups were including (LP) and (BB94). After the induction of demyelination by 3 μl of EB into the right dentate gyrus of the hippocampus in treatment groups, 1.5×108 probiotic bacteria were administered by gavage for 28 days. Data was analyzed using one-way ANOVA and Tukey post-hoc tests (p≤0.05).
    Results
    Findings demonstrated that injection of EB caused a significant increase in traveled distance (p
    Conclusion
    According to some studies, probiotics have a positive impact on improving the performance of spatial memory and learning, although the results of the current study could not indicate finality of this assumption. It seems that more researches is needed on this subject.
    Keywords: probiotic, demyelination, spatial memory, hippocampus
  • Rahim Khodayari, Zarnaq, Hamid Ravaghi*, Ali Mohammad Mosaddeghrad, Abbas Sedaghat, Minoo Mohraz Pages 654-666
    Background
    HIV/AIDS control are one of the most important goals of the health systems. The aim of this study was to determine how HIV/AIDS control was initiated among policy makers’ agenda setting in Iran.
    Methods
    A qualitative research (semi-structured interview) was conducted using Kingdon’s framework (problem, policy and politics streams, and policy windows and policy entrepreneurs) to analysis HIV/AIDS agenda setting in Iran. Thirty-two policy makers, managers, specialists, and researchers were interviewed. Also, 30 policy documents were analyzed. Framework analysis method was used for data analysis.
    Results
    the increase of HIV among Injecting drug users (IDUs) and Female Sex Workers (FSWs), lack of control of their high-risk behaviors, and exceeding the HIV into concentrated phase were examples of problem stream. Policy stream was evidence-based solutions that highlighted the need for changing strategies for dealing with such a problem and finding technically feasible and acceptable solutions. Iran’s participation in United Nations General Assembly special sessions on HIV/AIDS (UNGASS), the establishment of National AIDS Committee; highlighting AIDS control in Iran’s five years development program and the support of the judiciary system of harm reduction policies were examples of politics stream. Policy entrepreneurs linking these streams put the HIV/AIDS on the national agenda (policy windows) and provide their solutions.
    Conclusion
    There were mutual interactions among these three streams and sometimes, they weakened or reinforced each other. Future studies are recommended to understand the interactions between these streams’ parts and perhaps develop further Kingdon’s framework, especially in the health sector.
    Keywords: HIV, AIDS Policy, Agenda setting, Multiple streams framework, Health system
  • Nahid Hatam, Mohammadreza Zakeri, Ahmad Sadeghi*, Sajad Darzi Ramandi, Ramin Hayati, Elham Siavashi Pages 667-672
    Background
    One of the important aspects of equity in health is equality in the distribution of resources in this sector. The present study aimed to assess the distribution of hospital beds in Shiraz in 2014.
    Methods
    In this retrospective cross-sectional study, the population density index and fair distribution of beds were analyzed by Lorenz curve and Gini coefficient, respectively. Descriptive data were analyzed using Excel software. We used Distributive Analysis Stata Package (DASP) in STATA software, version 12, for computing Gini coefficient and drawing Lorenz curve.
    Results
    The Gini coefficient was 0.68 in the population. Besides, Gini coefficient of hospital beds’ distribution based on population density was 0.70, which represented inequality in the distribution of hospital beds among the nine regions of Shiraz.
    Conclusion
    Although the total number of hospital beds was reasonable in Shiraz, distribution of these resources was not fair, and inequality was observed in their distribution among the nine regions of Shiraz.
    Keywords: Equity, Hospital beds, Gini coefficient, Lorenz curve
  • Roya Safari, Faraman, Ali Akbar Haghdoost*, Nouzar Nakhaei, Shohreh Foroudnia, Zahra Mahmoodabadi, Mansooreh Safizadeh Pages 673-678
    Background
    Around one out of two mothers give births by cesarean section (CS) surgery in Iran and about half of this number is due to previous CS. Recently Health Sector Evolution (HSEP) program (started in April 2014) targets the high rate of CS in Iran. To assess the impact of the interventions, we emphasized that the First Birth Cesarean (FBC) proportion is one of the main indicators to assess the controlling programs.
    Methods
    Data on the mode of delivery were collected in Kerman province between 21 March and 20 March 2015 classified by hospital ownership. FBC proportion is defined as the number of CS in the first pregnancies divided by the total number of first births. Chi-square test for trend was used to assess the trends.
    Results
    Total number of births was around 34000. There were 8.9 and 13.1 percent reduction in CS and FBC proportion respectively. CS proportion was 54.5 at the end of the first quarter of the studied period and reached to 49.6 at the end of the period (p
    Conclusion
    Results suggested more reduction in FBC proportion than the CS proportion, so this is a very good sign since more potential CS cases will be prevented. As repeated CS is one of the main indications for the operation, in the short term, even effective policies may change the overall proportion slightly, while the FBC proportion is more sensitive to reflect the impacts. Therefore, it is necessary to target the main fuel to reduce CS proportion effectively.
    Keywords: Cesarean, Delivery, Health Policy
  • Bijan Pirnia, Fatemeh Givi, Rasool Roshan, Kambiz Pirnia*, Ali Akbar Soleimani Pages 679-687
    Background
    Stimulants addition and abuse can cause some functional and morphological changes in the normal function of glands and hormones. Methamphetamine as an addictive stimulant drug affects the Hypothalamic-pituitary-adrenal (HPA) axis and consequently makes some changes in the psychological state of the drug users. The present study aims to examine the relationship between plasma levels of cortisol with depression, stress and anxiety symptoms in chronic methamphetamine-dependent patients and normal individuals who have undergone the inguinal hernia surgery.
    Methods
    To meet the purpose of the study, 35 chronic methamphetamine-dependent patients in the active phase of drug abuse and 35 non-users (N=70) who were homogenized regarding the demographic features were purposefully selected from among the patients referred to undergo inguinal hernia surgery since March 15 to June 9, 2015. The participants were then divided into the control and experiment group. The changes in cortisol levels in plasma were measured using Radioimmunoassay (RIA) in three-time series including 0 (upon the induction of anesthesia), 12 and 24 hours after the surgery. Further, three behavioral indices of depression, anxiety and stress were measured using the Depression Anxiety Stress Scale 21 (DASS-21) and then the data were analyzed using t-test and Pearson Correlation coefficient.
    Results
    The plasma level of cortisol in the chronic methamphetamine-dependent patients (experiment group) had a significant increase in 24 hours after surgery (p
    Conclusion
    The Hypothalamic-pituitary-adrenal (HPA) axis is considered as a key structure in the addiction to simulants, the reason which can explain the faster response of the chronic methamphetamine-dependent patients to the stressors such as surgery.
    Keywords: Depression, Cortisol, Hypothalamic, pituitary, adrenal, Methamphetamine, Radioimmunoassay, Surgery, Ad, diction
  • Parsa Yousefichaijan, Farshad Jafari, Manijeh Kahbazi, Mohammad Rafiei, Abdol Ghader Pakniyat* Pages 688-695
    Background
    Clinical reasoning process leads clinician to get purposeful steps from signs and symptoms toward diagnosis and treatment. This research intends to investigate the effect of teaching clinical reasoning on problem-solving skills of medical students.
    Methods
    This research is a semi-experimental study. Nineteen Medical student of the pediatric ward as case group participated in a two-day workshop for training clinical reasoning. Before the workshop, they filled out Diagnostic Thinking Inventory (DTI) questionnaires. Fifteen days after the workshop the DTI questionnaire completed and “key feature” (KF) test and “clinical reasoning problem” (CRP) test was held. 23 Medical student as the control group, without passing the clinical reasoning workshop DTI questionnaire completed, and KF test and CRP test was held.
    Results
    The average score of the DTI questionnaire in the control group was 162.04 and in the case group before the workshop was 153.26 and after the workshop was 181.68. Compare the average score of the DTI questionnaire before and after the workshop there is a significant difference. The difference between average KF test scores in the control and the case group was not significant but between average CRP test scores was significant.
    Conclusion
    Clinical reasoning workshop is effectiveness in promoting problem-solving skills of students.
    Keywords: Clinical reasoning, Student, Problem solving, Pediatric medicine
  • Satar Rezaei, Ali Akbari Sari*, Mohammad Arab, Reza Majdzadeh, Asghar Mohammad Poorasl Pages 696-703
    Background
    Smoking imposes considerably high economic costs both on the healthcare system as well as on a country as a whole. This study was aimed at systematically reviewing the currently published literature on the direct and indirect costs associated with smoking globally.
    Methods
    A systematic review was performed on systematically searched articles from PubMed and Scopus databases published during the period 1990 to 2014. A combination of key terms such as “economic burden”, “direct cost”, “indirect cost”, and smoking, tobacco or cigarette” and “productivity lost was used for the search. Original research article published in English with the age of study population greater than 35 years, at least three smoking-related diseases and reported direct or indirect cost of smoking were the inclusion criteria.
    Results
    Fourteen original articles were included in the review. The cost of outpatient care and premature deaths were found to be the most important cost driver of direct and indirect costs respectively. The study showed that smoking-related diseases were responsible for 1.5 – 6.8 % of the national health system expenditures and 0.22-0.88% of GDP of a country.
    Conclusion
    Our review indicated that the costs of smoking are substantial, and smoking have a significant impact on the economy of a country. Policies such as increasing the taxation on a cigarette are required and should be implemented to reduce the economic burden of smoking.
    Keywords: Smoking, Systematic review, Direct costs, Indirect costs
  • Fariba Rad*, Ali Akbar Pourfathollah, Fatemeh Yari, Saeed Mohammadi, Maryam Kheirandish Pages 704-711
    Background
    Extracellular vesicles are particles ranged from 30 nm to 5µm and subcategorized into three groups; exosomes, microvesicles and apoptotic bodies, each of which have different biological impact. Lack of a standard method for the detection and isolation of MVs has led to a challenging issue that is a worth considering. In this study, we isolated MVs from the conditioned medium of UC-MSCs by four different schemes of ultracentrifugation.
    Methods
    We examined the efficacy of differential centrifugation ranging from 10,000×g to 60,000×g on UC-MSCs-derived microvesicles yield and purity. The fractions were evaluated by Dynamic Light Scattering (DLS) method, total protein quantification and flow cytometry.
    Results
    UC-MSCs were spindle cells that adhered to plastic culture flasks. These cells expressed MSC markers such as CD44 and CD73, whereas were negative for hematopoietic markers CD45 and CD34. UC-MSC- particles were successfully isolated. Particles were heterogeneous vesicles of approximately 50 to 1250 nm in diameter that bear the surface-expressed molecules UC-MSCs such as; CD90, CD106, CD166 and CD44, and negative for CD34, CD63, and CD9. According to the results of DLS method, centrifugation at 10,000, 20,000, 40,000 and 60,000 ×g, all gave MVs of less than 1000 nm. It is of notion that only at the centrifugation rates of 40,000 and 60,000×g, particles of less than 100 nm in diameter were also obtained.
    Conclusion
    The choice of exact speed greatly influences the purity of MVs and their yield. Our findings indicate that centrifugation at 20,000×g is appropriate for the purification of UC-MSC-MVs.
    Keywords: extracellular vesicles, exosomes, microvesicles, DLS method differential centrifugation
  • Fatemeh Sarvi, Somayeh Momenian, Mahmoud Khodadost*, Bagher Pahlavanzadeh, Mahshid Nasehi, Eghbal Sekhavati Pages 712-718
    Background
    Poverty and low socioeconomic status are the most important reasons of increasing the global burden of tuberculosis, not only in developing countries but also in developed countries for particular groups. The purpose of this study was to assess the association between socioeconomic factors and the number of tuberculosis patients using quantile regression for count data.
    Methods
    This cross-sectional study was conducted on 11,320 tuberculosis patients from March 2010 to March 201 in Iran. Data was gathered from the 345 sections of Iran by Ministry of Health and Medical Education and Statistical Center of Iran. The jittering method was applied for smoothing, and then, the quantile regression for count data was fitted. The AIC was used to compare the fitness of quantile regression for count data model and Poisson log-linear model. The R (3.0.1) software and Quantreg and AER packages were used for all analysis and modeling of the data.
    Results
    The results of fitting the quantile regression for count data showed that in all percentiles, the more increase in immigration rate, illiteracy rate, unemployment and urbanization rates, the more tuberculosis morbidity rate was increased. The maximum increase of tuberculosis due to immigration rate, urbanization rate, unemployment rate, and illiteracy rate was in 95th percentile (β ̂=0.315), 85'Th percentile (β ̂=0.162), 75'Th percentile (β ̂=0.114), and 95'Th percentile (β ̂=0.304), respectively. For 50th percentiles and higher percentiles, with increasing the sum of physicians to the number of population, the tuberculosis morbidity rate was decreased, and the maximum decrease was in 95'Th percentile (β ̂=-0.1). For all percentiles, the AIC showed that quantile regression for count data had been a better fit to data.
    Conclusion
    With respect to the relationship between socioeconomic factors and TB rate, health care observers should pay close attention to improving these factors in Iran to reduce the TB mortality and morbidity.
    Keywords: Quantile regression, Poisson regression, Tuberculosis, Iran
  • Mojgan Asgari, Mahtab Nabi Maybodi, Maryam Abolhasani Pages 719-723
    Background
    Flat urothelial lesions comprise a spectrum of morphologic changes ranging from reactive atypia to carcinoma in situ (CIS). Urothelial dysplasia and CIS are associated with the recurrence and progression of urothelial carcinoma. Distinguishing CIS and dysplasia from reactive atypia based on histolopathogical features alone is often difficult. Using different immunohistochemical markers such as Cytokeratin 20 (CK20), CD44, p53, and Ki-67 is recommended for differential diagnosis. The aim of this study was to evaluate the immunohistochemical pattern of these antibodies to differentiate different flat urothelial lesions.
    Methods
    In this cross- sectional study, three groups of bladder biopsy specimens were evaluated: 20 samples with reactive urothelial lesions, 20 histologically diagnosed as CIS, and 20 morphologically normal samples. Immunohistochemical staining of CK20, p53, CD44 and Ki-67 markers was performed on paraffin-embedded blocks. The groups were compared using chi square test, and the diagnostic value of the markers were evaluated with sensitivity, specificity, positive and negative predictive values.
    Results
    CK20 was full thickness positive in 15 (75%) CIS samples and negative in all samples of the normal and reactive groups (p
    Conclusion
    The results of this study revealed that CK20, CD44, P53 and Ki67 are useful in distinguishing CIS from reactive and normal samples. However, they should be used in a panel including at least three markers. Correlation with the morphologic features is necessary.
    Keywords: Urothelium, Urothelial Carcinoma in Situ, CK20, CD44, P53, Ki67
  • Bina Eftekharsadat, Arash Babaei, Ghazani*, Vahideh Zeinolabedinzadeh Pages 724-732
    Background
    This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis.
    Methods
    During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients’ plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension [ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis.
    Results
    The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (p
    Conclusion
    Despite the insignificant effect on ROMDF and ROMPE, trigger point dry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.
    Keywords: Plantar fasciitis, Myofascial trigger points, Chronic heel pain, Dry needling
  • Rita Mojtahedzadeh, Aeen Mohammadi* Pages 733-741
    Background
    Teachers’ self-efficacy and development may be conceptualized as their beliefs in their own ability to plan, organize and carry out activities that are required to attain educational goals. In this study, we examined the effect of different medical education training courses (six-day, one- month short- term and six-month long- term courses) on perceived self-efficacy and development.
    Methods
    This before-after quasi-experimental study was performed on 39 faculty members of Tehran University of Medical Sciences who participated in faculty development courses in 2013. We used valid and reliable scales to measure their perceived self-efficacy and empowerment.
    Results
    The results revealed a significant increase in faculty members’ perceived self-efficacy in pre and posttests in one-month and six-month courses, but no significant difference was found in the six-day course (p=0.004, p
    Conclusion
    This study revealed that long- term courses were more effective than the short- term ones. Thus, longitudinal courses are recommended for more effectiveness.
    Keywords: Self, Efficacy, Power (Psychology), Education, Medical, Faculty Development Programs
  • Fatemeh Keshmiri, Sari Ponzer, Amir Ali Sohrabpour, Shervin Farahmand, Farhad Shahi, Shahram Bagheri, Hariri, Kamran Soltani, Arabshahi, Mandana Shirazi, Italo Masiello* Pages 742-749
    Background
    Simulation can be used for educating, evaluating and assessing psychometric properties of an instrument. The aim of this study was to contextualize and assess the validity and reliability of the Interprofessional Collaborative Assessment tool (ICAR) in an Iranian context using simulation.
    Methods
    In this descriptive study, contextualization of the ICAR was assessed through several steps. Firstly, validity assessment was approved through expert panels and Delphi rounds. Secondly, reliability assessment was done by arranging a simulation video and assessing reproducibility, test-retest (ICC), internal consistency (Cronbach's Alpha) and inter-rater reliability (Kappa).The participants included 26 experts, 27 students and 6 staff of the Standardized Simulation Office of Teheran University of Medical Sciences.
    Results
    Contextualization and validity of the ICAR were approved in an Iranian context. The reliability of the tool was computed to be 0.71 according to Cronbach´s Alpha. The test-retest was calculated to be 0.76.
    Conclusion
    The Iranian ICAR can be a useful tool for evaluating interprofessional collaborative competencies. The development of the instrument through a simulation scenario has been a positive prospect for researchers.
    Keywords: Interprofessional Collaboration, Interprofessional Education, Assessment, Validation
  • Shandiz Moslehi, Pezhman Atefimanesh, Ali Sarabi Asiabar*, Nahal Ahmadzadeh, Mohamadhosein Kafaeimehr, Saeid Emamgholizadeh Pages 750-754
    Background
    There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences.
    Methods
    This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used.
    Results
    No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05).
    Conclusion
    Based on the students’ perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered.
    Keywords: Outsourcing, Public Private Partnership, Education, Teaching Hospitals
  • Ali Baradaran Moghaddam, Masoud Alebouyeh, Nastaran Farzi, Saeed Bayati, Nour Amirmozafari* Pages 755-759
    Background
    In this study, the efficacy of nitazoxanide in the treatment of Helicobacter pylori isolates, which were resistant to metronidazole, was examined.
    Methods
    One hundred twenty two patients who underwent endoscopy examinations at Kasra and Laleh hospitals in Tehran from November 2014 to July 2015 were enrolled. Helicobacter pylori strains were isolated from the patients’ endoscopy biopsies by bacteriological culture. Those bacterial isolates resistant to metronidazole were examined for susceptibility to nitazoxanide. Serial agar dilution method was utilized to determine the minimum inhibitory concentrations for the antibiotics.
    Results
    From 122 gastric biopsy specimens, 55 H. pylori isolates were recovered (45%); of which, 40 (72.7%) were resistant to metronidazole. Comparing the MIC values of nitazoxanide with metronidazole revealed significant differences (p
    Conclusion
    The high levels of metronidazole resistance suggest that this medication may not be beneficial for first-line therapy in Iran. However, considering the relative effectiveness of nitazoxanide, it may be considered a suitable alternative for patients in Iran.
    Keywords: Helicobacter pylori, Antibiotic Resistance, Metronidazole, Nitazoxanide, Minimum Inhibitory Concentration
  • Mahdi Moshki, Ali Delshad Noghabi, Fatemeh Darabi *, Hossein Safari Palangi, Narjes Bahri Pages 760-769
    Background
    Excessive and uncontrolled television watching by children predisposes them to some risks such as developmental, social and psychological disorders. Parents play an important role in nurturing their children and controlling the factors affecting their health. The aim of this study was to determine the impact of health education programs on parents’ supervision skills to control their children’s television watching habits based on the theory of planned behavior.
    Methods
    One hundred twenty parents of the students at the first and fifth grades of primary school were randomly divided into an intervention and a control group. Data were collected by a self-report questionnaire at the beginning of and one month after intervention. An educational intervention was implemented for the case group parents, who were divided into four 15-member groups, in the form of three 45-60 minute sessions with focus group discussions. Moreover, the parents were provided with children and television booklet. Data were entered into SPSS-16 and were analyzed using Chi-square, paired t test, Mann-Whitney and Wilcoxon tests.
    Results
    After the intervention, significant changes were detected in the intervention group with respect to the mean hours of watching television (from 6.74±2.02 to 4.28±2.40; p= 0.039), knowledge scores (from 5.8±2.1 to 7.7±1.9; p= 0.001), attitude towards less television watching (from 35.5±11.5 to 48.4±8.9; p=0.003), subjective norms (from 11.8±8.1 to 24.5±8.6; p>0.001) and behavioral intention (from 18.6±7.4 to 31.8±5.1; p=0.001).
    Conclusion
    The results revealed that educational interventions based on the theory of planned behavior are capable of changing knowledge, attitude, subjective norm and intention of parents towards controlling and monitoring their children's television watching and can improve the performance of parental control and reduce the hours of TV watching by children. Therefore, this pattern is suggested for reforming the nurturing skills of parents about other behavioral problems of their children.
    Keywords: Education, Parental Supervision, Student, Television Watching, Theory of Planned Behavior
  • Behzad Damari, Narges Tabrizchi*, Sahand Riazi, Isfahan Pages 770-775
    Background
    Prevalence of sexual dysfunction varies from 20% to 40% in men and women in different studies in Iran. Despite its high prevalence, it seems that this issue has been neglected, particularly in Islamic countries. The aim of this study was to assess sexual health in Iran. This was a mixed method study.
    Methods
    Data were collected through evaluating country’s sexual health programs and literature review. Sexual health status was drafted and formed following a sound analysis by stakeholders. After conducting interviews and focus group discussions, the main points of the meetings, influencing factors of the present status and oncoming strategies were obtained upon experts’ opinions.
    Results
    Review of general policies and the literature showed that although there is adequate support for improving sexual health status in the country, sexual health status has been decreased in the last decade. Based on Iranian sexual health indicators and experts’ opinions, the focus points could be divided into the following groups: Structural and functional –political, legal-behavior, and cultural.
    Conclusion
    Breaking the taboo of sexual health issues would require attention from the policy makers especially in Islamic nations to facilitate the steps on the road to sexual health. In this regard, clarified vision, strategic goals and interventional policies are proposed. An inter-sectional cooperation is needed to implement interventions to promote sexual health status.
    Keywords: Sexual Health, Sexual Health Status, Iran
  • Ali Montazeri, Sahand Riazi, Isfahani, Behzad Damari* Pages 776-784
    Background
    Social issues have prominent effects on the people's physical and mental health and on the health risk factors. In Iran, many organizations provide social care services to their target population. This study aimed to explore the roles and functions of Primary Health Care (PHC) system in providing social care services in Iran.
    Methods
    This was a qualitative study, for which data were collected via three sources: A review of the literature, in-depth interviews and focus group discussions with experts and stakeholders. The main objective was to find a way to integrate social care into the Iranian PHC system. A conventional content analysis was performed to explore the data.
    Results
    Overall, 20 experts were interviewed and the acquired data were classified into four major categories including priorities, implementation, requirements and stewardship. The main challenges were the existing controversies in the definition of social care, social service unit disintegration, multiple stewards for social care services, weaknesses of rules and regulations and low financing of the public budget. Social care services can be divided into two categories: Basic and advanced. Urban and rural health centers, as the first level of PHC, could potentially provide basic social care services for their defined population and catchment areas such as detecting social harms in high risk individuals and families and providing counseling for people in need. They can also refer the individuals to receive advanced services.
    Conclusion
    Iran has a successful history of establishing the PHC System especially in rural areas. This network has an invaluable capacity to provide social health services. Establishing these services needs some prerequisites such as a reform PHC structure, macro support and technical intersectoral collaboration. They should also be piloted and evaluated before they could be implemented in the whole country.
    Keywords: Social Harms, Primary Health Care, Social Care Services, Iran
  • Effective factors in expansion of medical tourism in Iran
    Reza Rezaee*, Mehdi Mohammadzadeh Pages 785-790
    Background
    Medical tourism (MT) refers to circumstances in which people travel for medical treatments. The present study focuses on determining factors affecting MT in Iran.
    Methods
    The study uses a mixed method approach. Initially, through a qualitative study, 12 experts were interviewed deeply; then, 22 participants in three equal focus groups expressed their ideas about growth and development of MT in Iran. Based on the expressed ideas, 120 factors were identified and accordingly a structured questionnaire was developed. Some members from the focus groups confirmed the questionnaire’s face and content validity. The reliability of pertinent items was confirmed using Cronbach’s alpha=0.8. Afterwards, 61 eligible subjects filled out this questionnaire.
    Results
    The findings showed that “healthcare quality” and “high level of expertise” are two most attractive factors in MT. However, other factors such as “healthcare costs”, and “visa facilities” are among key factors as well. Also, the role of “the healthcare providers” was found to be more prominent than the roles of “the government” and “the general tourist services”.
    Conclusion
    Although some attractive MT factors are present currently, MT expansion to a desirable level in Iran requires a comprehensive plan of which its factors were discussed in this paper.
    Keywords: Medical tourism, Health Tourism, Healthcare Quality, Healthcare Cost, Access to care, Iran
  • Nader Pestechian, Hosein Khanahmad Shahreza, Roghiyeh Faridnia, Hamed Kalani* Pages 791-796
    Background
    This study was designed to evaluate whether or not T. gondii and its derivatives can change the gene expression level of IL-10 in murine leukocytes in vivo.
    Methods
    Fifty BALB/c mice were divided into 5 groups, four of which received the excretory/secretory product (ESP) from cell culture medium, the ESP from cell free medium, the Toxoplasma lysate product (TLP) and the active tachyzoites, respectively. The fifth group was considered as control and received PBS. The peritoneal leukocytes from the mice were collected. Their total RNA were extracted and converted to cDNA and the gene expression levels of IL-10 in the samples were evaluated by quantitative real time-PCR using the REST-2009 software.
    Results
    The findings showed a decrease in the expression level of IL-10 in the TLP group (p=0.004). Moreover, the IL-10 gene expression level was upregulated in the group of the ESP from cell culture medium (p=0.04) and the active tachyzoite group (p=0.04). The expression of IL-10 gene in the group of ESP from cell-free medium was not significant compared to the control one (p=0.45).
    Conclusion
    T. gondii and its derivatives are able to increase (the active T. gondii tachyzoite and the ESP from cell culture medium) and decrease (the TLP) the gene expression level of IL-10 in a murine model. The question remains to be examined in further study about which molecules are involved in this process.
    Keywords: IL, 10, Toxoplasma gondii, Gene expression
  • Akram Hashemi, Azim Mirzazadeh, Mandana Shirazi, Fariba Asghari* Pages 797-804
    Background
    Professionalism is a core competency of physicians. This study was conducted to design a model for formative assessment of professional commitment in medical students according to stages of change theory.
    Methods
    In this qualitative study, data were collected through literature review & focus group interviews in the Tehran University of Medical Sciences in 2013 and analyzed using content analysis approach.
    Results
    Review of the literature and results of focus group interviews led to design a formative assessment model of professional commitment in three phases, including pre-contemplation, contemplation, and readiness for behavior change that each one has interventional and assessment components. In the second phase of the study, experts’ opinion collected in two main categories: the educational environment (factors related to students, students’ assessment and educational program); and administrative problems (factors related to subcultures, policymakers or managers and budget). Moreover, there was a section of recommendations for each category related to curriculum, professors, students, assessments, making culture, the staff and reinforcing administrative factors.
    Conclusion
    This type of framework analysis made it possible to develop a conceptual model that could be effective on forming the professional commitment and behavioral change in medical students.
    Keywords: Formative assessment, Professional Behavior, Stage of change theory, Remediation, Professionalism
  • Farid Najafi, Behzad Karami, Matin, Satar Rezaei, Ardashir Khosravi, Moslem Soofi* Page 805
    Background
    Economic burden due to premature mortalities is significant both on health system and on the society as a whole. This study aimed to determine the productivity costs and years of potential life lost associated with five leading causes of death in Iran from 2006 to 2010.
    Methods
    Data on mortality by sex and age-groups due to five main leading causes of death (myocardial infarction (MI), cerebral vascular diseases (CVD), transport accidents (TA), hypertensive heart disease (HHD) and gastric cancer (GC)) were obtained from the Ministry of Health and Medical Education from 2006 to 2010 for 29 providences of Iran (data on Tehran province was not available). Three measures including years of potential life lost (YPLL), years of potential productive life lost (YPPLL) and the cost of productivity loss (CPL) due to premature mortality were used. To estimate the CPL and YPLL, the human capital approach and life expectancy method were used, respectively.
    Results
    There were 518,815 deaths due to the five main leading causes of death; of which, 58% occurred in males. The estimated YPPLL resulted in 209,552,135 YPPLL from 2006 to 2011; of which, 141,966,592 (67%) were in males and 67,585,543 (33%) in females. The total cost of productivity loss caused by premature deaths due to the five leading causes of death was 7.86 billion dollars (US$) from 2006 to 2010, ranging from 1.63 billion dollars in 2006 to 1.31 billion dollars in 2010.
    Conclusion
    This study revealed that the economic burden of premature mortalities due to the five main causes of death is substantial, and that these five leading causes should be considered in policy/decision making and prevention programms. The allocation of financial resources to control these causes may decrease their economic burden, resulting in higher level of health and well-being.
    Keywords: Economic Burden, Premature Mortality, Lost Productivity, Iran
  • Ali A. Asadipooya, Mohammad A. Razavizadegan, Ali Sahraian, Mohammad A. Sahmeddini Pages 813-817
    Background
    Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy, characterized by drug-resistant multiple seizure types. The aim of this study was to determine if the adjunctive use of electroconvulsive therapy (ECT) in patients with LGS and drug-resistant epilepsy is efficacious in decreasing their seizure frequency and also to investigate its safety and tolerability.
    Methods
    This was an open-label pilot study with convenience sampling from one center. Bitemporal electrode placement was selected. ECT was administered three times per week for four weeks (considered as the induction phase), and then once a week for two months (considered as the maintenance phase). Follow-up visits were scheduled at 2, 3, 4, and 6 months to determine the seizure types and counts and also to determine the safety and tolerability of adjunctive use of ECT in these patients. All patients and / or their caregivers consented in writing to their participation.
    Results
    Seven patients were studied. Just one patient experienced more than 50% reduction in seizure frequency. One patient experienced more than 50% seizure increase with ECT. In three patients, there was an increase in aggressive behavior after receiving ECT. Two patients experienced mild and transient ataxia with ECT. One patient experienced mutism with ECT, which was transient and resolved with the termination of the procedure.
    Conclusion
    In this small study, adjunctive use of an intensive ECT program in patients with LGS was not efficacious in decreasing their seizure frequency. However, the safety profile was acceptable, and patients tolerated the adjunctive use of ECT very well. This finding can pave the road for future investigations.
    Keywords: Lennox, Gastaut syndrome, Treatment, Electroconvulsive therapy, Epilepsy, Safety
  • Jafar Hassanzadeh, Mansour Torabinia, Mohsen Asadi, Lari, Haleh Ghaem, Rostam Menati, Mohsen Niazi, Aziz Kassani* Pages 818-826
    Background
    Social capital has been defined as norms, networks, and social links that facilitate collective actions. Social capital is related to a number of main social and public health variables. Therefore, the present study aimed to determine the factors associated with social capital among the residents of Tehran, Iran.
    Methods
    In this large cross-sectional population-based study, 31531 residents aged 20 years and above were selected through multi-stage sampling method from 22 districts of Tehran in 2011. The social capital questionnaire, 28-item General Health Questionnaire (GHQ-28), and Short-Form Health Survey (SF-12) were used. Hypothetical causal models were designed to identify the pathways through which different variables influenced the components of social capital. Then, path analysis was conducted for identifying the determinants of social capital.
    Results
    The most influential variables in ‘individual trust’ were job status (β=0.37, p=0.02), marital status (β=0.32, p=0.01), Physical Component Summary (PCS) (β=0.37, p=0.02), and age (β=0.34, p=0.03). On the other hand, education level (β=0.34, p=0.01), age (β=0.33, p=0.02), marital status (β=0.33, p=0.01), and job status (β=0.32, p=0.01) were effective in ‘cohesion and social support’. Additionally, age (β=0.18, p=0.02), PCS (β=0.36, p=0.01), house ownership (β=0.23, p=0.03), and mental health (β=0.26, p=0.01) were influential in ‘social trust/collective relations’.
    Conclusion
    Social capital can be improved in communities by planning to improve education and occupation status, paying more attention to strengthening family bonds, and provision of local facilities and neighborhood bonds to reduce migration within the city.
    Keywords: Path analysis, Social capital, Individual trust, Social trust, Social support
  • Navid Mohammadi, Ferial Farahmand, Homayoun Hadizadeh Kharazi, Hossein Mojdehipanah, Hossein Karampour, Marzieh Nojomi Pages 827-833
    Background
    Back pain is a common patients’ complaint, and its etiology is important because of different potential treatment approaches (based on causes). For a better diagnosis, magnetic resonance imaging (MRI) is widely used in clinical settings that may result in inappropriate requests. This study aims to evaluate the appropriateness of the lumbosacral MRI requests in patients with back pain in two public/referral and private imaging centers in Tehran.
    Methods
    In this cross-sectional study, 279 patients from both centers were recruited in 2014. A checklist was developed based on the internationally recognized clinical guidelines (NICE, and AHRQ) for determining the indications. An expert panel of related specialties finalized them. Patients’ demographic and some anthropometric measures, as well as MRI reports, were collected.
    Results
    The mean±SD age of patients was 47.9±14.78 years with a dominance of females (M/F=38.4/61.6). About 77% (n=214) of lumbosacral MRIs were requested in accordance with the guidelines. Indicated MRI requests were significantly higher in the private imaging center (p=0.019, OR=2.087, CI 95%: 1.13-3.85). In the private center, 80.6% and in the public center, 70.4% of the MRI requests were in accordance with the guidelines.
    Conclusion
    The proportion of non-indicated MRI requests based on the valid guidelines is about ¼ of all requests that is compatible with some other studies mostly from developed countries.
    Keywords: Back pain, MRI, Practice guideline, Magnetic resonance imaging
  • Salime Goharinezhad, Mohammadreza Maleki*, Hamid Reza Baradaran, Hamid Ravaghi Pages 834-842
    Background
    The number of people aged 60 and older is increasing faster than other age groups worldwide. Iran will experience a sharp aging population increase in the next decades, and this will pose new challenges to the healthcare system. Since providing high quality aged-care services would be the major concern of the policymakers, this question arises that what types of aged care services should be organized in the coming 10 years? This protocol has been designed to develop a set of scenarios for the future of elderly care in Iran.
    Methods
    In this study, intuitive logics approach and Global Business Network (GBN) model were used to develop scenarios for elderly care in Iran. In terms of perspective, the scenarios in this approach are normative, qualitative with respect to methodology and deductive in constructing the process of scenarios. The three phases of GBN model are as follows: 1) Orientation: Identifying strategic levels, stakeholders, participants and time horizon; 2) Exploration: Identifying the driving forces and key uncertainties; 3) Synthesis: Defining the scenario logics and constructing scenario storyline.
    Results
    Presently, two phases are completed and the results will be published in mid-2016.
    Conclusion
    This study delivers a comprehensive framework for taking appropriate actions in providing care for the elderly in the future. Moreover, policy makers should specify and provide the full range of services for the elderly, and in doing so, the scenarios and key findings of this study could be of valuable help.
    Keywords: Future, Elderly, care, Scenario, Iran
  • Mahnaz Solhi, Marziyeh Shabani Hamedan, Masoud Salehi Pages 843-851
    Background
    Women-headed households are more exposed to social damages than other women. Such condition remarkably influences the women’s health-related life quality. The present study is aimed to investigate the effect of an educational intervention in quality of life of women-headed households under protection of Tehran Welfare Organization, in 2015.
    Methods
    In this quasi-experimental study with control group, 180 women-headed households participated. Sampling method was random allocation. Data collection tools were Life Quality standard questionnaire (WHOQOL-BREF) and a researcher-made questionnaire about structures of ecological and educational diagnosis phase of PRECEDE-PROCEED model. Validity and reliability of the questionnaire approved in a primary study. Based on the results obtained from the primary study, the intervention was performed in the case group only. Participants were followed one and three months after intervention. Data were analyzed through SPSS v. 15 software using descriptive and analytical tests.
    Results
    Before intervention no significant difference was observed among the mean scores of life quality, behavioral factors, and knowledge, enabling, and reinforcing factors in the two groups. But, one month and three months after intervention a significant difference was observed between the mean scores of these variables (in five instances p
    Conclusion
    Intervention through the PRECEDE-PROCEED model improved the women-headed households’ quality of life. The innovation of this study is using such intervention on quality of life in women-headed households for the first time.
    Keywords: Quality of life, women, headed household, PRECEDE, PROCEED model, ecological, educational assessment
  • Mojgan Amirpour, Hossein Ayatollahi, Maryam Sheikhi, Somaye Azarkerdar, Seyyede Fatemeh Shams* Pages 852-856
    Background
    Acute myeloid leukemia (AML) is known as one of the most common leukemia among adults. Environmental and different genetic factors affect disease process, prognosis and treatment. Among different genetic factors NPM1, FLT3, MLL and BAALC genes are the most effective on patient's survival rate. The aim of this study was to assess amount of BAALC gene expression in AML patients, and its relation to survival rate.
    Methods
    In this case-control study, from all 94 individuals referred to Ghaem Medical Center during 2012-2015, 47 cases were normal cytogenetic AML and others were healthy individuals that were studied as control group. Real-time PCR method was applied for gene expression evaluation. Other information of patients was extracted from medical documents. SPSS v.21 was used for data processing.
    Results
    Mean age of studied cases was 31.50 years. The most of BAALC gene expression was seen in M1 and M2 subtypes, and the less was in M5. A significant relation was found between amount of gene expression and patient's survival rate.
    Conclusion
    BAALC gene expression was increased significantly in AML cases. BAALC expression had reverse relation with patient's survival rate in North-East of Iran.
    Keywords: Acute myeloid leukemia, Survival rate, Prognosisampus
  • Morteza Khavanin Zadeh, Hamid Nouri, Yousef Moradi, Ladan Reza, Rashin Joodat, Shahrzad Arya Pages 857-862
    Background
    Central Venous Catheters (CVCs) are used not only as a tool to access to central venous system, but also for hemodynamic monitoring, parenteral nutrition, chemotherapy and hemodialysis. The use of CVCs is associated with some complications notably infections that are troublesome both to patient and physician. We conducted this study to examine catheter fixation with skin fold technique and to evaluate risk of catheter infection in this method and compare it to conventional technique.
    Methods
    This study is a controlled clinical trial (IRCT: IRCT2015081723229N1) and all cases are patients over 18 years, admitted to Hasheminejad Kidney Center from 2011 to 2012, who needed an internal jugular venous catheter for hemodialysis. Finally, two hundred and twenty two patients entered the study. We used chi square test and logistic regression for data analysis. P-value less than 0.05 was considered significant.
    Results
    In this study Mean±SD age of patients was 54.50±15.71 years. Mean ±SD ages of patients in the case and control group were 54.56±16.43 and 54.42±14.84 years, respectively. The rate of catheter infection significantly decreased with skin fold technique: Five patients (3%) in case group and 13 patients (16%) in control group had infection (p=0.002).
    Conclusion
    The findings of this study demonstrated that catheter fixation with skin fold could be an appropriate technique in comparison with current conventional method. However, further studies on other possible and unpredictable complications of this technique is required.
    Keywords: Central venous catheter, Fixation, Infection
  • Mohammad Meskarpour, Amiri, Nooredin Dopeykar, Ahmad Ameryoun*, Ali Mehrabi Tavana Pages 863-870
    Background
    Timely access to cardiovascular health services is necessary to prevent heart damages. The present study examined inequality in geographical distribution of cardiovascular health services in Iran.
    Methods
    Present study is a cross-sectional study conducted using demographic data from all Iranian provinces (31 provinces) from 2012 census by the Statistics Center of Iran (SCI). The Gini coefficients of CCU beds and cardiologists were used to assess equality in access to cardiovascular health services in Iran. MS Excel software was used to calculate Gini coefficients.
    Results
    The proportions of CCU bed and cardiologist per 100,000 population were 4.88 and 1.27, respectively; also the Gini coefficients were 0.129 and 0.045, respectively.
    Conclusion
    Descriptive statistics showed a skewness in distribution of pubic cardiovascular health services in Iran, though Gini coefficient revealed no significant inequality. However, equal distribution of CCU beds and cardiovascular specialists does not mean they are sufficiently available in Iran.
    Keywords: Public health, Cardiovascular services, Gini coefficient, Inequality, Iran
  • Elham Gouran Ourimi, Amir Shabani, Kaveh Alavi, Mohammad Reza Najarzadegan, Fatemehsadat Mirfazeli Pages 871-879
    Background
    Iran is facing an outbreak of methamphetamine-induced disorders and frequent use of these substances in patients with bipolar disorder. Using or intoxication of methamphetamine in patients with bipolar I disorder may alter the patient's clinical profile; however there is limited studies about impact of methamphetamine on clinical manifestation of bipolar disorders. This study aimed to compare psychiatric symptoms in patients with bipolar I disorder with and without concomitant use of methamphetamine.
    Methods
    In a cross-sectional study, psychiatric symptoms of bipolar I disorder in patients with (Meth) and without (Meth-) methamphetamine use was evaluated. A number of 57 participants with Meth and 50 subjects with Meth- were recruited. The clinical picture of bipolar disorder was investigated by Young Mania Rating Scale (YMRS), 17-item Hamilton Depressive Rating Scale (HDRS-17) and the Scale for Assessment of Positive Symptoms (SAPS). Statistical comparisons were performed using the T-test for independent samples and Mann-Whitney test.
    Results
    There was no statistically significant difference between two groups regarding age, duration of illness and hospitalizations. However, male participants were significantly higher in Meth group than in Meth- one (p
    Conclusion
    There was no significant difference in the overall clinical manifestation of bipolar I disorder in patients with and without methamphetamine use. However, in some symptomatology domains, there were some differences between the two groups.
    Keywords: Bipolar one disorder, Methamphetamine, Manic episode, Psychosis
  • Silva Hovsepian, Roya Kelishadi, Mohammad Esmaeil Motlagh, Amir Kasaeian, Gita Shafiee, Tahereh Arefirad, Fereshteh Najafi, Maliheh Khoramdad, Hamid Asayesh, Ramin Heshmat, Mostafa Qorbani Pages 880-890
    Background
    There are few epidemiological reports on adherence to physical activity (PA) and screen-time (ST) recommendations among Iranian children and adolescents at the provincial level. We used nationally representative data to provide recent prevalence estimates of Iranian children who met the recommendations for PA and ST.
    Methods
    This nationwide study was conducted among 14,880 students aged 6-18 years from 30 provinces of Iran. The frequency of the recommended level for PA (>1 hours/week) and ST (
    Results
    In this study, 13,486 students (response rate: 90.6%) were studied. Overall, 18.62%, 34.11%, 50.66% and 9.63% of the students reported high ST, low level of PA, high TV watching and high computer working, respectively. The frequency of the recommended level of PA and ST was 53.92%. Of the studied population, 6.63% had low PA and high ST. Paradox combinations of low PA and low ST and moderate/high PA and high ST was prevalent among 27.47% and 6.26% of the children and adolescents. The lowest and highest frequency of recommended level of PA and ST was 38.9% and 65%, respectively. The lowest and highest frequency of low PA and high ST was 1.87% and 13.77%, respectively.
    Conclusion
    The results of this study revealed that the frequency of low PA was high and that approximately 46% of the students did not meet the recommended level of PA and ST. The findings indicated that preparing facilities for improving PA level among children should be the main priority in our future interventions in this field.
    Keywords: Physical Activity, Screen Time, Children, Adolescents
  • Parisa Mirmoghtadaee, Ramin Heshmat, Shirin Djalalinia, Nazgol Motamed, Gorji, Mohammad Esmaeil Motlagh, Gelayol Ardalan, Saeid Safiri, Zeinab Ahadi, Gita Shafiee, Hamid Asayesh, Mostafa Qorbani, Omid Yaghini, Roya Kelishadi Pages 891-898
    Background
    Socioeconomic status (SES) is a major determinant of health inequality in children and adolescents. The aim of this study was to evaluate the association of SES of family and living region with self-rated health (SRH) and life satisfaction (LS) among children and adolescents.
    Methods
    This study was a part of the fourth survey of a national surveillance program, which was conducted in 30 provinces of Iran in 2011-2012. LS and SRH were assessed by a questionnaire based on the World Health Organization-Global School-based student Health Survey (WHO-GSHS). Family SES was estimated using principal component analysis (PCA) and based on family assets, parental education and occupation, and type of school. Region SES was calculated using PCA and some variables including literacy rate, family assets and employment rate.
    Results
    Out of 14,880 invited students, 13,486 (participation rate: 90.6%) completed the survey; of whom, 49.2% were girls, and 75.6% were from urban areas with the mean ± SD age of 12.47±3.36 years. In the multivariate model, SES of family and living region was associated with LS and good SRH. In the full models, in addition to all potential confounders, family and living region SES were included simultaneously. However, only the association of family SES with LS, and good SRH remained statistically significant.
    Conclusion
    The effect of families’ SES on SRH and LS is more important than regional SES. The presented patterns of SRH and LS may be useful in developing better health policies and conducting complementary studies in this field.
    Keywords: Life Satisfaction, General Health, Socioeconomic Status, Children, Adolescents
  • Afshin Ebrahimi, Mokhtar Mahdavi, Anoosheh Ghasemian, Parinaz Poursafa, Farshad Sharifi, Rasool Mohammadi, Masoumeh Nejatifar, Mohammad Mehdi Amin, Hamid Asayesh, Saeid Safiri, Hossain Ansari*, Mostafa Qorbani Pages 899-907
    Background
    Water, sanitation and hygiene have a very important role in public health. Poor sanitation is the cause of water contamination, which causes many types of diseases. The aim of this paper was to present the attributable death and disability adjusted life year (DALYs) of untreated water and insanitary environments from 1990 to 2010 in Iran.
    Methods
    In the Global Burden of Disease 2010 study, using the comparative risk assessment, the proportion of death and DALYs attributable to untreated water source and insanitary environment has been calculated in 1990 to 2010. The certain outcomes were intestinal infectious diseases for both untreated water source and insanitary environments. Estimated attributable deaths and DALYs were reported with 95% uncertainty interval (UI).
    Results
    DALY number for untreated water source and insanitary environments was 5838 (95% UI: 198-14837) in 1990, which decreased to 326 (95% UI: 9-863) in 2010 and the percent of decrease was 94.42%. In addition, DALY rate was 5667 (95% UI: 192-14402) DALY per 100,000 in 1990, which decreased to 453 (95% UI: 13-1199) DALY per 100,000 in 2010 and the percent of the reduction was 92.01%. The greatest percentage of decrease in the attributed number of deaths was also found in the late neonatal age group (95.45%).
    Conclusion
    A significant decrease has occurred in a number of DALYs and deaths between 1990 and 2010, which was attributed to the development of new water systems and environmental sanitations in Iran.
    Keywords: Water, Insanitary Environments, Disability Adjusted Life Year, Burden of Diseases, Iran
  • Roya Kelishadi, Arash Rashidian, Mohsen Jari, Ardeshir Khosravi, Roghayeh Khabiri, Elham Elahi, Maryam Bahreynian Pages 908-914
    Background
    Breastfeeding has been recognized to have a great deal of benefits for both the mothers and infants. Moreover, the importance of exclusive breastfeeding in the first six months of life has been greatly acknowledged. Therefore, this study aimed to determine the prevalence of starting breastfeeding in the first hour after delivery and the exclusive breast milk feeding as well as the age at which complimentary foods are provided to the child and duration of breastfeeding in Iran.
    Methods
    This nationwide cross-sectional study was conducted in the frame of a national survey, Iran Multiple Indicator Demographic and Health Survey (IrMIDHS), in 31 provinces of Iran. Participants were selected by multistage cluster sampling. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural families. Data were collected using a questionnaire through face-to-face interviews.
    Results
    The rate of exclusive breastfeeding was 53.13% with higher prevalence in rural (67.76%) than in urban areas (47.79%) (P = 0.04), and among girls (56.35%) compared to boys (50.60%). The prevalence of breastfeeding as the main diet of Iranian infants under six months old was 70.72% and the prevalence of initiation of breastfeeding (up to the first hour after delivery) was 68.70%. The probability of breastfeeding continuance among twelve to fifteen months children was 84.22%; the corresponding figure was 51% among twenty to twenty three months old babies (p=0.03).
    Conclusion
    Exclusive breastfeeding should be encouraged; and strategies that are more effective should be designed to protect, train and support young mothers to breastfeed their infants. The importance of early beginning of breastfeeding and its continuation should be underscored.
    Keywords: Breastfeeding, Infant, Prevalence, Iran
  • Ramin Heshmat, Forouzan Salehi, Mostafa Qorbani, Mahsa Rostami, Gita Shafiee, Zeinab Ahadi, Shayesteh Khosravi, Vahab Rezvani, Farzaneh Sadeghi Ghotbabadi, Maryam Ghaderpanahi, Zahra Abdollahi Pages 915-922
    Background
    Improper nutritional knowledge is one of the most important causes of nutritional problems, which can affect practice and cause more complications. The aim of this study was to assess the association between nutritional knowledge, attitude and practice (KAP) of Iranian households with socioeconomic status (SES).
    Methods
    The study population was 14,136 households (57 clusters of 8 individuals in each province) who lived in urban and rural regions of 31 provinces of Iran. The sample size of the study was selected using multi-stage cluster sampling technique. A structured questionnaire and interview with the qualified person in each family was used to collect data. The questionnaire included demographic, SES and nutritional KAP questions. Using principle component analysis, some variables including household assets, occupation and education level of the heads of the families and respondents and the number of family members were used to construct family SES. The SES was categorized as good, moderate and weak. Pearson’s Chi-square test was used to analyze categorical variables.
    Results
    The percentage of knowledge about growing up, acquiring energy and being healthy as reasons for eating food was 24.1%, 44.8% and 54.7%, respectively. Only 69.7%, 60.5% and 52.5% of the participants had knowledge of identification of meat and legumes, grain and dairy group, respectively. More than 97% of the participants had a favorable attitude toward importance of nutrition in health. The nutritional knowledge linearly increased with increasing SES. Families with good SES significantly consumed more fruit, vegetable, dairy group, red meat, chicken and poultry, fish and egg while sugar consumption was significantly higher in families with weak SES (p
    Conclusion
    SES can influence the rate of nutritional KAP. Some policies should be considered to increase nutritional KAP especially in lower SES group in the society.
    Keywords: Knowledge, Attitude, Practice, Socioeconomic Status, Nutrition
  • Pantea Hakimian, Azadeh Lak Pages 923-931
    Background
    In spite of the increased range of inactivity and obesity among Iranian adults, insufficient research has been done on environmental factors influencing physical activity. As a result adapting a subjective (self-report) measurement tool for assessment of physical environment in Iran is critical. Accordingly, in this study Neighborhood Environment Walkability Scale (NEWS) was adapted for Iran and also its reliability was evaluated.
    Methods
    This study was conducted using a systematic adaptation method consisting of 3 steps: translate-back translation procedures, revision by a multidisciplinary panel of local experts and a cognitive study. Then NEWS-Iran was completed among adults aged 18 to 65 years (N=19) with an interval of 15 days. Intra-Class Coefficient (ICC) was used to evaluate the reliability of the adapted questionnaire.
    Results
    NEWS-Iran is an adapted version of NEWS-A (abbreviated) and in the adaptation process five items were added from other versions of NEWS, two subscales were significantly modified for a shorter and more effective questionnaire, and five new items were added about climate factors and site-specific uses. NEWS-Iran showed almost perfect reliability (ICCs: more than 0.8) for all subscales, with items having moderate to almost perfect reliability scores (ICCs: 0.56-0.96).
    Conclusion
    This study introduced NEWS-Iran, which is a reliable version of NEWS for measuring environmental perceptions related to physical activity behavior adapted for Iran. It is the first adapted version of NEWS which demonstrates a systematic adaptation process used by earlier studies. It can be used for other developing countries with similar environmental, social and cultural context.
    Keywords: Environment, Physical activity, Neighborhood Environment Walkability Scale, Psychometrics, Iran
  • Nasser Mostafavi, Moein Bighamian, Sina Mobasherizade, Roya Kelishadi Pages 932-936
    Background
    The aim of this study was to determine the serotypes and antimicrobial susceptibility of Shigella spp. in Isfahan, (Iran) from 2010 to 2015.
    Methods
    This retrospective study was conducted on Shigella isolates in four tertiary care hospitals. The process of bacterial isolation and determination of susceptibility was performed by standard microbiological guidelines. The patients were categorized into three age groups of under 5, 5-15 and over 15 years.
    Results
    Among 45 isolates, S. sonnei (63.6%) was the predominant species, followed by S. flexneri (34.1%), and S. dysenteriae (2.3%). Substantial resistance to ampicillin, trimethoprim- sulfamethoxazole, ceftriaxone, cefotaxime, and cefixime was observed. Over 94% of the isolates were sensitive to ciprofloxacin. Susceptibility of isolates was similar between all age groups.
    Conclusion
    Significant resistance to third generation cephalosporins precludes the use of these agents for empirical treatment of shigellosis in our population. Ciprofloxacin is an appropriate option; however, susceptibility tests should be performed before prescription.
    Keywords: Shigellosis, Susceptibility, Ciprofloxacin, Third Generation Cephalosporin, Iran
  • Mahin Hashemipour, Maryam Kargar*, Alireza Ghannadi, Roya Kelishadi Pages 937-943
    Background
    Childhood obesity is becoming a global problem and its incidence is increasing. The role of dietary intervention with fruits containing vitamin C and flavonoid to control obesity consequences in childhood has not been yet defined. Lemon (Citrus aurantifolia) peels contain flavonoid, pectin and vitamin C. We aimed to compare the effects of lemon peels and placebo on cardiometabolic risk factors and markers of endothelial function among adolescents with overweight and obesity.
    Methods
    In this triple-masked, randomized controlled trial, 60 overweight/obese adolescents were enrolled in a 4-week trial. Eligible participants were randomly assigned into two groups of equal number receiving daily oral capsules containing lemon powder or placebo. Fasting blood sugar, lipid profile, ICAM-1 and VCAM-1, as well as systolic and diastolic blood pressure were compared between the two groups before and after administration of medication and placebo.
    Results
    Of the total 60 enrolled patients, 30 and 29 patients in the lemon and control groups completed the study, respectively. The results of within-group analysis demonstrated a slight reduction in body mass index, LDL-C and systolic blood pressure in the lemon group, but no between group differences existed in the studied variables.
    Conclusion
    This study revealed that consumption of lemon peel extract has some beneficial effects for childhood obesity; however, no considerable effect was documented on anthropometric measures and biochemical factors. Future studies with longer follow up are highly recommended.
    Keywords: Overweight, Adolescents, Citrus Fuit, Trial
  • Behzad Shams*, Elnaz Afshari, Mohammadhasan Tajadini, Mojtaba Keikha, Mostafa Qorbani, Ramin Heshmat, Mohammad Esmaeil Motlagh, Roya Kelishadi Pages 944-948
    Background
    Vitamin D (VitD) deficiency is a common worldwide problem. Some previous studies have shown that both Zinc (Zn) and VitD deficiency are prevalent in Iran. This study aimed to assess the relationship of serum Zn and vitamin D levels in a nationally representative sample of Iranian children and adolescents.
    Methods
    This case-control study was conducted as a sub-study of a school-based surveillance program entitled “the CASPIAN-III Study”. An equal number of individuals with and without hypovitaminosis D including 330 participants aged 10 to 18 years were selected. The correlation of serum 25 hydroxy vitamin D (25(OH) D), cardiometabolic factors and Zn concentrations was determined. Statistical analysis was done using one-way analysis of variance (ANOVA), Pearson's correlation, linear regression, and logistic regression.
    Results
    The mean age was not significantly different in participants with and without hypovitaminosis D (14.74±2.52 vs. 14.74±2.66 years, respectively, p>0.05). The mean 25(OH) D level was 6.34±1.47ng/ml in the group with hypovitaminosis D and 39.27±6.42ng/ml in controls. The mean Zn level was significantly lower in the hypovitaminosis D group than in controls (1.15±0.26 vs. 1.43±0.32µg/ml, respectively, p
    Conclusion
    We found significant associations between low serum concentrations of zinc and 25(OH) D. Food fortification or mineral supplementation should be considered in future health programs.
    Keywords: Vitamin D, Zinc, Adolescents, Iran
  • Mostafa Qorbani, Roya Kelishadi, Shirin Djalalinia, Mohammad Esmaeil Motlagh, Amir Kasaeian, Gelayol Ardalan, Gita Shafiee, Omid Safari, Ramin Heshmat*, Sadegh Baradaran Mahdavi Pages 949-958
    Background
    This study aimed to assess the pattern of hygienic behaviors of Iranian children and adolescents at national and sub-national levels according to the socioeconomic status (SES) of their living region.
    Methods
    Data were obtained from the fourth national school-based surveillance survey entitled, “CASPIAN-IV study” (2011-2012). It was conducted among 14,880 students, aged 6-18 years, who were selected by multistage random cluster sampling from 30 provinces in Iran. We used the World Health Organization Global School-based Student Health Survey (WHO- GSHS) questionnaire. Data were analyzed at national and sub-national levels according to the SES of the living region.
    Results
    Overall, 13,486 students (49.2% girls) with the mean (SD) age of 12.50 (3.36) years participated in this study (participation rate: 90.6%). At the national level, 67.21% of the participants had daily tooth brushing, the frequencies for always washing hands after using the toilet, washing hands before eating, and washing hands with soap in school were 85.61%, 56.53%, and 50.32%, respectively.
    The frequency of daily tooth brushing had no significant difference according to the SES of the living region. In all of the categories of washing hands, the West region (second high SES rank) had the highest frequency of hygienic behaviors (p
    Conclusion
    In general, the reported hygienic behaviors were at an acceptable level; however, a large comprehensive health-promoting plan should be considered for all children and adolescents at the national and sub-national levels taking into account the disparities according to their SES.
    Keywords: Hygienic Behaviors, Tooth Brushing, Hand Washing, Children, Adolescents, Iran
  • Shayesteh Shirzadi*, Mohammad Asghari Jafarabadi, Haidar Nadrian, Hassan Mahmoodi Pages 959-965
    Background
    Adolescence is a critical stage of growth and development. That is associated with changes in body shape and appearance. Issues such as irregular menstrual periods, amenorrhea, and menstrual cycle are major issues in women's health. The purpose of this study was to examine the determinants of physical puberty health based on the Health Belief Model (HBM) among female adolescents.
    Methods
    This analytical cross sectional study was conducted in welfare boarding centers in Tehran, Iran. Data were collected in 2011 by a structured and valid questionnaire. Total 61 female adolescents (age range: 12-19 yrs) participated in this study from welfare boarding centers in Iran, Tehran, by using convenience sampling method. The questionnaire consisted of demographic characteristics, health belief model constructs and physical puberty health behaviors gathered by using interview. A series of univariate general linear models were used to assess the relationship between puberty health and health belief model constructs.
    Results
    According to the results of this study there were positive significant relationships between perceived susceptibility, perceived benefits, perceived barriers, cues to action and increased puberty health in female adolescents (p
    Conclusion
    Based on the results of the study to improve the physical Puberty health behaviors of female adolescents should make them aware of the benefits of health behaviors, and remove or reform the perceived barriers of health behaviors. Also, the appropriate information resources should be introduced for obtaining information about puberty health.
    Keywords: Boarding Welfare Centers, Female adolescent, Health belief model, Puberty
  • Poupak Rahimzadeh, Farnad Imani, Azadeh Sayarifard, Sara Sayarifard, Seyed Hamid Reza Faiz* Pages 966-972
    Background
    Postoperative pain is one of the major problems in patients with femoral or hip fracture. Current study investigates the effect of 0.2% and 0.3% bupivacaine in ultrasound-guided fascia iliaca compartment block (FICB) on postoperative pain.
    Methods
    This randomized clinical trial study was conducted in Rasoul Akram Hospital of Iran University of Medical Sciences. Forty-eight patients with femoral or hip fractures who were candidates for surgery underwent FICB, divided into two groups receiving bupivacaine in 0.2% and 0.3% concentrations. Pain was evaluated with Visual Analog Scale (VAS) at times 2, 6, 12, 24, and 48 hours after surgery. Need for opioids, nausea and vomiting after surgery, patients’ satisfaction with pain control and motor block were also recorded. T-test or Mann-Whitney U test and Repeated measure ANOVA was used for analysis.
    Results
    Pain score after surgery was significantly lower in groups receiving 0.3% than the group receiving 0.2% concentration. Patients’ satisfaction with pain control in 0.2% group was significantly higher (p=0.04). Time to analgesic onset in both groups had no significant differences (p=0.5). The incidence of nausea and vomiting (p=0.5) and opioid consumption (p=0.1) between the two groups showed no significant difference.
    Conclusion
    In femoral or hip fracture, bupivacaine with 0.3% concentration in fascia iliaca compartment block can cause lower pain score compared to bupivacaine with 0.2% concentration, but patients’ satisfaction with pain control and severity of motor block is higher in bupivacaine 0.2%.
    Keywords: Postoperative pain, Bupivacaine, Fascia iliac block
  • Naser Havaei, Mandana Rezaei*, Hamid Reza Rostami Pages 973-979
    Background
    Dysgraphia as a problem with handwriting, affects student’s performance in school activities and participation. The purpose of the study was to compare dexterity and two-point discrimination of the hand between learning disabled students with dysgraphia and healthy students.
    Methods
    Forty-three students with developmental dysgraphia and 55 normal students in grade two to four from special and regular schools participated in this study. Hand dexterity and static/dynamic discriminative touch were assessed via Purdue Pegboard and Two-Point Discriminator respectively.
    Results
    Significant differences were found in Purdue Pegboard scores between two groups except in doing the test with the left hand (p0.05). Static two-point discrimination of the thumb finger was significantly higher in children with dysgraphia (p
    Conclusion
    Hand dexterity affects handwriting performance in children with dysgraphia. There were no correlations between two-point discrimination and Purdue Pegboard scores of children with dysgraphia. Intervention should focus on other aspects of dexterity rather than sensory components. Hand dominancy also may be a factor influencing hand performance in dysgraphia.
    Keywords: Learning disability, dysgraphia, hand, dexterity, two point discrimination
  • Nahid Jalilevand, Mohammad Kamali*, Yahya Modarresi, Yalda Kazemi Pages 980-989
    Background
    Developmental Sentence Scoring (DSS) was developed as a numerical measurement and a clinical method based on the morphosyntactic acquisition in the English language. The aim of this study was to develop a new numerical tool similar to DSS to assess the morphosyntactic abilities in Persian-speaking children.
    Methods
    In this cross-sectional and comparative study, the language samples of 115 typically developing Persian-speaking children aged 30 - 65 months were audio recorded during the free play and picture description sessions. The Persian Developmental Sentence Score (PDSS) and the Mean Length of Utterance (MLU) were calculated. Pearson correlation and one – way Analysis of variance (ANOVA) were used for data analysis.
    Results
    The correlation between PDSS and MLU in morphemes (convergent validity) was significant with a correlation coefficient of 0.97 (p
    Conclusion
    The PDSS could be used as a reliable numerical measurement to estimate the syntactic development in Persian-speaking children.
    Keywords: Language Measurement, Validity, Reliability, Typically Developing Children, Persian Language
  • Alireza Olyaeemanesh, Reza Majdzadeh* Pages 990-992
    Iran’s health system is in the serious need of reconstructing its infrastructures, a significant part of which is health technologies. An untapped market of 80 million people will be open to technologies of the world through Iran's entry to post-sanctions era. Health Technology Assessment projects date back to nearly eight years ago in Iran. However, given the current circumstances, its application for selecting technologies is needed more than ever.
    Keywords: Health technology assessment, health transformation plan, post, sanctions
  • Hamid Reza Koohestani, Nayereh Baghcheghi* Pages 993-999
    Background
    Team-based learning is a structured type of cooperative learning that is becoming increasingly more popular in nursing education. This study compares levels of nursing students’ perception of the psycho-social climate of the classroom between conventional lecture group and team-based learning group.
    Methods
    In a quasi-experimental study with pretest-posttest design 38 nursing students of second year participated. One half of the 16 sessions of cardiovascular disease nursing course sessions was taught by lectures and the second half with team-based learning. The modified college and university classroom environment inventory (CUCEI) was used to measure the perception of classroom environment. This was completed after the final lecture and TBL sessions.
    Results
    Results revealed a significant difference in the mean scores of psycho-social climate for the TBL method (Mean (SD): 179.8(8.27)) versus the mean score for the lecture method (Mean (SD): 154.213.44)). Also, the results showed significant differences between the two groups in the innovation (p
    Conclusion
    This study provides evidence that team-based learning does have a positive effect on nursing students’ perceptions of their psycho-social climate of the classroom.
    Keywords: Team, based learning, nursing students, Perception, Psycho, social climate, Classroom
  • Puzzle test: A tool for non-analytical clinical reasoning assessment
    Alireza Monajemi, Minoo Yaghmaei* Pages 1000-1004
    Most contemporary clinical reasoning tests typically assess non-automatic thinking. Therefore, a test is needed to measure automatic reasoning or pattern recognition, which has been largely neglected in clinical reasoning tests. The Puzzle Test (PT) is dedicated to assess automatic clinical reasoning in routine situations. This test has been introduced first in 2009 by Monajemi et al in the Olympiad for Medical Sciences Students.PT is an item format that has gained acceptance in medical education, but no detailed guidelines exist for this test’s format, construction and scoring. In this article, a format is described and the steps to prepare and administer valid and reliable PTs are presented. PT examines a specific clinical reasoning task: Pattern recognition. PT does not replace other clinical reasoning assessment tools. However, it complements them in strategies for assessing comprehensive clinical reasoning.
    Keywords: Illness Script, Clinical Reasoning, Clinical Reasoning Assessment, Pattern Recognition.
  • Roshanak Benabbas* Pages 1005-1011
    Background

    Empathy is an important element of physician-patient communication. Empathy is linked to a number of attributes such as patient treatment compliance and satisfaction, better history taking and physical examination and therefore achieving better clinical outcomes. Previous research indicates that self-reported empathy among medical students declines during the course of their medical education and this decrease in empathy particularly happens when students enter clinical training. Very limited data is available on the concept of empathy among Iranian medical students. The aim of the present study was to investigate empathy among Iranian medical students and the possible differences between students of different levels of medical education.

    Methods

    The data were collected using convenient sampling. The Jefferson Questionnaire of Physicians Empathy-student version as well as a demographic questionnaire was distributed among 500 medical students in different levels of medical education at medical school of Iran University of Medical Sciences.

    Results

    Response rate was 91.8% (459/500). Of 459 responders, 150 were first and second year students (Basic sciences), 170 were third to fifth year students (trainees) and 139 sixth and seventh year students (Interns). Sixty nine percent (n=318) were female and 31% (n=141) male. The mean score (SD) of empathy was 101 (15.6). The difference between mean score of empathy of female and male medical students was not significant (101.8 in females vs. 100 in males). The mean score of empathy in “interns” was significantly lower than both “stagers” and “basic sciences students” (96.2, 102 and 104, respectively p

    Conclusion

    The results of this study indicate that the empathy score of interns is significantly lower than other medical students. A longitudinal study is needed to test variations in students’ empathy throughout medical school.

    Keywords: Empathy, Medical, Education, Students
  • Maryam Mohammadian, Khoshnoud, Abbas Moghimbeigi, Javad Faradmal*, Mahnaz Yavangi Pages 1012-1018
    Background

    Birth weight and gestational age are two important variables in obstetric research. The primary measure of gestational age is based on a mother’s recall of her last menstrual period. This recall may cause random or systematic errors. Therefore, the objective of this study is to utilize Bayesian mixture model in order to identify implausible gestational age.

    Methods

    In this cross-sectional study, medical documents of 502 preterm infants born and hospitalized in Hamadan Fatemieh Hospital from 2009 to 2013 were gathered. Preterm infants were classified to less than 28 weeks and 28 to 31 weeks. A two-component Bayesian mixture model was utilized to identify implausible gestational age; the first component shows the probability of correct and the second one shows the probability of incorrect classification of gestational ages. The data were analyzed through OpenBUGS 3.2.2 and 'coda' package of R 3.1.1.

    Results

    The mean (SD) of the second component of less than 28 weeks and 28 to 31 weeks were 1179 (0.0123) and 1620 (0.0074), respectively. These values were larger than the mean of the first component for both groups which were 815.9 (0.0123) and 1061 (0.0074), respectively.

    Conclusion

    Errors occurred in recording the gestational ages of these two groups of preterm infants included recording the gestational age less than the actual value at birth. Therefore, developing scientific methods to correct these errors is essential to providing desirable health services and adjusting accurate health indicators.

    Keywords: Gestational age, Birth weight, Bayesian, Mixture model
  • Javad Nasseryan, Ebrahim Hajizadeh*, Aliakbar Rasekhi, Hassan Ahangar Pages 1014-1019
    Background
    The incidence of restenosis in patients suffering from coronary artery disease after undergoing angioplasty is of paramount importance. Accordingly, this study aimed to investigate factors affecting the time of the first incidence of restenosis in patients undergone angioplasty in the city of Zanjan, Iran.
    Methods
    This retrospective cohort study was conducted on 421 patients who referred to Ayatollah Musavi hospital in Zanjan for angioplasty during 2009 to 2012. The time of the incidence of restenosis after angioplasty constituted the dependent variable of the study. Independent variables of the study included signs of diabetes, hypertension, hyperlipidemia, kidney disease, carotid stenosis, lung disease, anemia, angina history, and MI. The Cox regression model with the significance level of 0.05 was deployed for the statistical analysis.
    Results
    According to the Cox regression model, hazard ratio of the first incidence of restenosis in patients with hypertension and angina was 22.8% and 29.5% less than other patients, respectively. However, hazard ratio of the first incidence of restenosis was 7.4 times more in patients suffering from carotid stenosis than other patients (p
    Conclusion
    The results of this study revealed that as time goes on, the risk of the incidence of restenosis in angioplasty patients increases such that patients’ survival decreases dramatically after a year. To determine the role of effective factors on the incidence of restenosis, conducting a prospective interventional study is highly recommended.
    Keywords: Angioplasty, Cardiovascular Disease, Restenosis, Survival, Cox Regression
  • Sepideh Kazemi, Soroor Parvizy*, Rasha Atlasi, Hamid R. Baradaran Pages 1032-1045
    Background
    Type 1 diabetes is one of the chronic metabolic disorders among children and adolescents. Peers are also important units in diabetes management through adolescence. This study aimed to evaluate the effectiveness of peer-based intervention in managing type 1 diabetes mellitus among children and adolescents.
    Methods
    Searching articles published prior to December 2013 in PubMed, Web of Science, Cochrane library, Science Direct, Google scholar, CINAHL and Scopus, we found 8,548 publications. The first reviewer critically appraised the retrieved articles, using the CONSORT and the TREND checklists and then the second-assessor checked them. All abstracts were screened, and only eight full text articles remained for evaluation based on inclusion criteria
    Results
    Eight studies, including five randomized controlled trials, one controlled trial, and two pre-post trials were critically appraised based on CONSORT and the TREND checklists. The outcomes of these studies were as follows: knowledge (three studies), attitude (two studies), performance (one study), clinical parameters—exclusively HbA1c—(four studies), and psychosocial parameters—such as quality of life, coping, self-care, self-confidence, satisfaction with the perceived social support, social skills, and diabetes-related conflicts
    Conclusion
    The findings of this systematic review revealed that peer-based interventions could help to manage diabetes. While there is a lack of professional or family-based interventions and education, peers can be involved in the process of patient education. As there are few studies in the area of peer-based diabetes management, conducting further interventional studies with robust methodology is highly recommended.
    Keywords: Peer-Based Interventions, Type I Diabetes, Diabetes Management, Children, Adolescents
  • Minoo Yaghmaei, Shahram Yazdani, Soleiman Ahmady Pages 1046-1051
    The aim of this study was to show the interaction between the society, applicants and medical schools in terms of medical student selection. In this study, the trends to implement social factors in the selection process were highlighted. These social factors were explored through functionalism and conflict theories, each focusing on different categories of social factors. While functionalist theorists pay attention to diversity in the selection process, conflict theorists highlight the importance of socio-economic class. Although both theories believe in sorting, their different views are reflected in their sorting strategies. Both theories emphasize the importance of the person-society relationship in motivation to enter university. Furthermore, the impacts of social goals on the selection policies are derived from both theories. Theories in the sociology of education offer an approach to student selection that acknowledges and supports complexity, plurality of approaches and innovative means of selection. Medical student selection does not solely focus on the individual assessment and qualification, but it focuses on a social and collective process, which includes all the influences and interactions between the medical schools and the society. Sociological perspective of medical student selection proposes a model that envelops the individual and the society. In this model, the selection methods should meet the criteria of merit at the individual level, while the selection policies should aim at the society goals at the institutional level.
    Keywords: Medical Student Selection, Medical Student, Medical education, Society
  • Towhid Babazadeh, Aziz Kamran, Abdollah Dargahi, Fatemeh Moradi, Fariba Shariat, Hamed Rezakhani Moghaddam* Pages 1052-1059
    Background
    Skin cancer is a serious public health problem in the world. Its prevalence in many countries has been increased in recent years. This study aimed to assess the effects of a theory-based educational intervention to promote skin cancer preventive behaviors (SCPBs) among rural farmers in Chalderan County, Iran.
    Methods
    This was a quasi-randomized controlled field trial study conducted on 238 rural farmers. The data were collected by a questionnaire containing the constructs of the Protection Motivation Theory (PMT) as well as the items of SCPBs. The differences between the groups before and 3 months after the intervention were determined by independent t-test, paired t-test, and chi-square applying SPSS software.
    Results
    Before the intervention, no significant difference was found in the scores of the PMT constructs between the two groups (p>0.05). However, significant differences were found between the scores of all the variables, as well as SCPBs, in the two groups after the intervention (p
    Conclusion
    The PMT was found to be an appropriate framework for designing educational interventions aiming at promoting SCPBs among rural farmers. It was concluded that designing an educational program with a focus on promoting perceived susceptibility increased the level of performing SCPBs among the rural farmers.
    Keywords: Skin cancer, Preventive medicine, Motivation, Education
  • Abbas Abbasi, Ghahramanloo, Sepideh Soltani, Ali Gholami, Mohammadreza Erfani, Somayeh Yosaee* Pages 1060-1065
    Background
    Metabolic syndrome (MetS), a combination of coronary heart disease and diabetes mellitus risk factor, refer to one of the most challenging public health issues in worldwide. The aim of this study was to identify the subgroups of participants in a study on the basis of MetS components.
    Methods
    The cross-sectional study took place in the districts related to Tehran University of Medical Sciences. The randomly selected sample consists of 415 subjects. All participants provided written informed consent. Latent class analysis was performed to achieve the study’s objectives. Analyses were conducted by using proc LCA in SAS 9.2 software.
    Results
    Except systolic and diastolic blood pressure, the prevalence of all MetS components is common in female than male. Four latent classes were identified: (a) non MetS, (b) low risk, (c) high risk, and (d) MetS. Notably, 24.2% and 1.3% of the subjects were in the high risk and MetS classes respectively.
    Conclusion
    Most of the study participants were identified as high risk and MetS. Design and implementation of preventive interventions for this segment of the population are necessary.
    Keywords: Latent class analysis, Metabolic syndrome, MetS component subgrouping, Iran
  • Masoud Mehrpour, Salameh Taghipour, Sahar Abdollahi, Fatemeh Oliaee, Azin Goran, Mohamadreza Motamed, Rezan Ashayeri Pages 1066-1070
    Background
    Firoozgar Comprehensive Stroke Center started up as the first organized care unit in the country in 2014; this study was performed to investigate quality indicators such as reduction in mortality, morbidity and hospital stay.
    Methods
    Two groups of ischemic stroke patients were compared. The first group had been admitted in general neurology ward (non-stroke unit patients) and the second one received specialized stroke care in the stroke unit within a period of two years (stroke unit patients). Non-stroke unit patients were selected from a pool of patients admitted two years before establishment of stroke unit. Variables compared were factors such as modified Rankin Scale (mRS), confinement days in stroke unit or Intensive Care Unit, total days of hospitalization, history of prior stroke, receiving recombinant tissue plasminogen activator (rtPA) and the stroke category indicating anterior or posterior circulation infarct. Quantitative testing was conducted using independent t-test as well as “Mann-Whitney U Test”; Chi-squared test was used for qualitative testing.
    Results
    A total number of 129 patients enrolled in the study (66 cases of non-stroke unit patients and 63 cases of stroke unit patients). The average total days of hospitalization were 17.32 (95% CI: 0.15-36.1) in non-stroke unit patients and 21.19 (95% CI: 4.99 - 38.1) in stroke unit patients (p=0.2). Results for stroke unit patients showed a lower mRS score (OR=1.48, p=0.01).
    Conclusion
    It was concluded that stroke unit patients tend to have a better outcome and a lower mRS score at discharge. No significant difference in hospitalization period was noted between the two groups.
    Keywords: Stroke Unit, Modified Rankin Scale (mRS), Recombinant Tissue Plasminogen Activator (rtPA)
  • Maryam Ramezanian, Joaquim Soares, Hamid Khankeh, Gloria Macassa Pages 1070-1078
    Background
    Socioeconomic status has been found to have a significant impact on the health as well as risk behaviors of adolescents across different contexts. This study was conducted to assess the effect of social relations adjusted by social class on physical and psychological well-being of adolescences in Teheran, Iran.
    Methods
    This was a cross- sectional study and carried out on 1,742 adolescences living in Tehran during 2011. Adolescences were selected, using proportional stratified sampling method and a questionnaire was filled over an interview for data gathering. Data were analyzed, using SPSS18 logistic regression.
    Results
    The prevalence of psychological symptoms was more than 24% and had a large range (24%-93%), while physical symptoms showed a lower prevalence with a smaller range (12%-33%). Furthermore, there was a significant relation between the adolescences gender and feeling the need for others’ help (p
    Conclusion
    The physical and psychological symptoms were common among adolescents from families with high socioeconomic status.
    Keywords: Health Behaviors, School, aged Children, Adolescents, Tehran
  • Ghobad Moradi, Farideh Mostafavi, Namamali Azadi, Nader Esmaeilnasab, Bijan Nouri Pages 1079-1087
    Background
    Screen time (ST), including watching television and playing electronic games are the leading cause of a growing obesity epidemic. This study aimed to evaluate ST and its association with physical activity, overweight and socioeconomic status (SES) in children 10 to 12 years of age in Sanandaj.
    Methods
    This study was designed as a cross-sectional study, which was conducted in Sanandaj in 2015. ST and physical activity data were collected using the Modifiable Activity Questionnaire (MAQ). Overweight indices are defined based on BMI age- and gender-specific percentiles, as proposed by WHO criteria. Considering household assets data, SES was calculated using principal component analysis (PCA). The relationship between ST and different determinants was assessed using logistic regression analysis.
    Results
    Based on the results obtained in our study, 47.28% (95% CI: 45.33-49.24) of the participants spent more than two hours a day on television and video watching and electronic games playing. People who spend greater time on ST activities, independent of their physical activities, are more susceptible to overweight and obesity (p=0.002). People in higher socioeconomic groups spent more time on watching TV and video and playing electronic games (p=0.001). There was a direct relationship between the residential area and ST (P=0.052). ST in male was found to be greater (p=0.033). In addition, ST was also lower in school-aged children whose mothers had a greater education (p=0.56).
    Conclusion
    Based on the results of this study, it is recommended to increase the education level and knowledge of mothers and design interventions consistent with children gender and residential location so that to reduce ST and its associated outcomes in children.
    Keywords: Screen time behavior, Socio, economic inequality, Inactivity, Physical activity, Children
  • Shaghayegh Omidvar, Zahra Jafari*, Saeid Mahmoudian, Mehdi Khabazkhoob, Mohsen Ahadi, Nasrin Yazdani Pages 1088-1098
    Background
    The possible role of cochlear function in tinnitus generation is still a matter of debate. To assess the role of outer hair cell dysfunction in tinnitus and its possible relationship with ultra-high frequency (UHF) hearing sensitivity, transient evoked otoacoustic emissions (TEOAE) and UHF hearing thresholds were investigated in normal hearing individuals with and without tinnitus.
    Methods
    Eighteen individuals with tinnitus and 22 without tinnitus participated in this study. TEOAE was recorded with click stimulus at 80 dBpeSPL. UHF pure tone audiometry was performed at 10, 12.5, 16, and 18 kHz.
    Results
    TEOAE was significantly abnormal in 72.2% of the tinnitus, and 18.2% of the control groups (p=0.001). The individuals with tinnitus had significantly poorer UHF hearing sensitivity compared to the control group at 12.5 and 18 kHz (p≤0.048). There was a stronger correlation between increasing UHFs hearing threshold and decreasing SNRs of TEOAEs in the tinnitus group compared to the controls.
    Conclusion
    Our study revealed poorer UHF hearing thresholds and more TEOAE abnormalities in normal hearing individuals with tinnitus compared to the controls. Perhaps the alterations in the basal cochlea, following a decrease in UHF hearing sensitivity, affect OAEs that are originated from more apical cochlear parts in tinnitus ears more than non-tinnitus ears.
    Keywords: Tinnitus, Otoacoustic Emissions, Ultra, High Frequency Thresholds
  • Ali Moradi, Hamid Soori, Amir Kavousi, Farshid Eshghabadi, Ensiyeh Jamshidi, Salahdien Zeini Pages 1099-1108
    Background
    More than 20% of deaths from traffic crashes are related to pedestrians. This figure in Tehran, the capital of Iran, reaches to 40%. This study aimed to determine the high-risk areas and spatially analyze the traffic crashes, causing death to pedestrians in Tehran.
    Methods
    Mapping was used to display the distribution of the crashes. Determining the distribution pattern of crashes and the hot spots/ low-risk areas were done, using Moran’s I index and Getis-Ord G, respectively.
    Results
    A total of 198 crashes were studied; 92 of which, (46.4%) occurred in 2013 to 2014 and other 106 cases (63.6%) occurred in 2014 to 2015. The highest and the lowest frequency of crashes was related to January (26 cases) and June (10 cases), respectively. One hundred fifty- eight cases (79.8%) of crashes occurred in Tehran highways. Moran’s index showed that the studied traffic crashes had a cluster distribution (p
    Conclusion
    The majority of traffic crashes causing death to pedestrians occurred in highways located in the main entrances and exits of Tehran. Given the important role of environmental factors in the occurrence of traffic crashes related to pedestrians, identification of these factors requires more studies with casual inferences.
    Keywords: Spatial Analysis, Road traffic injury, Pedestrians
  • Roxana Mansour, Ghanaei, Maziar Moradi, Lakeh, Sareh Shakerian, Abdollah Karimi, Shooka Esmaeeli, Farhad Shokraneh, Susan Mahmoudi, Mohsen Yaghoubi* Pages 1109-1119
    Background
    Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence.
    Methods
    We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package.
    Results
    Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55–0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60–0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85–0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64–0.93) in high-risk group.
    Conclusion
    The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended.
    Keywords: Whooping cough, Acellular vaccine, Whole cell vaccine
  • Parvin Babaei, Arsalan Damirchi, Bahram Soltani Tehrani, Yazgeldi Nazari, Reyhaneh Sariri, Rastegar Hoseini* Pages 1120-1127
    Background
    The balance between production of Reactive Oxygen Species (ROS) and antioxidant defense in the body has important health implications. The aim of this study was to investigate the changes in salivary antioxidants: catalase, vitamin C and brain-derived neurotrophic factor (BDNF), in sedentary men at rest and after acute exhaustive exercise.
    Methods
    This randomized controlled clinical trial (The registry code IRCT2011053212431N1) recruited twenty-five sedentary men (age=21±3yrs; height=172±8cm; weight=66±9kg; VO2 max=37.6±7.4mL•kg-1•min-1) participated in a double-blind randomized experiment. Unstimulated whole saliva samples were collected before, immediately and 1 hour after exhaustive treadmill running. Catalase, vitamin C (Vit C) concentration, and BDNF concentrations were determined using biochemical assays and ELISA respectively. Repeated measures ANOVA and Bonferroni posthoc test were used to analyze data.
    Results
    The results of the present study showed that an acute intensive exercise causes a reduction in salivary catalase, Vit C and also BDNF concentration (p
    Conclusion
    Reduction in antioxidants capacity of saliva might reflects disturbance in natural antioxidant defense mechanisms of the body after an acute intensive physical stress and possible further health threatening consequences.
    Keywords: Saliva, Antioxidants, Catalase, Vitamin C, BDNF, Exercise
  • Maryam Mehdizadeh, Laleh Lajevardi, Seyed Amir Hassan Habibi, Mina Arab Baniasad, Delaram Baghoori, Fatemeh Daneshjoo, Ghorban Taghizadeh Pages 1121-1132
    Background
    Despite the negative effect of fear of falling during functioning and social participation of patients with Parkinson' disease, so far, only few studies have investigated its effect on the quality of life in these patients. We aimed to investigate the association between fear of falling and quality of life controlling for balance impairments based on hip and ankle strategy in drug On- and Off-phase of patients with idiopathic Parkinson' disease.
    Methods
    In this non-experimental cross-sectional study, 139 patients with idiopathic Parkinson' disease (100 male, 39 female) by mean± SD age of 60.2±12.27 years, mean±SD time since diagnosis of 6.7±5.53 years and mean±SD Hoehn and Yahr stage of 2.8±1.49 were selected by a simple non-probability method. Balance function was measured by a functional reach test with hip and ankle strategy. The Persian version of the self-completed Fall Efficacy Scale-International and Parkinson's disease quality of life questionnaire was used to evaluate fear of falling and quality of life, respectively.
    Results
    The results showed that the score of all dimensions of quality of life (i.e., mobility, activities of daily living, emotional wellbeing, stigma, social support, cognition, communication and bodily discomfort) were significantly affected by the intensity of fear of falling. Multiple regression analysis indicated a significant association between fear of falling and quality of life in a way that fear of falling explained 11% to 47% and 12% to 43% of variance in drug On-phase, as well as 8% to 45% and 9% to 48% of variance in the drug Off-phase in dimensions of quality of life after controlling for balance function based on hip and ankle strategy, respectively. In the drug On-phase, the strongest association (R=0.85, p
    Conclusion
    This study found that fear of falling affects the quality of life of patients with Parkinson' disease beyond its relationship with balance impairments based on the hip and ankle strategy in both drug On- and Off-phase.
    Keywords: Parkinson's disease, Quality of life, Fear of falling, Functional reach test with hip, ankle strategy
  • Assessment of nutritional status in patients with Parkinson's disease and its relationship with severity of the disease
    Farzad Shidfar, Peivand Babaii Darabkhani, Leila Yazdanpanah*, Siamak Karkheiran, Hamid Noorollahi Moghaddam, Hamid Haghani Pages 1133-1139
    Background
    Malnutrition, loss of body weight, muscle and fat mass wasting are common in patients with Parkinson's disease, and are associated with disability, longer length of hospital stay, impaired immune system and increased risk of mortality. The aim of this study was to assess the nutritional status in patients with Parkinson's disease and its relation to the severity of the disease.
    Methods
    This cross- sectional study was conducted on 130 patients with Parkinson's disease, with a mean (SD) age of 59.1 (12.9) years in disease stages of 1 to 4. In this study, the Mini Nutritional Assessment (MNA) questionnaire was used along with anthropometric measurements (Body Mass Index (BMI), Mid-arm circumference (MAC), Calf Circumference (CC)) to evaluate the nutritional status, and they were applied by a trained nutritionist. Hoehn and Yahr Scale were used to determine the severity of the disease. One-way ANOVA test was used to assess the relationship between anthropometric indices, nutritional status and severity of disease. Assessment of the relationship between age, duration of disease and nutritional status was categorized according to MNA score, and was performed, using one-way ANOVA. Chi - Square test was utilized to assess the relationship between education level and nutritional status. SPSS Version 18 was used for data analysis.
    Results
    In this study, 30% (n=39) of the participants were diagnosed with normal nutritional status, 58.5% (n=76) were at risk of malnutrition and 11.5% (n=15) were malnourished according to MNA. Reduction of weight, and muscle mass wasting was observed in different disease stages. Muscle mass wasting and worsening nutritional status, based on MNA score, showed a significant increase as the disease progressed, MAC (p=0.009), MNA score (p
    Conclusion
    Reduction of BMI, depletion of muscle mass, and worsening of nutritional status according to MNA, was observed in many patients along with an increase in the severity of the disease. Assessing nutritional status in those with Parkinson's disease to provide information to identify necessary nutritional intervention is highly recommended.
    Keywords: Nutritional Status, Parkinson's Disease, Anthropometric Indices, Mini Nutritional Assessment
  • Yousef Jahandideh, Leila Roohi Balasi, Bardia Vadiati Saberi, Ideh Dadgaran* Pages 1140-1148
    Background
    Above all methods effective learning results from decent training, acquired in the proper environment and encouraging creative methods. Computer-assisted training by educational software is considered a fundamental measure to improve medical and dentistry education systems. This study aims to design and assess fixed dental prostheses via 2 multimedia instructional contents at the Guilan dentistry school.
    Methods
    This is a descriptive and cross-sectional study. First off, the instructional content was analyzed. The software used to produce multimedia was the iSpring suite Ver.7.0. After designing the instructional multimedia, this software was loaded by LMS. Sixty-nine dentistry students in the 5th semester at Guilan Dentistry School were selected via convenience sampling. At the end of the course, a structured questionnaire containing 26 items were handed to the students to evaluate the instructional multimedia quality.
    Results
    Mean ±SD age was 24.68±3.24 years, 43 were women (62.4%) and 26 were men (37.6%) –the majority of 76.8% used the internet at home. A portion of 33.3% were inclined to use multimedia and the internet with in-person training. About 60% declared that multimedia quality as being good.
    Conclusion
    the instructional multimedia designs which are compatible with lesson objectives and audio-visual facilities can have a great effect on the student's satisfaction. Preparing instructional multimedia makes the instructional content easily accessible for students to be able to review it several times at the proper opportunity and if presented through LMS they would be able to study the lesson subject wherever and whenever accessing the internet.
    Keywords: Dental Prostheses, Dentistry, Education, Multimedia
  • Marjan Ghazisaeedi, Ameneh Safari, Abbas Sheikhtaheri*, Hamid Dalvand Pages 1149-1155
    Background
    Mobile health and e-learning may have a significant impact on training patients, physicians, students and caregivers. This study aimed to evaluate the effect of using an educational mobile application on the knowledge of the caregivers of children with cerebral palsy (CP).
    Methods
    We used a previously developed mobile application. The knowledge of 17 caregivers of children with CP (including parents) about the daily care of their children was evaluated through a self-assessment and a test with multiple-choice and true-false questions. Next, the application, which included several educational modules for the daily care of the children with CP, was given to the caregivers to use continually for two months. After this period, the knowledge of the caregivers was evaluated by the same tools. Data analysis was performed by SPSS-16, using paired-sample t-test or Wilcoxon test.
    Results
    The effect of the use of this educational application on the knowledge of caregivers in all childcare domains, except for eating, was reported to be significant (p
    Conclusion
    Training through novel technologies such as Smartphone along with their applications can improve the knowledge of caregivers about the daily care of children with cerebral palsy.
    Keywords: Mobile Health, Smartphone, Cerebral Palsy, E, learning, Knowledge, Children, Parenting
  • Mohammadhiwa Abdekhoda, Afsaneh Dehnad*, Sayd Javad Ghazi Mirsaeed, Vahide Zarea Gavgani Pages 1156-1162
    Background
    Electronic Learning (E-learning), is the use of electronic technology in education via computer and the internet. Despite its slow adoption by faculty members, e-learning provides several benefits to individuals and organizations. This study was conducted to determine the factors influencing the adoption of e-learning by faculty members in Tabriz University of Medical Sciences.
    Methods
    This was a cross- sectional study, in which a sample of 190 faculty members of Tabriz University of Medical Sciences was randomly selected, using stratified sampling. A Conceptual Path Model of Unified Theory of Acceptance and Use of Technology (UTAUT) was applied to assess the faculty members’ attitude towards e-learning. The collected data were analyzed by SPSS16, using descriptive statistics and regression analysis. The model was tested by structural equation modeling (SEM) and was finally represented by Analysis of Moment Structures.
    Results
    The results evidenced that UTAUT model explains about 56% of the variance for adoption of e-learning. The findings also revealed that performance expectancy, effort expectancy, social influences and behavior indentation had direct and significant effects on faculty members’ behavior towards the use of e-learning. However, facilitated condition had no significant effects on the use of e-learning.
    Conclusion
    The authorized model provides considerable insight for perception and anticipation of faculty members’ behaviors in adopting e-learning. The survey clearly identified significant and non-significant factors that may affect the adoption of e-learning. The results of this study could help the policy makers when successful adoption of e-learning is in their agenda.
    Keywords: E-learning, Unified Theory of Acceptance, Use of Technology (UTAUT), Structural Equation Modeling (SEM)
  • Niloofar Mohaghegh, Puran Raiesi Dehkordi, Mohammad Reza Alibeik, Ahmad Ghashghaee, Mojgan Janbozorgi* Pages 1163-1168
    Background
    In-service training courses are one of the most available programs that are used to improve the quantity and quality level of the staff services in various organizations, including libraries and information centers. With the advent of new technologies in the field of education, the problems and shortcomings of traditional in-service training courses were replaced with virtual ones. This study aimed to evaluate the virtual in-service training courses from the librarian's point of view in libraries of state universities of medical sciences in Tehran.
    Methods
    This was a descriptive- analytical study. The statistical population consisted of all librarians at libraries of universities of medical sciences in Tehran. Out of 103 librarians working in the libraries under the study, 93 (90%) participated in this study. Data were collected, using a questionnaire.
    Results
    The results revealed that 94/6% of librarians were satisfied to participate in virtual in-service training courses. In this study, only 45 out of 93 participants said that the virtual in-service courses were held in their libraries. Of the participants, 75.6% were satisfied with the length of training courses, and one month seemed to be adequate time duration for the librarians to be more satisfied. The satisfaction level of the individuals who participated in in-service courses of the National Library was moderate to high. A total of 84.4% participants announced that the productivity level of the training courses was moderate to high. The most important problem with which the librarians were confronted in virtual in-service training was the “low speed of the internet and inadequate computer substructures”.
    Conclusion
    Effectiveness of in-service training courses from librarians’ point of view was at an optimal level in the studied libraries.
    Keywords: In-Service Training, Virtual in, Service Training, Librarians, Libraries
  • Frahang Hoseini*, Haleh Ayatollahi, Seyed Hamid Salehi Pages 1169-1177
    Background
    Telemedicine has been used in different fields of medicine in the past 20 years. The main advantages of this technology include saving costs, improving quality of care, and increasing access to specialists. This study aimed to review telemedicine applications in treating burn patients.
    Methods
    In this systematized review study, related papers were searched using various databases, including PubMed, Scopus, and Science Direct. The time frame was between January 2000 and March 2016; finally, 32 papers were included in the study.
    Results
    The findings revealed that telemedicine was used in burn care in three different ways: Remote patient follow-up, teleconsultation, and patient assessment.
    Conclusion
    It seems that telemedicine can be easily applied in treating burn patients even when there is a limited financial resource. The use of this technology can help reduce possible errors in categorizing burn patients and decrease patient's transportation and treatment costs.
    Keywords: Telemedicine, Burns, Remote Consultation, Medical Informatics
  • Nasrin Sayfouri* Pages 1178-1187
    Background
    Learning Management System (LMS) is a web-based system designed to support teaching and learning at an institution. The capabilities of any LMS are required to be evaluated to detect the room for improvement. This study aimed at discovering the students’ perceptions of the functions of the LMS at Iran University of Medical Sciences (IUMS).
    Methods
    This qualitative study included 15 students of two master programs of Biostatistics and Medical Librarianship during the fall semester of 2015. The participants were asked to write down their perceptions of the experiences they had while using the LMS and classify them based on two categories of “Advantages and Drawbacks”. Framework Analysis technique was used to analyze the views.
    Results
    The themes emerging from the ‘Advantages’ included advantages for the students, advantages for the teachers, and advantages for both; however, those from the ‘Drawbacks’ were found to be technical and non-technical problems.
    Conclusion
    The major debated points in the comments comprised the students’ positive accounts of the Forum section, and their complaints of the frequent glitches recurring in the system as well as some constructive problems such as inefficient tools for typing in English. Some all-inclusive inferences concerning the methodology of the study have also been pointed out in the final section.
    Keywords: Computer, Assisted Instruction, Qualitative Research, Education, Students, Perceptions, Language, learning, Health Services Research, Iran
  • Maryam Koopaie*, Sajad Kolahdouz Pages 1188-1194
    Background
    A comprehensive database, comprising geometry and properties of human teeth, is needed for dentistry education and dental research. The aim of this study was to create a three-dimensional model of human teeth to improve the dental E-learning and dental research.
    Methods
    In this study, a cross-section picture of the three-dimensional model of the teeth was used. CT-Scan images were used in the first method. The space between the cross- sectional images was about 200 to 500 micrometers. Hard tissue margin was detected in each image by Matlab (R2009b), as image processing software. The images were transferred to Solidworks 2015 software. Tooth border curve was fitted on B-spline curves, using the least square-curve fitting algorithm. After transferring all curves for each tooth to Solidworks, the surface was created based on the surface fitting technique. This surface was meshed in Meshlab-v132 software, and the optimization of the surface was done based on the remeshing technique. The mechanical properties of the teeth were applied to the dental model.
    Results
    This study presented a methodology for communication between CT-Scan images and the finite element and training software through which modeling and simulation of the teeth were performed. In this study, cross-sectional images were used for modeling. According to the findings, the cost and time were reduced compared to other studies.
    Conclusion
    The three-dimensional model method presented in this study facilitated the learning of the dental students and dentists. Based on the three-dimensional model proposed in this study, designing and manufacturing the implants and dental prosthesis are possible.
    Keywords: Three-Dimensional Modeling, Dental Education, Finite Element Analysis
  • Hossein Navidinia*, Majid Zare Bidaki, Nargess Hekmati Pages 1195-1201
    Background
    The spread of technology has influenced different aspects of human life, and teaching and learning are not exceptions. This study aimed to examine the potential contribution of the use of technology in teaching English language to medical students.
    Methods
    This qualitative-action research study was conducted in Birjand University of Medical Sciences (BUMS), with 60 medical students taking a general English course in the Fall Semester of 2015. The class favored different tools and multimedia facilities such as a tube channel, e-dictionaries, educational films, and e-textbooks to enhance students’ learning. In addition, the class had a weblog in which students could upload assignments and receive feedback from peers and the instructors.
    Results
    The results revealed that e-learning could enhance students’ language proficiency and facilitate the teaching process. Learners preferred to use more e-dictionaries to learn the meaning of the new words, watch English medical films to boost their speaking and listening skills, and use the electronic version of their textbook as they could carry it wherever they wanted.
    Conclusion
    The students preferred this method of learning English as they became more independent by using the electronic facilities. They found that learning English did not have a fixed institutionalized method, and e-learning activities could provide them with authentic input for language learning even outside of the classroom.
    Keywords: E-learning, English Language, Medical Students, Technology
  • Mohammad Reza Soleymani, Zahra Akbari*, Shahin Mojiri Pages 1202-1207
    Background
    With the recent spread of virtual learning programs in universities, especially in the field of medical sciences, libraries play a crucial role to support these programs. This study aimed at investigating the skills required by librarians to support virtual learning programs in Isfahan University and Isfahan University of Medical Sciences.
    Methods
    This was an applied survey study. The population of the study includes all librarians working in Isfahan University and Isfahan University of Medical Sciences. A sample of 89 librarians was selected by stratified random sampling. Data were collected by a researcher-made questionnaire, the validity of which was confirmed by specialists in the fields of librarianship and information sciences and virtual learning, and its reliability was determined to be 0.92, using Cronbach's Alpha. The questionnaire consisted of 51 items designed to evaluate the librarian's virtual learning skills using Likert scale. Descriptive and inferential statistics were used to analyze the findings.
    Results
    The findings of this study revealed that librarians had low level of skills with respect to the online reference services, and familiarity with virtual learning environment. They also showed low and average level of skills with respect to their general information technology, communication skills, ability to teach electronic information literacy and ability to create access to electronic resources. The results revealed no significant difference between the librarians of the two universities, or between male and female librarians. However, librarians with educational background in librarianship and information sciences were significantly more skillful and competent than their colleagues.
    Conclusion
    Despite the crucial role of libraries in supporting virtual learning programs, the librarians in Isfahan University and Isfahan University of Medical Sciences had low-level skills to play such an important role. Therefore, it is essential to provide on-the-job virtual training courses for librarians to improve their job performance and the quality of library services.
    Keywords: Distant Learning, Virtual Learning, Librarians, Isfahan University, Isfahan University of Medical Sciences
  • Khalil Kimiafar, Masoumeh Sarbaz*, Abbas Sheikhtaheri Pages 1208-1218
    Background
    There are no general strategies or tools to evaluate daily lesson plans; however, assessments conducted using traditional methods usually include course plans. This study aimed to evaluate the strengths and weaknesses of online survey software in collecting data on education in medical fields and the application of such softwares to evaluate student's views and modification of lesson plans.
    Methods
    After investigating the available online survey software, esurveypro was selected for assessing daily lesson plans. After using the software for one semester, a questionnaire was prepared to assess the advantages and disadvantages of this method and students’ views in a cross-sectional study.
    Results
    The majority of the students (51.7%) rated the evaluation of classes per session (lesson plans) using the online survey as useful or very useful. About 51% (n=36) of the students considered this method effective in improving the management of each session, 67.1% (n=47) considered it effective in improving the management of sessions for the next semester, and 51.4% (n=36) said it had a high impact on improving the educational content of subsequent sessions. Finally, 61.4% (n=43) students expressed high and very high levels of satisfaction with using an online survey at each session.
    Conclusion
    The use of online surveys may be appropriate to improve lesson plans and educational planning at different levels. This method can be used for other evaluations and for assessing people’s opinions at different levels of an educational system.
    Keywords: Online Survey Software, Student's View, Lesson Plan
  • Abbas Saleh Ardestani, Ali Sarabi Asiabar*, Farbod Ebadifard Azar, Seyyed Ali Abtahi Pages 1219-1224
    Background
    Effective leadership that rises from managerial training courses is highly constructive in managing hospitals more effectively. This study aims at investigating the relationship between leadership effectiveness with providing management training courses for hospital managers.
    Methods
    This was a cross-sectional study carried out on top and middle managers of 16 hospitals of Iran University of Medical Sciences. As a sample, 96 participants were selected through census method. Data were collected using leadership effectiveness and style questionnaire, whose validity and reliability were certified in previous studies. Pearson correlation coefficient and linear regressions were used for data analysis.
    Results
    Leadership effectiveness score was estimated to be 4.36, showing a suitable status for manager's leadership effectiveness compared to the set criteria. No significant difference was found between leadership effectiveness and styles among managers who had passed the training courses with those who had not (p>0.05).
    Conclusion
    Passing managerial training courses may have no significant effect on manager's leadership effectiveness, but there may be some other variables which should be meticulously studied.
    Keywords: Leadership Effectiveness, Leadership Style, Hospital Management, Managerial Trainings
  • Mohammad Sadegh Ghasemi, Jalil Koohpayehzadeh, Hamidreza Kadkhodaei, Ali Asghar Ehsani Pages 1225-1231
    Background
    According to clinical observations, foot hyperpronation is very prevalent and may cause malalignment of the lower extremity, leading to structural and functional deficits in standing and walking. This study aimed at investigating the effect of foot hyperpronation on spine alignment in the standing position.
    Methods
    Thirty-five healthy males with an age range of 18-30 years participated in this cross-sectional study. Evaluation was performed with two examiners in four standing positions (on the floor, and on the wedges angled at 10, 15, and 20 degrees) using a motion analysis system (Zebris). Moreover, each of the measurement methods was repeated for three short times. Paired t- test and repeated measures ANOVA test were used for statistical analysis.
    Results
    Significant differences were observed between all modes in the sacral angle, pelvic inclination, lumbar lordosis, and thoracic kyphosis variables (except between the first and second mode). Finally, a positive correlation was obtained for the examiners and all the variables with an increasing slope of the angle of wedge.
    Conclusion
    The results of the present study revealed sacral angle, pelvic inclination, lumbar lordosis, and thoracic kyphosis were increased with an increase in bilateral foot pronation. In fact, each one of them is a compensatory phenomenon.
    Keywords: Biomechanics, Hyperpronation, Motion Analysis System, Spine Alignment, Wedges, Zebris System
  • Mashallah Aghilinejad, Ali Asghar Ehsani, Atefeh Talebi, Jalil Koohpayehzadeh, Naser Dehghan* Pages 1232-1237
    Background
    Musculoskeletal symptoms are the main cause of loss of working time, and increase in labor costs. Poor posture is the most important risk factor for work-related musculoskeletal symptoms. This study aimed at evaluating the role of ergonomic risk factors in different surgical (open surgery, laparoscopy, and microsurgery) in the frequency or resonance frequency of musculoskeletal symptoms.
    Methods
    This descriptive-analytic study was conducted on 81 surgeons in a hospital in Tehran. In this study, the prevalence of musculoskeletal symptoms was evaluated using the Nordic Questionnaire. Moreover, Workplace ergonomic risk assessment method (WERA) was used to evaluate ergonomic risk factors in 3 types of open surgery, laparoscopy, and microsurgery.
    Results
    The results revealed that the prevalence of musculoskeletal symptoms of the neck, back, shoulder, and arm is high in surgeons (over 75%). The mean final score of WERA was 40.11, representing the high risk of the 3 types of surgery for the prevalence of musculoskeletal symptoms. Results revealed that the prevalence of musculoskeletal symptoms in the neck, waist and wrists had a significant relationship with the body posture in the 3 types of open surgery, laparoscopy, and microsurgery (p
    Conclusion
    In the present study, the prevalence of musculoskeletal symptoms was high in the neck, waist, and hands surgeries. Depending on the type of surgery, teaching correct working methods, using proper seats and ergonomic equipment are the best strategies to reduce musculoskeletal symptoms in the surgical profession.
    Keywords: Ergonomic Risk Factors, Musculoskeletal Symptoms, Surgeons, Posture
  • Mansour Nassiri Kashani*, Mohammad Hassan Nassiri Kashani, Mostafa Ghafari Pages 1238-1243
    Background
    Occupational contact dermatitis, especially in hand, is one of the most common occupational disorders. The present study aimed at evaluating patients with occupational allergic contact dermatitis (ACD) caused by common allergens based on occupation type and disease history.
    Methods
    This cross-sectional study aimed at evaluating the data of the patients with probable diagnosis of ACD in Center for Research and Training in Skin Diseases and Leprosy (CRTSDL) in Iran. In the present study, 946 patients were assessed from different regions of Iran. One hundred fifty-one cases with positive patch test and relevant exposure were entered into the study; data related to their occupation and disease activity history were evaluated and recorded. Then, factors related to disease activity history were assessed considering the occupational groups and common exposures.
    Results
    Nickel sulphate was the most common allergen in the 151 patients. Disease activity was constant in 29.8% of the patients; it increased in 27.8%, and decreased just before doing the patch test in 42.4%. Of the patients, 52.3% were getting worse during the working days. Occupational groups were significantly different in age and gender. Disease duration was also different in the occupational groups (p=0.001). The least disease duration was observed in healthcare workers, and the most in service workers. Lesions in the foot were related to period of employment. In administrative work group, (teachers, technicians and housewives) disease activity was decreased in the most cases, while it was increased in most patients of service workers (p=0.086).
    Conclusion
    The present study, similar to previous reports, revealed that nickel sulphate is the most common allergen in ACD cases. Moreover, it was found that the symptoms of disease activity remained constant or increased in a significant proportion of the cases during the working days. Therefore, these workers should seriously follow up on this matter and change their occupation, or limit the exposure to allergens.
    Keywords: Allergic Contact Dermatitis (ACD), Disease History, Occupational Allergic Contact Dermatitis, Patch Test
  • Farideh Khodabandeh, Elaheh Kabir Mokamelkhah*, Mahsa Kahani Pages 1244-1249
    Background
    Construction work (building houses, roads, workplaces, and repairing and maintaining infrastructures) is a dangerous land-based job. This includes many hazardous tasks and conditions such as working at the following conditions: Height, excavation, noise, dust, power tools and equipment.
    Construction work has been increased in developed and underdeveloped countries over the past few years. Occupational fatalities have increased with an increase in this type of work. Occupational fatalities refer to individuals who pass way while on the job or performing work related tasks. In the present study, to identify the factors, personal characteristics and work-related factors associated with fatal occupational mortality were assessed using data for Tehran, Iran, 2014-2016.
    Methods
    We conducted a retrospective study, using 967 postmortem reports from fatal occupational injuries collected through postmortem investigations during 2014-2016. A sampling frame of 967 postmortem reports from fatal occupational injuries was used to draw a total sample of 714 fatal construction accidents for this cross-sectional study. Pearson χ2 test and Kruskal-Wallis tests were used for statistical analysis.
    Results
    Based on the results of this study, male gender (n=714; 100%), age range of 30-39 years (n=183; 25.6%), secondary educational level (n=273; 38.2%), being married (317; 44.4%), causal employee (n=389; 54.5%), unskilled performance (389; 54.5%), no insurance coverage (472; 66.1%), and daytime duty work (287; 40.2%) were identified as risk factors for fatality in the event of construction fatal injury. A significant relationship was found between the type of injury and sociodemographic and work related variables.
    Conclusion
    Workers’ characteristics such as age, gender, experience, and educational background, and work related variables such as skill training, safety measurement, and close monitoring could be used to discriminate among different severity levels of occupational fatal accidents.
    Keywords: Construction, Accidents, Fatality, Forensic Hall
  • Jalil Koohpayehzadeh, Amir Bahrami Ahmadi, Hamidreza Kadkhodaei*, Seyed Alireza Mortazavi, Ziba Amiri Pages 1250-1256
    Background
    Identifying the predisposing factors of neck and shoulder complaints and finding solutions to avoid them could improve the occupational health condition of the nurses. In this study, we aimed at determining the role of psychological and physical occupational factors in developing neck and shoulder complaints among the participants.
    Methods
    This analytic cross-sectional study was conducted on the nurses of main hospitals of Tehran. To study the prevalence of neck and shoulder pain, the Nordic questionnaire was used, and job content questionnaire was used to assess the psychological and physical occupational factors. Data were analyzed using SPSS and statistical methods. Independent sample t-test was used to compare the qualitative variables, and chi-square test was utilized for the statistical analysis of the qualitative variables.
    Results
    Prevalence of neck and shoulder complaints among the nurses with high physical workload was significantly higher than in those nurses with low physical workload. Unlike physical workload, the prevalence of neck and shoulder complaints was not significantly different between the nurses with low or high psychological workload. Prevalence of neck and shoulder complaints among the female nurses was significantly higher than in the male nurses. In our study, only female nurses with high physical workload had been known as independent predictors of neck and shoulder complaints.
    Conclusion
    Those nurses who had more workload, especially physical workload, had a higher prevalence of neck and shoulder complaints, and this fact could affect their work tasks.
    Keywords: Neck Complaint, Nurses, Physical Factors, Psychological Factors, Shoulder Complaints
  • Amir Bahrami Ahmadi, Seyed Alireza Mortazavi, Roghayeh Soleimani, Mohammad Hasan Nassiri Kashani Pages 1257-1262
    Background
    There are some challenges about the role of work- related stress on development of musculoskeletal complaints. The present prospective study was conducted on nurses of Milad hospital in Tehran (Iran) to assess the role of work- related stress on development of neck and shoulder pain among nurses.
    Methods
    From the 1,900 nurses who completed the registry forms, 1,450 nurses met the inclusion criteria. We divided the participants into exposed and unexposed groups according to their DASS-21 scores. We collected the data of neck and shoulder pain among the nurses at two points of the first and the second year after the study, using the Nordic Questionnaire. Qualitative and quantitative variables were compared between the exposed and unexposed variables with chi-square and independent sample t-test, respectively.
    Results
    One year after the commencement of the study, 62 (9.1%) nurses in the exposed group and 36 (4.7%) in the unexposed group had been reported as new cases of neck and shoulder pain, respectively. The incidence of the new cases of neck and shoulder pain was significantly higher in the exposed group compared to the unexposed group (p= 0.001). Two years after the start of the study, at the second follow-up point, 135 (19.8%) nurses in the exposed group and 76 (9.9%) in the unexposed group had been reported as new cases of neck and shoulder pain, respectively. The incidence of new cases of neck and shoulder pain was significantly higher in the exposed group compared to the unexposed group (p
    Conclusions
    The incidence of neck and shoulder pain was higher in those nurses with high level of work- related stress. According to our results, more attention should be paid to mental health as well as physical symptoms and limitations of the healthcare workers when they refer to occupational health services with musculoskeletal pain complaints.
    Keywords: Neck, Nurse, Pain, Shoulder, Stress
  • Naser Dehghan, Mashallah Aghilinejad, Mohammad Hassan Nassiri Kashani, Ziba Amiri, Atefeh Talebi Pages 1263-1267
    Background
    Work-related musculoskeletal disorders (WMSDs) are the most common occupational injuries in dentists. These disorders occur due to the specific characteristics of dentistry occupation such as the use of tools and instruments and awkward posture. The present study aimed at evaluating the effect of multifaceted ergonomic program on reducing musculoskeletal disorders in dentists.
    Methods
    One hundred-two male dentists who worked in dentistry clinics of Tehran's hospitals participated in this interventional study. Participants were randomly divided into control (n=50) and intervention (n=52) groups. Dentists in the intervention group (n=52) underwent multifaceted ergonomic intervention program for 8 weeks and dentists in the control group (n=50) only received the measurements. The prevalence of musculoskeletal disorders was evaluated in each of the 2 groups at 3 time points before the intervention, 3, and 6 months after the intervention using the Nordic Musculoskeletal Questionnaire (NMQ). Paired t-test was used to compare the prevalence of musculoskeletal disorders before and after the ergonomic intervention program at the end of 3 and 6 months.
    Results
    The results revealed that the prevalence of musculoskeletal disorders was reduced after the intervention in the neck, shoulder, arm, wrist, back, thigh, knees, and feet (p
    Conclusion
    The results of this study revealed that the multifaceted ergonomic intervention program, which included improving working conditions, identifying ergonomic risk factors, regular exercise, and discussion group meetings, could decrease the prevalence of musculoskeletal disorders in dentists.
    Keywords: Dentists, Multifaceted Ergonomic Intervention Program, Musculoskeletal Disorders
  • Mashallah Aghilinejad, Elaheh Kabir Mokamelkhah, Atefeh Talebi, Roghayeh Soleimani, Naser Dehghan* Pages 1268-1274
    Background
    Work-related musculoskeletal disorders are the most important problems in the health workforce. These discomforts cause many working days losses, increase absenteeism from work, and impose annual economic costs. Awkward posture is the most important factor among the risk factors for work-related musculoskeletal disorders. This study aimed at implementing an interventional ergonomic program to minimize musculoskeletal disorder among dentists.
    Methods
    This semi- experimental study was conducted on 75 dentists of Milad hospital using a census method. The Nordic Questionnaire was used to determine the prevalence of musculoskeletal disorders. In this study, the intervention was to apply optical magnification lens whose impact on reducing musculoskeletal disorder had been previously investigated. Corlett and Bishop Scale was used to evaluate musculoskeletal disorders before and after the intervention. Paired t-test was conducted to compare the discomfort intensity before and after the intervention
    Results
    The results revealed that the prevalence of musculoskeletal disorders in neck, back, shoulder, and arm were higher than other areas of the body in dentists. There was a significant difference in discomfort intensity of the neck, shoulder, arm, back, elbow, forearm, and the whole body after the ergonomic intervention (p
    Conclusion
    The present study revealed that the use of optical magnification loupes, because of providing a suitable posture while working, could reduce musculoskeletal disorders in different areas of the body. Thus, we can predict that the prevalence of musculoskeletal disorders will be reduced in dentists in a long run if they use optical magnification loupes.
    Keywords: Assessing Body Conditions, Corlett, Bishop, Dentists, Ergonomic intervention, Musculoskeletal Disorders
  • Elaheh Kabir Mokamelkhah, Amir Bahrami, Ahmadi, Negar Aghili Pages 1275-1281
    Background
    Impairment in quality of life and mental health had been reported in the previous studies as the results of musculoskeletal disorders among workers. Mental health has a wide concept and contains different disorders including anxiety, depression or even decreased quality of life, all of which having challengeable impacts on work- related characters such as work productivity and absensism. The present study aimed at evaluating work- related stress and quality of life among Iranian blue-collar workers of Fars ABFA Company with self-reported low back pain.
    Methods
    In the present study, we focused on the low back pain among 451 blue-collar workers and assessed their work- related stress and quality of life status using DASS-21 and short form questionnaire (SF-36), respectively. Independent sample t-test was used to compare the qualitative variables, and chi-square test was utilized for statistical analysis of the qualitative variables.
    Results
    Mean of the total score of quality of life among workers with low back pain was significantly lower than in those workers without low back pain. The mean of work- related stress score was significantly higher in workers with low back pain than in workers without low back pain. The mean quality of life subdomains in patients with low back pain was significantly lower than in workers without low back pain.
    Conclusion
    Findings of the present study revealed that workers with low back pain had lower quality of life score and higher work- related stress score. These findings should be considered in designing preventive programs rather than controlling the pain.
    Keywords: Low Back Pain, Quality of Life, Occupational Stress
  • Amene Homami, Farideh Ghazi* Pages 1282-1289
    Bladder cancer is the fifth most common cancer with significant morbidity and mortality. Recently, numerous studies demonstrated that microRNAs are emerging as diagnostic biomarkers for bladder cancer. Specific miRNA profiles have been identified for several samples from patients with bladder cancer. MicroRNAs are noncoding RNA molecules of approximately 23 nucleotides that play important roles in multiple steps during the progression of bladder cancer. Here, we review the expression profiles of miRNAs and their biological functions, regulation, and clinical implications in bladder cancer. Either downregulation or upregulation of miRNAs occurs in bladder cancer through epigenetic changes or defects of the biogenesis apparatus. Deregulation of miRNAs is involved in cell cycle arrest, apoptosis, proliferation, metastasis, drug resistance, and other functions in bladder cancer. A number of miRNAs, have been associated with tumor type, stage, or patient survival, and miRNAs might be developed as diagnostic or prognostic markers. A better understanding of the roles of miRNAs in bladder cancer will shed light on the molecular mechanisms of bladder cancer.
    Keywords: Bladder cancer, Biomarkers, MicroRNA, Diagnostic