Iranian Journal of Public Health
Volume:46 Issue: 4, Apr 2017

There are several conflicting conceptual models to explain social determinants of health (SDH) as responsible for most health inequalities. This study aimed to present these models in historical perspective and provide main component of SDH models as an SES indicators.
This was a narrative study using international databases to retrieve literature dealing with conceptual models of SDH. All publication in English language until Mar 2015 was included. The CASP and PRISMA were used to summarize the literature.
Overall, 248 publications were retrieved and screened. After exclusion of irrelevant and duplicates, 94 citations were found to be relevant and 21 publications included in this review. In general, 21 models of SDH were found: some models presented before year 1995(n=4), some models presented between 1995 and 2005 (n=13) and some models presented after 2005 (n=4). However, we found three categories of indicators that contribute to SDH models and that were classic factors, fixed and demographic factors and proxy factors.
Reduction of socioeconomic inequalities in health requires understanding of mechanisms and causal pathways; therefore, every country needs to design the specific model. As the available models are for developed countries, lack of a specific model for developing ones is tangible. As there is no gold standard related to SES indicators, therefore, it is proposed to use the various indicators based on life course approach, which leads to understanding and adopting effective policy interventions.

Student's view is an important factor in assessing the quality of universities. Servqual pattern is regarded as the most prominent for services quality measurement. This study aimed to review systematically studies that investigated the quality of educational services.
A systematic review and meta-analysis of studies evaluating students’ viewpoint about quality of educational services were conducted. Required data were collected from PubMed, Embase, Scopus, Science Direct, Google Scholar, SID, Magiran, and Iranmedex, without time restriction. Computer software CMA, ver. 2 was applied to estimate the total mean score of students’ perception and expectation of services quality and the gap between them.
The 18 eligible studies were entered into study. The studies were conducted between 2004 and 2014. Based on the random effect model, the total mean score of students’ perception, students’ expectation and the gap between them were estimated 2.92 (95% CI, 2.75 - 3.09), 4.18 (95% CI, 3.98 - 4.38), respectively and -1.30 (95% CI= -1.56, -1.04).
The studied student's expectation level is higher than the current quality of educational services. There is a tangible difference between their expectations and the current quality, which requires official's efforts to improve quality in all dimensions and effective steps can be taken towards improving the quality of educational services through appropriate training planning and training for empowering employees in colleges and universities.

Metabolic syndrome (MetS) is the major risk factor for development of type 2 diabetes and cardiovascular diseases in different populations. The aim of this study was to evaluate the prevalence of MetS among Iranian population.
Thirty-four cross-sectional studies were analyzed with a sample of 83227 people. National and international English electronic databases (PubMed, Google scholar, Web of Science, Science Direct, and Scopus) and Persian language databases (SID, Medlib, Iran medex, Magiran, Medlib, and IranDoc) were used to search the articles published on MetS in Iranian population from Jan 2005 to May 2016. The MetS diagnosis was performed according to the ATP-III, NCEP/ATP-III, IDF and WHO criteria.
The overall weighted prevalence of MetS was 31% (95% CI: 28-35). According to ATP III criteria, total and gender-stratified prevalence of MetS in women and men were 29% (95% CI: 22-36), 37% (95% CI: 26-48) and 29% (95% CI: 23-36), respectively. Total prevalence of MetS based on NCEP/ATP III criteria was 29% (95% CI: 24-35) that the prevalence was 24% (95% CI: 18-30) and 35% (95% CI: 25-44) in men and women, respectively. According to the IDF and WHO criteria, total prevalence of MetS were 38% (95% CI: 32-43) and 30% (95% CI: 7-53), respectively.
The findings demonstrate an emerging high prevalence of MetS in total and in particular among Iranian women population. Therefore, to minimize the risk of cardiovascular events in Iranian population, screening and early detection of risk factors for MetS are required.

We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension, or antepartum hemorrhage.
We searched the PubMed, Scopus, and ISI web of science from 1990 to Feb 2015. In addition, electronic literature searches supplemented by searching the gray literature (e.g., conference abstracts thesis and the result of technical reports) and scanning the reference lists of included studies and relevant systematic reviews. We explored statistical heterogeneity using the, I2 and tau-squared (Tau2) statistical tests.
Eighteen studies were included. Preterm rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension and antepartum hemorrhage were considerable outcomes in this survey. The results showed no significant association between inactive HB and these complications in pregnancy. The small amounts of P-value and chi-square and large amount of I2 suggested the probable heterogeneity in this part, which we tried to modify with statistical methods such as subgroup analysis.
Inactive HB infection did not increase the risk of adversely mentioned outcomes in this study. Further, well-designed studies should be performed to confirm the results.

Despite growing interest in the public health of sexual minority, youth around the world due to the high rates of suicidal ideation and attempts in this population, few studies on the sexual orientation of Korean adolescents have been conducted. Therefore, this study investigated the relationship between the sexual orientation of Korean adolescents and their suicide-related behavior.
Raw data from the tenth Korea Youth Risk Behavior Web-based Survey were analyzed by logistic regression analysis. The sample consisted of 3603 adolescents who provided selected demographic variables and reported on their experience of sexual intercourse with the same or the opposite sex, along with lifestyle and suicide-related behaviors.
Rates of suicidal ideation, plans, attempts, and medically serious attempts were higher in both homosexual and bisexual than heterosexual groups. Suicidal ideation (odds ratio 95% confidence interval: 1.09–2.08), suicidal plans (odds ratio 95% confidence interval: 1.01–2.09), and suicide attempts (odds ratio 95% confidence interval: 1.28–2.88) had the strongest associations with homosexuality after multivariate adjustment. In contrast, bisexuality was only significantly associated with suicidal attempts (odds ratio 95% confidence interval: 1.01–2.97) after multivariate adjustment.
Effective suicide prevention interventions are required for homosexual and bisexual adolescents, in the form of targeted programs to improve their mental health status and ability to cope with stress.

Peripherally inserted central catheter (PICC) is commonly used in nursing for patients with leukemia. The purpose of this study was to investigate the risk factors of Catheter-related infection (CRI) in patients with leukemia and to provide some nursing strategies based on the results.
Clinical data from 140 patients with leukemia between May 2014 and July 2016 in Haiyang People's Hospital, China were retrospectively analyzed. We employed univariate analysis to explore the relationship of various factors, including leukemia types, puncture times, underlying diseases, Catheter indwelling time, hormones use, chemotherapy use, immune functions and seasons, with the incidence of CRI. Further, multivariate logistic regression analysis was conducted to identify the potential independent risk factors of CRI. Bacterial culture was performed for etiological detection.
Among the 140 patients with leukemia, 25 cases were diagnosed as CRI, with the incidence of 17.9%. Univariate analysis showed that puncture times, underlying diseases, catheter indwelling time, hormones use, chemotherapy use, immune functions and seasons were significantly correlated with the incidence of CRI. Multivariate logistic regression analysis revealed that immune functions, puncture times and seasons were independent risk factors for CRI. Etiological bacterial culture detected 20 strains of bacteria (Staphylococcus aureus: n=10, Klebsiella pneumonia: n=4, Corynebacterium: n=2 and other species: n=4) in 25 cases diagnosed with CRI.
Based on risk factors of CRI and its etiological distribution, appropriate nursing measures can be taken to reduce the incidence of CRI in patients with leukemia.

Human breast milk is the most important food for infants and one of the main roads to exposure to toxic substances. In this study, nonylphenol (NP) levels in human milk samples collected from Turkish mothers (n=100) were determined, and the factors including mothers’ demographics, eating habits, obstetric histories, and usage of cleaning and cosmetic products were examined.
Participants were mothers of randomly selected infants and toddlers from the Primary Health Care Center Number-8 in Afyonkarahisar City in western Turkey. The concentrations of NP in milk samples were measured using high-performance liquid chromatography (HPLC).
All the analyzed samples showed the occurrence of NP at levels up to 47 ng/ml. The mean± SE and the median NP concentrations were 10.1±0.98 ng/ml and 8.46 ng/ml or ppb, respectively. A negative correlation with infant age was observed. There was a significant correlation between fresh fish consumption and the level of NP in the breast milk of mothers. No significant association between body mass index (BMI) and the NP level in human milk of mothers was observed. The mothers who were using excessive cleaning products in comparison to those using less had significantly higher NP in their breast milk.
This study provides the first report about NP levels in a population and characterizes individual variation, thus giving a measure of exposed infants through breastfeeding in Turkey.

We aimed to observe the effect of holistic nursing on patients undergoing hematodialysis for uremia who simultaneously were suffering from moderate to severe malnutrition.
Eighty patients with uremia on maintenance hematodialysis with malnutrition between June 2014 and June 2015 from Yantaishan Hospital, Yantai, Shandong, China were included and equally and randomly were divided into the control group (n=43) and observation group (n=43). Routine nursing was used in the control group while holistic nursing was used in observation group (before, during and after dialysis) and the clinical effects in the two groups were compared after 3 months.
At follow-up visits, serum creatinine and urea nitrogen levels of the patients in the two groups were decreased, whereas hemoglobin and albumin levels were increased. In addition, these improvements were greater in the observation group and the differences were statistically significant (P Holistic nursing is able to improve significantly malnutrition in patients with uremia on hematodialysis.

Estimating the burden of non-communicable diseases particularly cardiovascular disease (CVD) is essential for health management and policymaking. In this paper, we used a regression model to estimate the future impact of demographic changes on the burden of CVD in Iran during the next two decades.
Disability-adjusted life years (DALY) were used to estimate the future burden of CVD in Iran. A regression model was used to estimate DALY caused by CVD in the Iranian population aged 30–100 yr, stratified by age group and sex. The predicted population of Iranians aged ≥ 30 yr was entered into the model and DALY were calculated over 2005-2025. To assess the areas of uncertainty in the model, we did sensitivity analysis and Monte Carlo Simulation.
In the year 2005, there were 847309 DALYs caused by CVD in Iranian adults aged ≥ 30 yr. This figure will nearly be 1728836 DALYs in 2025. In other words, just because of the aging, DALY related to CVD will increase more than two-fold in 2025 compared with 2005. The burden of CVD was higher in men (443235) than in women (404235) in 2005; but in 2025, the difference will be less (867639 vs. 861319).
The burden of CVD will increase steeply in Iran over 2005–2025, mainly because of the aging population. Therefore, more attention is needed to deal with the impact of CVD in the following decades in Iran.

Pregnancy Associated Osteoporosis (PAO) can lead to serious difficulties such as fragility fractures, elongated back pain and height loss in affected women. Soluble Receptor Activator of Nuclear Factor-Kappa B ligand (sRANKL) to Osteoprotegerin (OPG) ratio is chosen as a bone metabolism equation in many bone diseases characterized by bone resorption, such as post-menopausal osteoporosis and would be modified with folic acid supplementation. This study was done to compare the effects of high dose (5mg/day) and low dose (0.5 mg/day) folic acid in the RANKL/OPG ratio and Tumor Necrosis Factorα (TNFα) concentration during pregnancy.
Forty-five pregnant women who visited the AL-Zahra Hospital, Tabriz Iran, from September 2013 to November 2014 were assigned into two groups in this randomized, double-blind, clinical trial, included women who took 5 mg/day (group1) and who took 0.5 mg/day (Group 2) folic acid supplementation before pregnancy until 36th pregnancy. The biochemical variables in serum of pregnant women were measured before and at the end of the study. The study was registered in the Iranian Registry of Clinical Trials (IRCT) as ID, IRCT2013122315903N1.
OPG levels were significantly higher compared with the baseline value (P=0.008), although sRANKL (P High dose of folic acid supplementation could decrease bone resorptive biomarkers and may prevent PAO in pregnant women by increasing OPG and decreasing sRANKL and TNFα.

Malaria is a big problem of public health in many tropical countries where socioeconomic development is deficient. Four species of plasmodium are capable of infecting human: P. falciparum, P. malaria, P.vivax, P. ovale. Southeastern corner of Iran, including Sistan and Baluchestan, Hormozgan and the tropical part of Kerman Province, are endemic region of malaria. This study aimed to find out clinical findings in malaria caused by various plasmodium species in moderate transmission area of southern Kerman Province.
This study was conducted in health centers of Kahnooj, Manujan, Ghale-Ganj, Roudbar and Fariab in south of Kerman Province, Southeastern Iran during 2005-2009. Three hundred and thirty patients with positive malaria parasite slides entered the study. Frequencies of several malaria clinical presentations were investigated in four plasmodium species.
54.2% of considered patients were male. Mean age of patients was 22.8±17.8 yr. Younger and older patient were 6 months and 80 yr, respectively. Ten patients were infected with P. falciparum, 314 with plasmodium vivax and 6 with mixed infection. The symptoms of fever, chills and sweating were present in 74.6% of subjects. Other complaints were joint pain, headache, fatigue, vomiting, and diarrhea. Splenomegaly was detected in 17.57% of the individuals.
Malaria should be considered in differential diagnosis of all acutely febrile patients in endemic area. Classic symptoms of fever, chills and sweating may not present in all of patients.

Scleroderma is a chronic connective tissue disease of unknown etiology. Vitamin D and parathyroid hormone (PTH) that play particular functions in calcium and phosphate homeostasis may be involved in the etiology of this disorder. Klotho, the co-receptor of the fibroblast growth factor 23 (FGF-23), can interfere with calcium and phosphate metabolism. The purpose of this study was to evaluate serum Klotho, FGF-23, intact PTH (iPTH) and vitamin D levels in scleroderma patients compared with the healthy controls.
The study was performed in Biotechnology Research Center, Tabriz University of Medical Sciences (TUMS) from 2014-2015. Sixty scleroderma patients based on the classification criteria of systemic sclerosis and 30 age- and sex-matched healthy controls were included in this study. Serum Klotho, FGF-23, 25-hydroxy vitamin D (25-OH Vit D), and iPTH levels were analyzed using ELISA.
Serum levels of Klotho and 25-OH Vit D in the scleroderma patients were lower than those in the healthy controls (P˂0.001). In addition, scleroderma patients had higher serum iPTH levels than the controls (P The decreased serum Klotho, 25-OH Vit D, and increased iPTH levels in the scleroderma patients may be associated with the pathogenesis of this disease and could be considered a future therapeutic target.

Exposure to endogenous hormones such as estrogen is known as a lifetime Breast Cancer (BC) risk factor. Polymorphisms in genes that are involved in the steroidogenic process, such as Cytochrome P450c17alpha (CYP17), affect individuals’ susceptibility to BC. In Iran, the highest incident of BC is among young women. This study aimed to find prevalence of Single Nucleotide Polymorphisms (SNPs) in genes such as CYP17 and significant correlation with age-oriented group of breast cancer.
In 2016, a case series study was conducted on a total population of 205 patients suffering from breast cancer referred to Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran. This population consisted of 104 cases less than 40 yr old and 101 cases over 40. The genotype variants of CYP17 MspA1 were determined using PCR, followed by RFLP. The association of CYP17 MspA1 polymorphisms with the risk of BC in two different age groups was evaluated by calculating odds ratio and 95% confidence intervals using unconditional logistic regression.
Carriers of at least one A2 allele may have higher risk of developing breast cancer at younger age compared to patients with A1/A1 genotype (Odds Ratio: 1.99, 95% Confidence Interval: 1.11-3.57, P=0.02).
CYP17gene polymorphisms may have influence on the early onset of breast cancer.

Clinicians have been searching for ways to obtain "super normal" wound healing. Honey is a traditional remedy for the treatment of infected wounds. We aimed to evaluate the wound contraction and antibacterial properties of locally produced Thyme honey on managing full-thickness wounds in vivo.
This experimental study was conducted in 2015, in Department of Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran on 54 adult male Wistar rats weighing 200-250 gr, and ages of 3-4 months. A square 1.5*1.5 wound was made on the back of the neck. The rats were divided into control and two experimental groups. Additionally, the control and experimental groups were separated into three subgroups corresponding to 4, 7, and 14 d of study. The control group did not receive any treatment. For histological studies, samples were taken from the wound and adjacent skin. This tissue was examined using histological staining (H&E). Wound surface and wound healing were evaluated. Data were analyzed by using one-way ANOVA with post hoc Tukey test and (P The macroscopic and microscopic evaluations showed that the percentage of wound healing on different days in the control and experimental groups were significant (P Using honey twice a day on open wounds will accelerate the healing process.

During the last decades, the number of dentistry units increased significantly across the country. The aim of this study was to assess the efficiency of dental units of Iran provinces regarding dental health inputs and outputs using Data Envelopment Analysis approach.
In this applied descriptive-analytical study, the study population included all of Iran 31 provinces. The output variables included DMFT and DMFT indices of 6-12 yr old students. The data about DMFT and DMFT indices were taken from 2013 Nationwide School Pupils Screening Program. Input variables included active dental chairs located in the public sector, general dentists of public sector, general and specialist dentists of private sector by different provinces. The data were analyzed using Deap software version 2.1.
The lowest amount of scale efficiency was for Tehran Province (0.204) followed by Isfahan Province (0.205). Provinces of Isfahan, Razavi Khorasan, Kerman, Zanjan, Hamedan, Kordestan, Golestan, Yazd and Tehran, Iran had decreasing return to scale and provinces of Gilan, West Azerbaijan, Mazandaran, Fars, Kermanshah, Markazi, Lorestan, Qazvin, Sistan-and-Baluchestan, Bushehr, Alborz, Hormozgan and Khuzestan had increasing return to scale.
Despite provinces of Isfahan, Razavi Khorasan, Kerman, Zanjan, Hamedan, Kordestan, Golestan, Yazd and Tehran which had a better situation in terms of the number of dentistry chairs, public dentists, general and specialist dentists of private sector than other provinces, they had decreasing return to scale. Investment in dental primary health care, preventive and educational programs can be more cost-effective.

Phenylketonuria (PKU) is an inborn error of amino acid metabolism with an autosomal recessive inheritance caused in most cases by mutations in the phenylalanine hydroxylase (PAH) gene. PKU has wide allelic heterogeneity. Here we report a novel heterozygous substitution (c.1223G>T (p.Arg408Leu)) in the PAH gene in an Iranian PKU family. The patient was 19-yr-old female with diagnosis of moderate PKU referred to Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran for genetic counseling/analysis in April 2015. We used PCR-Sequencing to identify any sequence variations in the PAH gene.