فهرست مطالب

Medical Journal Of the Islamic Republic of Iran - Volume:31 Issue: 1, 2017
  • Volume:31 Issue: 1, 2017
  • تاریخ انتشار: 1396/03/06
  • تعداد عناوین: 139
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  • Hamid R. Baradaran, Mazyar Moradi Lakeh Page 1
  • Parya Abdolalizadeh *, Saeed Pourhassan, Roghayeh Gandomkar, Farrokh Heidari, Amir Ali Sohrabpour Pages 2-6
    Background
    Despite the advantages of dual peer mentoring, there are a few reports of implementing and evaluating such programs for medical students. This study aimed at exploring the perceptions of mentors and mentees about the dual peer mentoring program for the first year undergraduate medical students of Tehran University of Medical Sciences.
    Methods
    This qualitative study was conducted at the end of the first year of implementing the mentoring program. All mentees and mentors were invited to participate in focus group discussions. Data were analyzed using a qualitative content analysis.
    Results
    All mentors (n= 12) and a group of mentees (n= 21) participated in focus group discussion sessions. We provided a variety of supports for the mentees including academic and psychosocial support and positive relationship; as a result, some developments occurred to the mentors We also explored participants’ views on some unique aspects of the program such as student-authorized, dual mentoring, and role model sessions.
    Conclusion
    Our participants found the mentoring program beneficial in various academic achievements and psychosocial supports for both the mentors and the mentees. Dual peer mentoring program can be an alternative to school administered programs
    Keywords: Peer mentoring, Dual mentoring, Undergraduate, Medical education
  • Seyed Emad Emadi, Andrew Juma Suleh, Farhang Babamahmoodi, Fatemeh Ahangarkani, Vanessa Betty Chelimo, Beatrice Mutai, Seyyed Reza Raeeskarami, Alireza Ghanadan, Seyed Naser Emadi * Pages 7-12
    Background
    Albinos in Africa are at constant risk of developing skin cancer due to the damage caused by ultra-violet exposure. This study identifies the common skin conditions among albinos in Kenya as a country located along the equator.
    Methods
    In this descriptive study on albino patients who were admitted to Mbagathi District Hospital in Nairobi, Kenya the census method was used for sampling and a total of 151 albinos were registered. All necessary data including age, gender, type, site and the number of skin lesions were recorded. Suspected patients with malignant and premalignant lesions were studied individually through skin biopsy and histopathological investigation. Finally, the collected data were analyzed using SPSS software.
    Results
    Albinos with serious skin lesions were 121(80%) patients. Females were 64 (52.9%). The frequency of the following premalignant and malignant skin lesions including actinic-cheilitis, solar elastosis, actinic keratosis (AK), basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were 17.88%, 11.92%, 37.08%, 7.94% and 5.29%, respectively. Hands (20.52%), face (19.20%), head (18.18%), shoulder (14.56%) and neck (7.94%) were the most affected areas by malignant and premalignant lesions.
    Conclusions
    BCC was the most common type of cutaneous malignancy on the face and shoulders while AK was the most common cutaneous pre-malignancy on the hands and face in albinos in Kenya. Therefore, appropriate physical protection, avoiding any trauma when carrying sharp, heavy or rough instruments by the shoulder and hands, and finally urgent and quality treatment for any lesion even a small erosion and ulcer, especially on exposed areas in albinos, are recommended.
    Keywords: Albinos, Skin Cancer, Kenya
  • Hossein Mobaraki, Saber Azami-Aghdash, Ali Sarabi Asiabar, Aziz Rezapour, Mohammad Hossein Kafaei Mehr *, Saeed Emamgolizadeh Pages 13-22
    Introduction
    In recent years, a few studies have been conducted in the area of the cost-effectiveness of the Eplerenone; it's notable that coherent and clear evidence are not available. Therefore, this study aimed to systematically review studies of cost-effectiveness of Eplerenone in the treatment of cardio-vascular patients.
    Methods
    This systematic review study was conducted in 2016. The required information were collected by using key Mesh words from databases such as: Google scholar, PubMed, Science Direct, MagIran, SID, Scopus and hand searching journals and selected articles references. The Quality of selected articles was assessed by the Drummond's check-list.
    Results
    Nine articles were included from 296 articles found in literature review. Studies have been conducted in 8 countries (America, Britain, Australia, Switzerland, France, Spain, the Netherlands and Canada). In general, the cost-effectiveness of Eplerenone was investigated on 31757 in treating cardio-vascular patients. Average of quality-adjusted life years (QALY) in studies with non-modeling was equal to 0.0908 in terms of Framingham approach, 0.0595 in terms of Saskatchewan approach and 0.1309 in terms of Worcester approach. In general, the overall average cost of treating cardiovascular patients with Eplerenone was equal to $6694 of America in one year. The cost per additional (QALY) was estimated to be $ 9478 of America. Incremental cost-effectiveness ratio was high in the United States compared to European countries. The Average quality of articles was estimated about 7.4 from 10.
    Conclusion
    Based on the results of the studies reviewed in this study, it seems that Eplerenone has acceptable cost-effectiveness compared with current treatments, placebo and similar drugs.
    Keywords: Cost-effectiveness, Cardiovascular disease, Eplerenone, Systematic review
  • Sedigheh Saedi, Mona Noroozi, Naghmeh Khosrotabar, Shadi Mazandarani, Behshid Ghadrdoost * Pages 23-28
    Background
    Restricted intakes of saturated and trans-fatty acids and replacement with poly or monounsaturated fatty acids are emphasized in healthy diets. This study evaluates the effects of a six-month consumption of canola oil compared to sunflower oil on lipid profile and anthropometric parameters of people affected by dyslipidemia.
    Methods
    This randomized controlled trial was conducted on 96 patients with dyslipidemia, who were randomly assigned into canola oil or the sunflower oil groups. The participants were instructed to record the contents of their daily meals, beverages, fruits, and snacks a day before treatment, at the second clinic visit, in the third month, and at the end of study (i.e., six months). Lipid profile and anthropometric parameters were compared between the two groups. Student t-test or Mann Whitney U test was used for statistical comparisons of variables between groups. Multivariate analysis was performed to adjust the confounding factor effects.
    Results
    Of the enrolled participants, 44 (45.8%) were on sunflower oil diet and 52 54.2%) on canola oil diet. We observed no change in anthropometric parameters and thus no significant difference between the two groups (p>0.05). Significant reductions in LDL-C (p
    Conclusion
    Dietary fats in the form of canola oil or sunflower oil effectively lower the serum cholesterol, LDL-C and triglyceride concentrations. They also result in an increase in serum concentration of HDL-C. These oils, however, did not modify general anthropometric parameters.
    Keywords: Canola Oil, Sunflower Oil, Lipid Profile, Dyslipidemia, Anthropometric Parameters
  • Seyed Aliakbar Faghihi, Hamid Reza Khankeh, Seyed Jalil Hosseini *, Seyed Kamran Soltani Arabshahi, Zahra Faghih, Mandana Shirazi Pages 29-33
    Background And Objective
    Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients’ care, reducing the medical errors, and/or altering physician's behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In the present study, we have done our best to explore the parameters involved in the degree of CME programs’ effectiveness in Iran.
    Methods
    In this study, 31 participants, consisting of general practitionares, CME experts and providers, were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis).
    Results
    Our analysis demonstrated that: based on participant experiences, the insufficient consistency of the training program contents with the demands of GPs, besides non-beneficiary programs for physicians in addition to non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by unrealistic continuing education, which is the main theme here.
    Conclusion
    Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much so that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance.
    Keywords: Continuing Medical Education, General Practitioners, Qualitative Study, Content Analysis, Effectiveness
  • Parsa Yousefi Chaijan, Fatemeh Dorreh, Mojtaba Sharafkhah *, Mohammad Amiri, Mohsen Ebrahimimonfared, Mohammad Rafeie, Fatemeh Safi Pages 34-39
    Background
    Congenital hypothyroidism (CH), as one of the most common congenital endocrine disorders, may be significantly associated with congenital malformations. This study investigates urogenital abnormalities in children with primary CH (PCH).
    Methods
    This case-control study was conducted on 200 children aged three months to year, referred to Amir-Kabir Hospital, Arak, Iran. One hundred children with PCH, as the case group, and 100 healthy children, as the control group, were selected using convenient sampling. For all children, demographic data checklists were filled, and physical examination, abdomen and pelvic ultrasound and other diagnostic measures (if necessary) were performed to evaluate the congenital urogenital abnormalities including anomalies of the penis and urethra, and disorders and anomalies of the scrotal contents.
    Results
    Among 92 (100%) urogenital anomalies diagnosed, highest frequencies with 37 40.2%), 26(28.2%) and 9 (9.7%) cases including hypospadias, Cryptorchidism, and hydrocele, respectively. The frequency of urogenital abnormalities among 32 children with PCH, with 52 cases (56.5%) was significantly higher than the frequency of abnormalities among the 21 children in the control group, with 40 cases (43.4%). (OR=2.04; 95%CI: 1.1-3.6; p=0.014).
    Conclusion
    Our study demonstrated that PCH is significantly associated with the congenital urogenital abnormalities. However, due to the lack of evidence in this area, further studies are recommended to determine the necessity of conducting screening programs for abnormalities of the urogenital system in children with CH at birth.
    Keywords: Congenital hypothyroidism, Urogenital abnormalities, Children
  • Maryam Aalaa, Mahnaz Sanjari, Samimeh Shahbazi, Zahra Shayeganmehr, Maryam Abooeirad, Mohammad Reza Amini, Hossien Adibi, Neda Mehrdad* Pages 40-42
    Diabetes mellitus as one of the most common metabolic disorders has some complications, one of the main ones is diabetic foot (DF). Appropriate care and education prevents 85% of diabetic foot amputations. An ideal management to prevent and treat diabetic foot necessitates a close collaboration between the health team members and the diabetic patient. Therefore, improving nurse's knowledge about DF care and advancement in the quality of care provided by the nurses could significantly improve diabetic foot prevention and management. Therefore, the aim of DF workshop was to improve technical and educational skills of the nurses to prevent and manage diabetic foot. Considering the vital role of the nurses in providing DF care, EMRI decided to conduct Diabetic foot workshop for them. The following five steps were designed for the 14 coordinating sessions in the workshop: Goals definition, deciding about attendees, location selection, creating agenda, and developing a follow-up plan. “Diabetic Foot Workshop for Nurses” provides appropriate training to DF nurses at the national level; and combining theory and practice in this workshop not only increases nurse's knowledge, but also improves their skills in the field of the diabetic foot. Providing education and care to patients by DF nurse specialists instead of general nurses could be an important output of this workshop, which may lead to DF prevention and amputation decrease in the long term.
    Keywords: Diabetic foot, Nurse, Workshop
  • Masoud Mirzaei, Mehran Karimi, Shima Beheshti, Masoud Mohammadi * Pages 43-52
    Background
    The prevalence of asthma and allergy has increased during the last decades, especially in children. However, little is known about it in the Middle East region. This systematic review is aimed to estimate the prevalence of asthma among the Middle Eastern children.
    Methods
    Local and international scientific databases including SID, Iranmedex, Medline and Science Direct were systematically searched for relevant keywords including; asthma, prevalence, children, International Study of Asthma and Allergies in Childhood (ISACC) and the names of Middle Eastern countries for the period of 1996-2011. Papers in Persian and English which met the defined criteria were included into the study. Bibliographies of the extracted articles were also searched. After extraction of data, heterogeneity between studies and publication bias were measured using Eggers-test. Effect size was pooled by the random-effect model. Since significant heterogeneity was found between studies, univariate meta-regression analyses were done to assess the association of variables with the overall results.
    Results
    Fifty studies in the Middle East examined the prevalence of asthma and allergy in children under the age of 18 years according to the ISAAC criteria and were included. A total number of 289,717 children were examined in the included studies and the prevalence varied from 0.7 % in Isfahan to 22.3 % in Bagdad. The total prevalence of diagnosed asthma was calculated 7.53 % (95% Cl: 6.38-8.75). Prevalence of asthma in the 13-14 years age group was 7.57% (95% Cl: 5.78-9.29) and in 6-7 years age group was 7.43% (95% Cl: 5.75-9.10). The prevalence of asthma among girls, based on random effect model, was 6.30% (95% Cl: 4.97-7.61) and among boys, it was 8.91% (95% Cl: 6.80-11.04).
    Conclusion
    The prevalence of asthma in the Middle East is lower than most developed countries. However, there is not enough longitudinal data to estimate the trend over time. In order to have more accurate estimates and to provide evidence for proper planning, standard epidemiologic studies should be conducted in countries of the region.
    Keywords: Asthma, Prevalence, Middle East, Children, Systematic review
  • Nahid Dehghan Nayeri, Esmaeil Shariat *, Zahra Tayebi, Majid Ghorbanzadeh Pages 53-59
    Background
    The main philosophy of postgraduate preparation for working in critical care units is to ensure the safety and quality of patients’ care. Increasing the complexity of technology, decision-making challenges and the high demand for advanced communication skills necessitate the need to educate learners. Within this aim, a master’s degree in critical care nursing has been established in Iran. Current study was designed to collect critical care nursing students’ experiences as well as their feedback to the field critical care nursing.
    Methods
    This study used qualitative content analysis through in-depth semi-structured interviews. Graneheim and Lundman method was used for data analysis.
    Results
    The results of the total 15 interviews were classified in the following domains: The vision of hope and illusion; shades of grey attitude; inefficient program and planning; inadequacy to run the program; and multiple outcomes: Far from the effectiveness. Overall findings indicated the necessity to review the curriculum and the way the program is implemented.
    Conclusion
    The findings of this study provided valuable information to improve the critical care-nursing program. It also facilitated the next review of the program by the authorities.
    Keywords: Nursing curriculum, Critical care nursing, Nursing student
  • Yousef Veisani, Ali Delpisheh*, Kourosh Sayehmiri, Ghobad Moradi, Jafar Hassanzadeh Pages 60-65
    Background
    Seasonality in suicide has been investigated from the early 19th century to explore the productive environmental variables. Seasonality studies can provide information on prevention and interventions in suicide. In this study, we examined seasonality in suicide and aimed to explore the differences in seasonality between rural and urban areas, mental disorders, and genders.
    Methods
    In this cross-sectional study, overall identified suicide cases in Ilam province from 21 March 2010 and 11 December 2014 were identified, using systematic registration suicide data (SRSD). Two methods were used separately to analyze seasonality (Chisquare, Edward's T). Seasonal effect (peak/ trough seasons) and (deaths/ attempts suicide) was explored by ratio statistics. The null hypothesis was that the completed suicides in each method group were evenly distributed over a year.
    Results
    Significant seasonality was observed in suicide during the study period, with one peak in the spring and one in the winter. Our results showed that suicide seasonality following mental disorders was statistically significant with a peak in the spring, regardless of other factors such as gender and age. When all non- mental suicides are taken into account, the seasonality remains statistically significant, but the peak season is shifted to autumn.
    Conclusion
    Investigating suicide in Ilam revealed a significant seasonality for both rural and urban areas, which was greater in the urban part. A significant seasonality in suicide was observed in attempters with mental disorders. In suicide attempters with mental disorders, findings showed two peaks in the spring and the autumn.
    Keywords: Seasonality, Suicide, Mental disorders, Ilam, Iran
  • Raheleh Rafiei Sefiddashti, Seyedeh Maryam Sharafi, Soltan Ahmad Ebrahimi, Lame Akhlaghi, Ali Moosavi, Abbasali Eskandarian, Alireza Hejrati, Hossein Yousofi Darani Pages 66-70
    Background
    Hydatid disease is characterized by long-term growth of hydatid cysts in the human. The glycan antigens have an important role in the immunology of hydatid cyst. In this study immunological reaction of host sera to different glycan antigens of the cyst, has been investigated.
    Methods
    The antibody responses were tested to glycoprotein and glycolipid of the laminated layer (LL), cyst fluid (CF) and protoscolex (PS) antigens of E. Granulosus using ELISA and western immunoblotting tests. Thin-layer chromatography and ß-elimination were used for glycan purification.
    Results
    Both hydatid cyst and normal human sera reacted with hydatid cyst fluid, protoscolices, laminated layer, glycoprotein and glycolipid antigens. The most antigen-antibody reaction was related to CF and PS antigens, and LL antigens had the minimal reaction with the sera. Thin layer chromatography (TLC) of the antigens showed presence of many glycan bands in the laminated layer.
    Conclusion
    The parasite may elaborate different glycan antigens in LL to evade host immune response.
    Keywords: Echinococcus granulosus, Hydatid cyst, Laminated Layer, Thin-layer chromatography, Enzyme Linked Immunosorbent Assay, ß-elimination
  • Sara Aghababa, Amir Ashkan Nasiripour, Mohammadreza Maleki *, Mahmoodreza Gohari Pages 71-76
    Background
    Long-term financial support is essential for the survival of a charitable organization. Health charities need to identify the effective factors influencing donor retention.
    Methods
    In the present study, the items of a questionnaire were derived from both literature review and semi-structured interviews related to donor retention. Using a purposive sampling, 300 academic and executive practitioners were selected. After the follow- up, a total of 243 usable questionnaires were prepared for factor analysis. The questionnaire was validated based on the face and content validity and reliability through Cronbach’s α-coefficient.
    Results
    The results of exploratory factor analysis extracted 2 factors for retention: donor factor (variance = 33.841%; Cronbach’s α- coefficient = 90.2) and charity factor (variance = 29.038%; Cronbach’s α-coefficient = 82.8), respectively. Subsequently, confirmatory factor analysis was applied to support the overall reasonable fit.
    Conclusions
    In this study, it was found that repeated monetary donations are supplied to the charitable organizations when both aspects of donor factor (retention factor and charity factor) for retention are taken into consideration. This model could provide a perspective for making sustainable donations and charitable giving.
    Keywords: Charitable Giving, Donor, Retention, Factor Analysis, Health care
  • Farnoush Davoudi, Shooka Esmaeeli, Masoud Ahmadzadasl, Marzieh Nojomi * Pages 77-82
    Background
    Better understanding of factors associated with medical school performance is necessary to improve admission processes and to help students succeed in their career. This study follows a group of Iranian med students during their first 2.5 years of medical education, to evaluate their academic success in accordance with their demographic, cognitive and non-cognitive characteristics.
    Methods
    143 of 200 matriculants of Iran University of Medical Sciences medical school in 2010, were followed for 5 consecutive semesters of the preclinical stage. Demographic and cognitive characteristics were collected using self-administered data collection forms. The NEO Five-Factor (personality) Inventory (NEO-FFI) was used to assess participants’ non-cognitive characteristics. The 5 semesters’ cumulative Grade Point Average (GPA) was the measure of academic performance. Pooled t-test, one-way ANOVA, multiple linear regression and logistic regression model, and Spearman coefficients of correlation were applied in data analysis
    Results
    There was a significant difference in participants’ GPA regarding their gender (p 0.008), using privilege in National University Entrance Examination (NUEE)(p
    Conclusions
    Females and students with a better academic performance prior to their admission in medical school had better academic records. We found no association between academic performance and personality because participants were followed through a preclinical stage where non-cognitive characteristics plays a less important role in their performance and evaluations.
    Keywords: Students, Medical education, Medicine, Undergraduate, Iran
  • Mansour Torabinia, Sara Mahmoudi, Mojtaba Dolatshahi *, Mohammad Reza Abyaz Pages 83-89
    Background
    Considering the overall tendency in psychology, researchers in the field of work and organizational psychology have become progressively interested in employees’ effective and optimistic experiments at work such as work engagement. This study was conducted to investigate 2 main
    Purposes
    assessing the psychometric properties of the Utrecht Work Engagement Scale, and finding any association between work engagement and burnout in nurses.
    Methods
    The present methodological study was conducted in 2015 and included 248 females and 34 males with 6 months to 30 years of job experience. After the translation process, face and content validity were calculated by qualitative and quantitative methods. Moreover, content validation ratio, scale-level content validity index and item-level content validity index were measured for this scale. Construct validity was determined by factor analysis. Moreover, internal consistency and stability reliability were assessed. Factor analysis, test-retest, Cronbach’s alpha, and association analysis were used as statistical methods.
    Results
    Face and content validity were acceptable. Exploratory factor analysis suggested a new 3- factor model. In this new model, some items from the construct model of the original version were dislocated with the same 17 items. The new model was confirmed by divergent Copenhagen Burnout Inventory as the Persian version of UWES. Internal consistency reliability for the total scale and the subscales was 0.76 to 0.89. Results from Pearson correlation test indicated a high degree of test-retest reliability (r = 0. 89). ICC was also 0.91. Engagement was negatively related to burnout and overtime per month, whereas it was positively related with age and job experiment.
    Conclusion
    The Persian 3– factor model of Utrecht Work Engagement Scale is a valid and reliable instrument to measure work engagement in Iranian nurses as well as in other medical professionals.
    Keywords: Work Engagement, Validity, Reliability, Burnout, Persian
  • Nastaran Habibi, Nasrin Dodangi, Ali Nazeri Pages 90-95
    Background
    In the treatment of bipolar disorder in youths, often more than one medication should be prescribed. In the current study, we compared the efficacy and tolerability of the combination of lithium and quetiapine with lithium and risperidone in the treatment of manic or mixed episodes in children and adolescents.
    Methods
    Thirty patients (aged 10-18 years) who were hospitalized for a manic or mixed episode were recruited from consecutive inpatient admissions to the Child and Adolescent Psychiatric Unit at Razi Psychiatric Hospital (University of Social Welfare and Rehabilitation Sciences, Tehran, Iran) from June 2012 to September. They were randomly treated with lithium (with the usual dose to achieve blood levels 0.8-1) and quetiapine (400-600 mg per day) or risperidone (0.5-6 mg per day). The primary outcome measure with respect to efficacy was the mean decrease in Young Mania Rating Scale (YMRS) score. Side effects were also assessed. The independent t test and two-factor repeated measure analysis of variance (ANOVA) was used for data analysis. P-value of less than 0.05 was considered statistically significant.
    Results
    The reduction in YMRS scores was similar in both groups. The remission rate (YMRS
    Conclusion
    Both protocols were effective. Quetiapine in combination with lithium in manic or mixed episodes of bipolar I disorder in children and adolescents was not superior to lithium and risperidone, but was associated with fewer complications.
    Keywords: Children, Adolescents, Bipolar Disorder, Quetiapine, Risperidone, Lithium
  • Shahnam Sedigh Maroufi, Shoaleh Bigdeli, Ladan Fata, Seyed Kamran Soltani Arabshahi Pages 96-103
    Background
    Behavioral, social, psychological and biological factors influence health and disease; and, to achieve professional competency, physicians should be knowledgeable about their society and its inhabitants’ behavior. This knowledge will help physicians to become competent in communication, professional behavior, self-awareness, ethical reasoning, and understanding cultural and social differences. In this regard, this research is an attempt to explore perspectives of medical faculty members on necessity of integrating Behavioral and Social Sciences (BSS) components into the medical curriculum.
    Methods
    In this qualitative study, data were collected by semi-structured interview and observation of participants who were recruited from educational departments of faculty of medicine of Iran University of Medical Sciences. 12 faculty members were interviewed individually and were ask about their experiences and perspectives on integration of BSS subject matters into medical curriculum. Data were analyzed using content analysis.
    Results
    The six following themes were emerged from data analysis: “physician-patientinteraction”, “medical culture”, “facilitating behavior change”, “socio-cultural issues”, “mind-body medical experience” and “physician interaction with health care system”.
    Conclusion
    The results revealed that “physician-patient interaction” was the most prominent among the emerged themes. The participants emphasized communication, professionalism, social accountability, and socio-cultural psychological aspects.
    Keywords: Behavioral, Social Sciences, Curriculum, Competency, Medical Student, Faculty Member, Qualitative Research
  • Maryam Kazerani*, Atefeh Davoudian, Farid Zayeri, Hamid Soori Pages 104-109
    Background
    Systematic reviews and meta-analysis have significant advantages over conventional reviews in that all available data should be presented. This study aimed to evaluate Iranian systematic reviews and meta-analysis abstracts indexed in WOS and Scopus during 2003-2012 based on PRISMA checklist.
    Methods
    This is an analytical study. We evaluated 46 article abstracts indexed in WOS, 89 article abstracts indexed in Scopus and 158 article abstracts indexed in WOS and Scopus both (overlapped group). The quality of the abstracts was evaluated according to the PRISMA checklist for abstracts. Some indicators including distribution per year, total citation, average citations per year, average citations per documents and average citations per year in each article were determined through searching the WOS and Scopus Databases’ analytical section. Then, the correlations between the abstract''s PRISMA scores, average citations per year, and publication year were calculated.
    Results
    The abstract’s quality is not desirable as far as the PRISMA criteria are concerned. In other words, none of the articles’ abstracts is in line with the PRISMA items. The average of scores of the current study was 5.9 while the maximum score was 12. The PRISMA criteria showed the highest compliance with “Objectives” (98.6%), the second highest with “Synthesis of result” (85%) and “Title” (80.2%) and the lowest compliance with “Registration” (2%). There was a positive correlation between the compliance of PRISMA score and the average citations per year while there was a negative correlation between PRISMA score and the publication year.
    Conclusion
    It seems that the suggested criteria for reporting Iranian systematic reviews and meta-analysis are not considered adequately by the writers and even scientific journal editors.
    Keywords: Systematic Review, Meta, analysis, Iran, Article Abstracts, PRISMA, WOS, Scopus
  • Nasrin Khalessi, Ali Mazouri, Mandana Bassirnia, Ladan Afsharkhas Pages 110-112
    Background
    Asphyxia is one the most important causes of neonatal mortality and morbidity. It is suggested that magnesium may have a protective role against cellular damage during hypoxic brain insult, or change effect post-asphyxia consequences. Our study was performed for comparison of serum magnesium in neonates with and without asphyxia.
    Methods
    This study was done in Neonatal Ward of Ali-Asghar hospital, from January 2010 to 2011 in Tehran, Iran. Serum magnesium levels of seventy-six cases with a diagnosis of asphyxia grade 2 were compared with 76 normal newborns. Collected data including gestational age, sex, birth weight and serum magnesium levels were analyzed by SPSS software.
    Results
    Of 152 neonates, 81 (53.3%) were male. Mean gestational age was 37.9 ± 1.07 weeks. Mean birth weights were 3172.9± 411.20 grams. Mean serum magnesium levels were compared in asphyxiated and normal neonates and between two groups significant difference was found (p=0.01). The odds ratio was 2.188 (with lower1.826, upper 2.626 and confidence interval 95 percent) which suggested a significant correlation between asphyxia and hypomagnesemia.
    Conclusion
    This study showed that serum magnesium levels in neonates with asphyxia was significantly lower than normal neonates and asphyxia can lead to hypomagnesemia.
    Keywords: Asphyxia, Magnesium, Neonate
  • Tahereh Ashktorab, Nayereh Baghcheghi*, Naimeh Seyedfatemi, Ahmadreza Baghestani Pages 113-118
    Background
    The Brief COPE is widely validated and popularly used in assessing coping strategies in major life stressors on various populations. This study carried out to determine the validity and reliability of the Persian version of the Brief COPE among wives of patients under hemodialysis.
    Methods
    The Brief COPE was translated into Persian language according to the standard method and the psychometric properties of the instrument were assessed among 212 wives of patients under hemodialysis in Tehran, Iran, in 2016. Content validity was established, by 15 expert opinions. Face validity was determined by respondents and expert opinion. Construct validity was analyzed through confirmatory factor analysis. The Cronbach''s alpha coefficient and intraclass correlation coefficient were used to determine the internal consistency and test-retest reliability, respectively.
    Results
    All 28 Items of Brief COPE scale had content validity index greater than 0.7, suggesting a good validity value of the items in terms of relevancy (range 0.8 - 0.94). The wording of some items was modified to make them more readily understood by the participants, although the core meaning of each item was kept intact and to observe Iranian cultural adaptation; two items were adjusted. Result of confirmatory factor support 14 factor structure of the scale has good fit. Cronbach''s alpha coefficient was acceptable for the total scale (α= 0.77) and for subscales (range 0.7 - 0.91). The intraclass correlation coefficient was acceptable for scale (r=0.76, P value= 0.001).
    Conclusion
    The Persian translation of the Brief COPE is a valid and reliable instrument to determine coping strategies in women living with the husband on hemodialysis.
    Keywords: Cope, Hemodialysis, Validity, Reliability
  • Yousef Moradi, Mahshid Nasehi, Mohsen Asadi-Lari, Mohammad Ebrahim Khamseh, Hamid Reza Baradaran* Pages 119-123
    Background
    Social capital is an important interpersonal organizational resource that may affect health behaviors and seems to be an important factor in chronic diseases. Considering the lack of evidence on this topic, in the present study, we aimed at investigating the association between components of social capital, socioeconomic condition, and controlling Type 2 diabetes mellitus in Iran.
    Methods
    This study was conducted on 300 patients with Type 2 diabetes in Tehran, Iran. In this study, simple random sampling method was used for data collection. Path analysis model was used to examine the potential association between social capital components and to determine the factors that control Type 2 diabetes.
    Results
    In the present study, most of the participants were female (70.7%) and married (78.7%). Path coefficients were calculated by a series of multiple regression analyses based on the conceptual model. The final model had a proper fit with Chi-square = 2.08 (DF = 1, P = 0.049), GFI = 0.542, AGFI = 0.915, NFI = 0.228, RFI = 0.284, IFI = 0.299, TLI = 0.292, CFI = 0.219, and RMSEA = 0.033. The Groups and networks (network) (β = 0.051, p = 0.036) and trust and solidarity (β = -0.018, p = 0.028) had a direct positive and negative effect on HbA1C, respectively. The results also revealed that education levels had a direct positive effect on groups and networks (network) (β = 0.118, p = 0.036), trust and solidarity (β = 0.082, p = 0.007), information and communication (β = 0.037, p = 0.027), and contribution in team works and public activities (β = 0.064, p = 0.003). In addition, education levels had an indirect positive effect on HbA1C through their effect on groups and networks (network), trust and solidarity, and information and communication.
    Conclusion
    Social capital has a significant relationship with diabetes. Although it was not specified clearly which components of social capital were associated with diabetes, trust and solidarity showed a negative direct effect on HbA1C, respectively. Therefore, developing and implementing local and collective programs to build trust and increase the standards of social trust in patients with diabetes can be effective in controlling HbA1C.
    Keywords: Social capital, Blood glucose, Diabetes, Iran
  • Fateme Arabi Basharic, Alireza Olyaeemanesh, Behzad Raei, Reza Goudarzi, Morteza Arab Zozani, Mohammad Ranjbar Ezzatabadi Pages 124-129
    Background
    Bariatric surgery with the improvement of obesity-related diseases, increases longevity and quality of life and is more cost-effective when compared to non-surgical Procedures.
    Objective
    The aim of this study is to compare the cost-effectiveness of Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB).
    Method
    This study was performed in two stages. Initially, a cross-sectional study was carried out for costing LSG and LRYGB in Rasoul Akram and Bahman hospitals in Tehran in the year 2014. Direct costs for each surgical procedure were calculated according to the average time of surgery in both the private and public sectors. In the second stage, using Outcome (ΔBMI) collected by means of a systematic review study and cost data; cost effectiveness of two surgical procedures was examined by ICER analysis and compared with threshold limit. The Perspective of this analysis was health system.
    Results
    The direct cost of services for LRYGB was $ 2991.5 (98121659 Rials) in the public sector and $4221.9 in the private sector. In LSG, it was $ 1952.9 (64055468 R) in the public sector and $ 3177.2 in the private sector. ICER for LSG was 720.48(23631855 R) and $716.27 (23493924 R) in private and public sector respectively.
    Conclusion
    In this study, LSG procedure when compared to LRYGB was cost effective. The ICER obtained indicated that LSG surgery in comparison to LRYGB was $716.27 (23493924 R) and $720.48(23631855 R) in the public and private sector respectively. Moreover, per unit change in BMI was less than the threshold.
    Keywords: Cost, effectiveness, Laparoscopic sleeve gastrectomy, Laparoscopic Roux, en, Y gastric bypass, Tehran
  • Fereshteh Baygi, Olaf C. Jensen, Mostafa Qorbani, Aliasghar Farshad, Seyed Ali Salehi, Fatemeh Mohammadi, Hamid Asayesh, Farzad Shidfar Pages 130-135
    Background
    Little information is available on the trend in cardiovascular risk factors and hepatic enzymes in Iranian seafarers. The present study aimed to assess the pattern of obesity, hypertension, diabetes, elevated serum glutamic oxaloacetate transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) in Iranian seafarers during 2010 to 2014.
    Methods
    Data on cardiovascular risk factors and hepatic enzymes were extracted from seafarers’ annual health examination of National Iranian Tanker Company (NITC) of 2010, 2012, and 2014. Over weight was defined as BMI (Body Mass Index) >25 kg/m2; obesity was defined as BMI>=30 kg/m2; hypertension was defined as systolic blood pressure (SBP)> 140 mmHg and diastolic blood pressure (DBP)> 90 mmHg or a history of antihypertensive drug use; diabetes (DM) was defined as fasting blood sugar (FBS) > 110 mg/dl or having a history of oral hypoglycemic agents; elevated SGOT and SGPT were defined as SGOT > 40 U/L and SGPT > 40 U/L, respectively.
    Results
    The BMI mean values of Iranian seafarers were 24.81±3.07 kg/m2, 25.51±2.96 kg/m2, and 25.96 ± 3.02 kg/m2 in 2010, 2012, and 2014, respectively. A significant difference was observed in BMI over the study period. The mean of systolic and diastolic blood pressure did not significantly increase over the time. The SGOT and SGPT means were not significantly different from 2010 to 2014. The prevalence of over weight increased significantly from 46.7% to 60.9% over the study period, and the prevalence of obesity, hypertension, elevated SGOT, and elevated SGPT did not change significantly.
    Conclusion
    The current survey showed that the obesity problem has increased among Iranian seafarers working on tankers, which is a concerning problem since obesity has negative effect on seafarers’ health.
    Keywords: seafarer, cardiovascular, prevalence, liver enzyme, pattern
  • Fatemeh Estebsari, Mohammad Hossein Taghdisi, Davood Mostafaei, Zahra Rahimi Pages 136-142
    Background
    Death is a natural and frightening phenomenon, which is inevitable. Previous studies on death, which presented a negative and tedious image of this process, are now being revised and directed towards acceptable death and good death. One of the proposed terms about death and dying is “healthy death”, which encourages dealing with death positively and leading a lively and happy life until the last moment. This study aimed to explain the views of Iranians about the elements of healthy death.
    Methods
    This qualitative study was conducted for 12 months in two general hospitals in Tehran (capital of Iran), using the thematic analysis method. After conducting 23 in-depth interviews with 21 participants, transcription of content, and data immersion and analysis, themes, as the smallest meaningful units were extracted, encoded and classified.
    Results
    One main category of healthy death with 10 subthemes, including dying at the right time, dying without hassle, dying without cost, dying without dependency and control, peaceful death, not having difficulty at dying, not dying alone and dying at home, inspired death, preplanned death, and presence of a clergyman or a priest, were extracted as the elements of healthy death from the perspective of the participants in this study.
    Conclusion
    The study findings well explained the elements of healthy death. Paying attention to the conditions and factors causing healthy death by professionals and providing and facilitating quality services for patients in the end stage of life make it possible for patients to experience a healthy death.
    Keywords: End of life, Good death, Healthy Death, Element, Thematic analysis
  • Fatemeh Gholami, Malihe Khoramdad, Ebrahim Shakiba, Yousef Alimohamadi, Jabbar Shafiei, Alireza Firouzi Pages 143-149
    Background
    There is no global consensus about the relationship between dairy consumption and cardiovascular diseases (CVD). This study aimed at integrating the results of several studies to predict the dairy effects on CVD, e.g. stroke and CHD.
    Methods
    In the present study, some major databases such as Scopus, Science Direct, and PubMed were searched up to September 2014. All prospective cohort studies dealing with dairy products consumption and CVD were surveyed regardless of their publication date or language. This reference population includes all individuals without any delimitation with regard to age, gender, or race. The quality of the study was evaluated using STROBE Checklist. Study selection and data extraction were done by 2 independent researchers separately. The indices in this study were RR and HR. The random model was used to combine the results.
    Results
    Out of 6234 articles, 11 were included in the meta-analysis. No relationship was found between stroke and consumption of milk, cream, and butter, and the results are as follow: RR = 0.91 (95%CI: 0.81-1.01) for milk, RR = 0.97 (95%CI: 0.88-1.06) for cream, and RR = 0.95 (95%CI: 0.85-1.07) for butter. However, cheese was found to decrease stroke risk: RR = 0.93 (95%CI: 0.88-0.99).
    The relationship of CHD with consumption of milk, cheese, cream, and butter are as follows, respectively: RR = 1.05 (95% CI: 0.96-1.15), RR = 0.90 (95%CI: 0.81-1.01), RR = 0.96 (95% CI: 0.87-1.06), and RR = 0.99 (95%CI: 0.89-1.11). In other words, no relationship existed between dairy products and CHD.
    Conclusion
    No relationship was found between consumption of various dairy products and CHD or stroke, except for cheese that decreased stroke risk by 0.07%. Considering the small number of studies, the result of the present study is not generalizable and more studies need to be conducted.
    Keywords: Dairy Products, CHD, Stroke, Cardiovascular Disease, Meta, analysis
  • Fatemeh Azadinia, Ismail Ebrahimi-Takamjani, Mojtaba Kamyab, Mohammad Parnianpour, Morteza Asgari Pages 150-157
    Background
    Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain.
    Methods
    This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability.
    Results
    The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was
    Conclusion
    Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.
    Keywords: Low Back Pain, Orthoses, Postural Control, Center of Pressure, Pain, Functional Disability
  • Hossein Sanaei-Zadeh*, Sayed Mahdi Marashi, Rouhullah Dehghani Pages 158-166
    Background
    Scorpionism is a public health problem in some provinces in Iran. The present study aimed to assess the clinical manifestations of scorpion envenomation in Shiraz and determine a clinical severity grading for Iranian scorpion envenomation in order to suggest a treatment guideline for emergency physicians.
    Methods
    In this analytic retrospective study, all medical charts of patients with scorpion sting admitted in the adult medical toxicology center in Shiraz during July 2012 to July 2016 were assessed. Data regarding the patient's age, gender, sting site, month of envenomation, time of sting, clinical manifestations, vital signs, presence of blood or hemoglobin in urine analysis, duration of admission, color of scorpion, received treatments, and administration of scorpion antivenin were recorded.
    Results
    The scorpions in Shiraz and its suburban area were classified into two groups: yellow scorpions (Mesobuthus eupeus, Mesobuthus caucasicus, and Compsobuthus matthiesseni) and Hottentotta scorpions (Hottentotta jayakari and Hottentotta zagrosensis). A total of 126 cases of scorpion stings were assessed. About 59% (n=74) were males. The patients aged 8-63 years (mean age, 33.8±11.5 years). About 38.4% (n=48) of the stings occurred during summer. More than 40% of patients (n=51) referred to the emergency department (ED) at night. Localized pain was the most frequent presenting complaint (76.2%). The most frequent general symptom was nausea (6.3%). The most prevalent envenomation site was the lower extremities followed by upper extremities (43.5% and 41.9%, respectively). Based on the clinical severity grading for Iranian scorpion envenomation, 65, 43, and 18 patients (51.6%, 34.1%, and 14.3%) were classified in the grades I, II, and III, respectively. Eighty-one (73%) patients stayed in the ED from 1 to 6 hours, and 30 (27%) patients stayed for >6 hours for observation. Severe localized pain was more prevalent in stings with Hottentotta scorpions than yellow scorpions (P=0.01). The season of envenomation with Hottentotta scorpions was summer in all cases, but envenomation with yellow scorpions was seen throughout the year. All patients received symptomatic treatment, and five were given scorpion antivenin. No death was reported.
    Conclusion
    Hottentotta jayakari is recommended to be listed among the medically important scorpions in Iran. Moreover, scorpion-stung patients in geographical regions where Hemiscorpius lepturus and Androctonus crassicauda are not prevalent may be treated in outpatient departments. The presented grading system can be used for treating patients with scorpion envenomation.
    Keywords: Scorpions, Scorpion Stings, Iran, Epidemiology, Clinical Manifestations, Clinical Severity Grading
  • Zohreh Mousavi, Azita Ganji*, Donya Farrokh Tehrani, Ali Bahari, Abbas Esmaeilzadeh, Mehdi Delghandi Pages 167-170
    Background
    Metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) is a common public health problem. Visfatin is secreted by visceral adipose tissue and is an adipocytokine.
    It could be a pro-inflammatory adipocytokine and is related to the metabolic syndrome and non-alcoholic fatty liver disease. This study evaluated the association between visfatin levels in patients with the metabolic syndrome with and without non-alcoholic fatty liver disease (NAFLD).
    Methods
    In this cross-sectional study, 120 patients with metabolic syndrome were selected. They were categorized into two groups, patients with fatty liver (n=70) and without fatty liver disease (n=50). Laboratory and anthropometric options such as age, sex, systolic blood pressure, fasting blood sugar, lipid profile, liver enzymes, uric acid, visfatin, insulin, BMI, waist circumference, and TNF-α were measured. The chi-square test, Mann-Whitney, t test, Spearman and Pearson correlations were used for the data analysis.
    Results
    There was a significant difference between the fatty liver and non-fatty liver disease with visfatin, BMI, FBS and lipid profile (p
    Conclusion
    According to this study, there was a correlation between visfatin levels and fatty liver disease.
    Keywords: Metabolic Syndrome, Visfatin, Non-alcoholic fatty liver disease
  • Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Hassan Rafiey, Arash Mirabzadeh, Mohammadreza Vaez-Mahdavi, Seyed Hossein Mohaqeqi Kamal Pages 171-177
    Background
    Health is an essential component of human rights and the rights are interdependent, indivisible, and correlated. The present study aimed at codifying a multidimensional health index according to multistage index development and describing the status of this index in 22 municipal districts of Tehran.
    Methods
    This study was conducted using the data collected in the second round of Urban HEART Project of Tehran (2012-2013). The sample size was 34 700. To develop a multidimensional health index (MDHI), the nine steps of the Organization for Economic Cooperation and Development (OECD) were followed, from codifying theoretical framework to introducing the index.
    Results
    According to the constructed MDHI, the districts no. 13, 10, 17, 1, 3, 4, and 22 had the best status and the district no. 8 the worst status. With respect to physical health, the districts no. 13, 17, 1, 3, 10, and 18 had the best status and the district no. 8 the worst. Concerning mental health, the districts no. 3, 6, 1, and 10 had the best status and the districts no. 8 and 12 the worst status. With respect to social health, the districts no. 10, 22, and 21 had the best status and the districts no. 6, 7, 12, and 14 the worst status. The analysis of sensitivity indicated that the MDHI was more sensitive towards physical health. Based on the mean, minimum, and maximum scores on each indicator of the questionnaires, the physical, mental, social, and MDHI status of Tehran residents (2012-2013) was high-medium, medium, low-medium, and high-medium, respectively.
    Conclusion
    The right to health should be widely investigated, as it is a primary principle needed for sustainable development, which can be accomplished when the attitudes of different organizations towards the health construct are multidimensional rather than unidimensional.
    Keywords: Multidimensional Health, Mental Health, Social Health, Physical Health
  • Akram Azad*, Tayyebe Mohammadinezhad, Ghorban Taghizadeh, Laleh Lajevardi Pages 178-183
    Background
    Katz Index is a well-known index for assessing basic activities of daily living. The aim was to determine validity and reliability of the Katz Index in Iranian patients with acute stroke.
    Methods
    Eighty-seven patients (56 male, 31 female) with acute stroke (1-30 days post-stroke) participated in this psychometric properties study. Interval time for retest was 14 days. All participants were Iranian with Persian as native language, had no other major diseases (e.g. cancer, Alzheimer) and no psychiatric disorder. Cognitive mental score of all participants was above 18 (according to Mini-Mental State Examination). If they had another stroke during the following-up period, they were excluded from the study. Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) were calculated to investigate the reliability of the KI. Criterion validity of the KI was assessed by Spearman’s Correlation Coefficient (ρ). Moreover, Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to investigate the construct validity of the KI.
    Results
    Inter-rater and intra-rater reliability of Persian Katz Index were reasonable (ICC2,1=0.93, ICC2,1=0.83; respectively). Internal consistency of this index was high (cronbach’s alpha=0.79). The high to excellent correlation was found between Katz Index and the motion (ρ=0.88), self-care (ρ=0.98), and total scores (ρ=0.92) of Barthel Index. Factor analysis of the Persian Katz Index indicated two factors including motion (bathing, toileting, and transferring) and self-care (dressing, bowel & bladder control, and feeding).
    Conclusion
    The results of this study suggest that Persian version of Katz Index in patients with acute stroke can be considered as an acceptable clinical instrument in practice and research.
    Keywords: Validation, Katz Index, Acute stroke
  • Jalal Arabloo*, Pejman Hamouzadeh, Mohammadreza Mobinizadeh, Alireza Olyaeemanesh, Mina Nejati, Shila Doaee, Fereshteh Eftekharizadeh Pages 184-188
    Background
    Magnet therapy has been used increasingly as a new method to alleviate pain. Magnetic products are marketed with claims of effectiveness for reducing pain of various origins. However, there are inconsistent results from a limited number of randomized controlled trials (RCTs) testing the analgesic efficacy of magnet therapy. This study aimed to evaluate the safety and effectiveness of magnet therapy on reliving various types of pain.
    Methods
    A systematic search of two main medical databases (Cochrane Library and Ovid Medline) was conducted from 1946 to May 2014. Only English systematic reviews that compared magnet therapy with other conventional treatments in patients with local pain in terms of pain relieving measures were included. The results of the included studies were thematically synthesized.
    Results
    Eight studies were included. Magnet therapy could be used to alleviate pain of various origins including pain in various organs, arthritis, myofascial muscle pain, lower limb muscle cramps, carpal tunnel syndrome and pelvic pain. Results showed that the effectiveness of magnetic therapy was only approved in muscle pains, but its effectiveness in other indications and its application as a complementary treatment have not been established.
    Conclusion
    According to the results, it seems that magnet therapy could not be an effective treatment for relieving different types of pain. Our results highlighted the need for further investigations to be done in order to support any recommendations about this technology.
    Keywords: Magnet therapy, Pain relief, Systematic review
  • Hassan Amiri, Samad Shams Vahdati, Mehdi Gharehkhani, Radin Maheronnaghsh, Hamid Shokoohi Pages 189-191
    Background
    Ankle injuries are one of the most common complaints of patients presenting to emergency departments (ED). The Ottawa ankle rules (OAR) was introduced to help physicians to decide who may require x-ray for blunt injuries. The present study aimed at validating the four steps weight-bearing rule of OAR as a sole criterion.

    Methods
    This prospective observational study was conducted on 214 patients with acute ankle injury who referred to 3 emergency departments over a 7-months period in 2008. Main outcome measures of this survey included the sensitivity, specificity, positive and negative predictive values, and the likelihood ratios (positive and negative) of the four steps weight-bearing rule.

    Results
    In this study, 34 fractures were found among the patients. The decision rule had a sensitivity of 0.88 and specificity of 0.61 in detecting all midfoot and ankle fractures. Application of this rule by emergency medicine residents resulted in a 47% reduction in the use of midfoot and ankle radiography.

    Conclusion
    Applying a four steps weight-bearing rule as a sole criterion to detect ankle fractures is not as accurate and sensitive as OAR. Solitary application of this rule may lead to an increasing number of missed fractures compared with OAR.
    Keywords: Ankle injury, Decision rules, Ottawa Ankle Rules, Four Steps Weight Bearing Rule
  • Ensieh Pourhoseingholi, Mohammad Amin Pourhoseingholi, Azam Bagheri, Elham Esfandiari, Morteza Saeb Pages 192-195
    Background
    X- ray images provide accurate and reliable data in different foot pathologies. However, the accompanied complications will limit its use for epidemiological studies and research purposes, especially in children. Therefore, simple, accessible, and cost- effective methods such as footprint, with a good correlation with x-ray images, are needed to help diagnose different foot pathologies. In the present study, the accuracy of footprint technique in assessing hallux valgus angle (HVA) was evaluated based on x-ray images through measuring the angle between the medial border protrusion of the foot and the hallux.

    Methods
    In this cross-sectional study, 42 participants with symptomatic hallux valgus were recruited. HVA was measured by both x-ray imaging and footprint. The differences between the two approaches were identified by applying correlation-coefficient test and reliability, which was assessed using interclass correlation (ICC).

    Results
    A significant correlation was found between the HVA measured by x-ray and HVA by footprints (p
    Conclusion
    Foot print is a reliable method for measuring HVA, as it was highly correlated with the HVAs obtained by x-ray imaging.
    Keywords: Hallux valgus angle, X-ray, Foot print
  • Sara Kaviani, Haleh Dadgostar, Ali Mazaherinezhad, Hanie Adib, Masoud Solaymani-Dodaran, Fahimeh Soheilipour, Mahdi Hakiminezhad Pages 196-201
    Background
    Effectiveness of various exercise protocols in weight reduction after bariatric surgery has not been sufficiently explored in the literature. Thus, in the present study, we aimed at comparing the effect of minimally supervised home-based and closely supervised gym-based exercise programs on weight reduction and insulin resistance after bariatric surgery.

    Methods
    Females undergoing gastric bypass surgery were invited to participate in an exercise program and were randomly allocated into 2 groups using a random number generator in Excel. They were either offered a minimally supervised home-based (MSHB) or closely supervised gym-based (CSGB) exercise program. The CSGB protocol constitutes 2 weekly training sessions under ACSM guidelines. In the MSHB protocol, the participants received a notebook containing a list of recommended aerobic and resistance exercises, a log to record their activity, and a schedule of follow-up phone calls and clinic visits. Both groups received a pedometer. We measured their weight, BMI, lipid profile, FBS, and insulin level at baseline and at 20 weeks after the exercises, the results of which were compared using t test or Mann-Whitney U test at the end of the study. All the processes were observed by 1 senior resident in sport medicine.

    Results
    A total of 80 patients were recruited who were all able to complete our study (MSHB= 38 and CSGB= 42). The baseline comparison revealed that the 2 groups were similar. The mean change (reduction) in BMI was slightly better in CSGB (8.61 95% CI 7.76–9.45) compared with the MSHB (5.18 95% CI 3.91–6.46); p
    Conclusion
    As we expected a non-inferiority result, our results showed that both MSHB and CSGB exercise methods are somewhat equally effective in improving lipid profile and insulin resistance in the 2 groups, but a slightly better effect on BMI was observed in CSGB group. With considerably lower costs of minimally supervised home- based exercise programs, both methods should be considered when there is lack of adequate funding.
    Keywords: Postoperative Exercise, Insulin Resistance, Bariatric Surgery, Morbid Obesity
  • Elahe Ramezanzade Tabriz, Zohre Parsa Yekta, Sara Shirdelzade, Masume Saadati, Arezoo Orooji, Hooman Shahsavari*, Mehdi Khorshidi Pages 202-206
    Background
    The identification and management of unmet needs is an essential component of health care for the growing cancer patient population. Information about the prevalence of unmet need can help medical service planning/redesigning. Therefore, this study aimed to identify unmet needs in Iranian patients suffering from cancer.

    Methods
    This cross-sectional correlational study was conducted on 650 cancer patients admitted to the major medical centers in Mashhad and Neyshabur by census sampling. The data was gathered by the Survivor Unmet Needs Survey (SUNS). Data were analyzed using ANOVA, t-test and Pearson correlation.

    Results
    Most of participants were female (56%, n=263) and Mashhad resident (67.1%, n=436). The most common cancers were colorectal (17.8 %, n=116), stomach (13.6%, n=88) and lung (9.4%, n=62), respectively. The highest unmet needs score belonged to work and financial needs (2.46 ± 0.91), and the least was the emotional domain (1.92±0.90). Among demographic factors, a significant relationship was found between resident places (p
    Conclusion
    This is the first study addressing the unmet needs of cancer patients in Iran. It reveals that cancer patients had a relative high number of unmet needs; this shows the necessity of including these factors in the routine assessment of all cancer patients and planning treatment interventions based on their individual’s need.
    Keywords: Cancer, Patient, Iran
  • Maryam Delphi, Yones Lotfi*, Abdollah Moossavi, Enayatollah Bakhshi, Maryam Banimostafa Pages 207-212
    Background
    Many elderly individuals complain of difficulty in understanding speech in noise despite having normal hearing thresholds. According to previous studies, auditory training leads to improvement in speech-in-noise perception, but these studies did not consider the etiology, so their results cannot be generalized. The present study aimed at investigating the effectiveness of envelope-based interaural time difference (ITD ENV) localization training on improving ITD threshold and speech-in-noise perception.

    Methods
    Thirty-two elderly males aged 55 to 65 years with clinically diagnosed normal hearing at 250-2000 Hertz, who suffered from speech-in-noise perception difficulty participated in this study. These individuals were randomly divided into training and control groups: 16 elderlies in the experimental group received envelope-based interaural time difference localization training in 9 sessions, but 16 matched elderlies in the control group did not receive any training. The ITD ENV threshold and spatial word recognition score (WRS) in noise were analyzed before and after the localization training.

    Results
    Findings demonstrated that following the training program, the interaural time difference envelope threshold and spatial word recognition score (WRS) in noise were improved significantly in the experimental group (p≤ 0.001). Moreover, a significant difference was detected in interaural time difference envelope threshold and spatial word recognition score (WRS) in noise (p≤ 0.001) before and after the training in the experimental group.

    Conclusion
    The results of the present study revealed the effectiveness of envelope- based interaural time difference localization training in localization ability and speech in noise perception in the elderlies with normal hearing up to 2000 Hz who suffered from speech-in-noise perception difficulty.
    Keywords: Interaural Time Difference, Training, Speech-in-Noise Perception, Localization
  • Elham Khalaf Adeli, Seyed Mostafa Alavi, Alireza Alizadeh-Ghavidel, Hooman Bakhshandeh-Abkenar, Ali Akbar Pourfathollah Pages 213-218
    Background
    Patients undergoing cardiac surgery are at increased risk of bleeding due to multifactorial coagulopathies. In the present study, we aimed at investigating the changes in platelet count and function during and after surgery as well as determining the association of the platelet dysfunction with bleeding and transfusion requirements in these patients.

    Methods
    A total of 40 adult patients scheduled for elective valve coronary cardiac surgery were included in this prospective observational study. Changes in platelet count and function with ADP, acid arachidonic, and collagen (light transmission aggregometry) were analyzed at three time points: before CPB, after CPB, and 24 hours after end of surgery. Postoperative bleeding and intraoperative transfusion requirements were recorded.

    Results
    There were a significant reverse correlation between CPB time and ADP-induced aggregation, particularly after CPB and postoperative AA-induced aggregation. There was not any significant correlation between platelet count and function at all-time points. Both platelet count and platelet aggregation significantly reduced during CPB. While platelet aggregation increased on postoperative Day 1, platelet count reduced by about 40% after CPB, and remained at this level postoperatively. Patients with abnormal ADP-induced aggregation had significant increased postoperative bleeding and transfusion requirements.

    Conclusion
    The results of this study demonstrate that platelet count and platelet aggregation are reduced during CPB. Our results emphasized the effect of platelet dysfunction on increased postoperative bleeding and transfusion requirements. Perioperative monitoring of platelet function can be considered as a bleeding management strategy for implantation of PBM programs.
    Keywords: Platelet Function Tests, Cardiovascular Surgical Procedures, Hemorrhage, Blood Transfusion
  • Kobra Z. Entezami*, Tahere Mosavi Pages 219-223
    Background
    Thermal burn injuries impair the host defence system. Hence, in the present study, we aimed at investigating the changes in the number and phenotype of peripheral blood lymphocyte populations (T, B, and natural killer cells) and their subpopulations in patients with thermal burns and determining the relationships with different sizes of total body surface area (TBSA).

    Methods
    Blood samples from 67 patients, admitted to Motahary Burn Center in Tehran, with burns from 30% to more than 70% TBSA were collected on Days 3 and 7 postburn. Lymphocytes and their subpopulations were identified by monoclonal antibodies. The cells were analyzed using flow cytometry. The results were compared with healthy controls.

    Results
    In this study, 3 and 7 days after burn injury, the percentages of CD3, CD4 and CD8 lymphocyte significantly decreased, CD4ﰠ ratios were below the normal range, and CD19 (B cells) significantly increased. No significant difference was obtained in the mean percentage of CD16 (NK cells) between Days 3 and 7 postburn. Patients with burns of 30% TBSA or greater (>70%) had a significant reduction in CD3, CD4 and CD8 ( T cells) numbers up to 7 days compared with 3 days after burn injury. Patients with 30% to >70 % TBSA burn failed to show any significant changes in CD4ﰠ ratio as well as CD16 (NK cells) 3 to 7 days after burn. In patients with burns more than 30% to>70% TBSA, CD19 (B cells) number changes were found to be complicated after 3 and 7 days.

    Conclusion
    The results of this study suggest that alterations of immune cell surface markers and TBSA% can reflect postburn lymphocyte activation.
    Keywords: Thermal Burn, Total Body Surface Area (TBSA%), Lymphocytes, Flow cytometry
  • Amir Ali Ebadi Fard Azar, Aziz Rezapour, Vahid Alipour, Ali Sarabi-Asiabar, Serajaddin Gray, Mohammadreza Mobinizadeh, Mani Yousefvand, Jalal Arabloo Pages 224-229
    Background
    Hip, vertebral and wrist fractures are the most common consequences of osteoporosis. This study aimed at analyzing the cost-effectiveness of teriparatide (CinnoPar®), compared with alendronate and risedronate, in the treatment of women aged 60 and over with postmenopausal osteoporosis in Iran.

    Methods
    A decision tree model with a 2-year time horizon was used to compare treatment with teriparatide (CinnoPar®) with the following treatment strategies: two years of treatment with alendronate and two years of treatment with risedronate in women aged 60 years and over or those at risk of osteoporosis. Cost per QALY was calculated for 3 treatment strategies from the model. After base case analysis, one-way sensitivity analysis was performed on key parameters of the model to assess their impact on the study results and the cost-effectiveness of different treatment strategies and the model robustness. TreeAge Pro 2006 software was used for modeling and data analysis.

    Results
    Incremental cost-effectiveness ratio (ICER) of alendronate and teriparatide than risedronate (base treatment) were US$-2178.03 and US$483,783.67 per QALY, respectively. Therefore, the dominant and cost-effective treatment option was alendronate. In the one-way sensitivity analysis, the impact of annual 25% increase or decrease in the teriparatide cost on its ICER was remarkable. Also, reducing the discount rate from 0.03 to 0.0 had the greatest impact on the ICER of the teriparatide.
    Conclusion
    The treatment strategy of teriparatide is more expensive than risedronate and alendronate and is associated with very little increase in QALYs. A significant reduction in teriparatide price and a limit in its use only for high-risk women and for acute and short-term treatment courses can contribute to its cost-effectiveness.
    Keywords: Osteoporosis, Cost-effectiveness, Teriparatide, Risedronate, Alendronate, Postmenopausal Women, Fracture, Iran
  • Soroor Parvizy, Hamid Peyrovi, Hosein Rostami, Marjan Delkhosh* Pages 230-235
    Background
    Males’ health plays a basic role in the community's health, especially in family’s health. Health is a multifaceted issue that affects people in all aspects. Health is also one of the 4 metaparadigm concepts in nursing. This study was conducted to explore males’ perspectives on health.
    Methods
    In this qualitative study conducted based on a grounded theory approach, 22 males were selected through a purposive sampling. Data were collected through semi-structured interviews and continued until data saturation. Data analysis was done using Strauss and Corbin's three-stage coding process.

    Results
    Based on the perspectives of the participants, 8 categories emerged, which are as follow: psychological health; physical health; family health; spiritual health; welfare and social health; health and relationships; sexual health; and occupational-economic health. Psychological health was emerged as the core variable.
    Conclusion
    As a multifaceted phenomenon, health is an individual’s general condition in all these aspects, particularly psychological aspect. Males’ health should be taken into account for the role they play in managing the family. Males as the family heads require evidence-based decision making and planning.
    Keywords: Health, Male, Family, Qualitative Research, Grounded Theory
  • Mohsen Bayati, Arash Rashidian*, Ali Akbari Sari, Sara Emamgholipour Pages 236-240
    Background
    Based on the target income hypothesis, the economic behavior of physicians is mainly affected by their target income. This study aimed at designing an instrument to explain how general practitioners (GPs) set their desired income.

    Methods
    A self-administered questionnaire of affecting factors on GP's target income was extracted from literature reviews and a small qualitative study. Respondents were 666 GPs who completed the questionnaire (response rate= 52%) during 2 seasonal congresses of Iranian GPs. The principal component analysis (PCA) with varimax rotation was used to classify the variables and data reduction. Sample adequacy test, sphericity test, eigenvalues of components, and scree plot were evaluated for PCA. Cronbach's alpha was also checked to assess the internal consistency of the principal components.

    Results
    The results of the KMO measure of sampling adequacy (0.657) and Bartlett’s test of sphericity (809.05, p
    Conclusion
    Based on the target income hypothesis, a physician’s desired level of income affects their behavior. Our developed instrument and its mentioned components can be used in future studies related to GP's behavior, especially those studies related to the economic aspects of GPs’ behavior. It also helps formulate a better payment mechanism for primary care providers.
    Keywords: General practitioner, Behavioral economics, Healthcare economics, organizations, Target income hypothesis, Principal component analysis
  • Amjad Ahmadi, Behzad Mohsenpour, Pari Doroudian, Aram Mokarizadeh, Daem Roshani, Shole Shahgheibi, Farnaz Zandvakili, Fariba Farhadifar, Fariba Seyedoshohadaei Pages 241-244
    Background
    Brucellosis is one of the most prevalent diseases common between humans and animals. It is also called Malta fever, Undulant fever and Mediterranean fever. This disease is spread by consuming milk and its unpasteurized derivatives. Clinical symptoms of brucellosis in humans are fever, chills, headache, muscular pain, tiredness, loss of appetite, joint pain, weight loss, constipation, sore throat, and dry cough. The present study aimed at surveying the seroprevalence of brucellosis in pregnant women and those women who suffered from spontaneous abortion.

    Methods
    This case- control study was conducted in Sanandaj (Iran) in 2016 and included 2 groups of pregnant women: one group included 160 pregnant women and the other included 160 women who suffered from spontaneous abortion. Then, the participants were asked to fill out the questionnaire. After receiving permission from an obstetrician, a 10-cc blood sample was taken from each person to be used in the Rose Bengal, Wright, 2ME, and Coombs tests. Independent samples t test and Chi-square test were used to analyze the data and compare the groups.

    Results
    Mean±SD age of women in the case group was 30.9±7.3 years, while it was 27.74±5.41 years in control women. The Rose Bengal, Wright, and 2ME prevalence for both groups was negative, but the Coombs and Wright tests score was 33 (20.6%) in pregnant women and it was 27 (16.9%) in women who experienced spontaneous abortion. No meaningful relationship was observed between spontaneous abortion and brucellosis (p= 0.39).

    Conclusion
    Even though the present study did not find a meaningful relationship between spontaneous abortion and brucellosis (p=0.39), high brucella seroprevalence rates between both groups of women indicated that screening tests should be considered before gestation as an appropriate therapeutic strategy.
    Keywords: Brucellosis, Seroprevalence, Pregnant women, Spontaneous abortion
  • Ghobad Moradi, Hossein Safari, Bakhtiar Piroozi, Laila Qanbari, Salahadin Farshadi, Homan Qasri, Fariba Farhadifar Pages 245-251
    Background
    One of the main goals of health systems is to protect people against financial risks associated with diseases that can be catastrophic for patients. In 2014, Health Sector Evolution Plan (HSEP) was implemented in Iran; one of the objectives of HSEP was to reduce out-of-pocket payments and provide more financial protection for people. Therefore, the present study aimed at exploring the likelihood of facing catastrophic health expenditures (CHE) among households with members suffering from dialysis, kidney transplant, or multiple sclerosis (MS) after the implementation of HSEP.
    Methods
    A total number of 385 households were selected using stratified random sampling and were asked to complete the World Health Survey questionnaire through telephone conversations. As outlined by the World Health Organization (WHO), when household out-of-pocket expense for health services is ≥40% of its capacity to pay, then that household is considered to be facing CHE. Furthermore, determinants of CHE were identified using logistic regression.

    Results
    The percentage of facing catastrophic health care expenditures for households with a MS, dialysis, and kidney transplant patient was 20.6%, 18.7%, and 13.8%, respectively. Results of logistic regression analysis revealed that patient’s economic status, level of education, supplementary insurance status, type of disease, multiple members with special diseases in the household, rural residence, use of inpatient, dental, and rehabilitation services were effective factors for determining the likelihood of facing CHE.

    Conclusion
    Despite the implementation of HSEP, the percentage of CHE is still high for households that have members who suffer from special diseases. However, basic health insurance packages should be amended and more cost-sharing exemptions should be granted to provide more financial protection for the vulnerable households.
    Keywords: Catastrophic Health Expenditures, Health System Reform, Health Expenditures, Dialysis, Kidney Transplant, Multiple Sclerosis (MS)
  • Maryam Mobini*, Avideh Maboudi, Reza Ali Mohammadpour Pages 252-256
    Background
    There are some discrepancy in association between activity of rheumatoid arthritis (RA) and periodontitis. The aim of this study was to evaluate the periodontal status of outpatients with RA.

    Methods
    The study was conducted in 2013-14 in a rheumatology clinic in Sari, north of Iran on 74 patients with RA. Evaluation of RA disease activity was according to disease activity score 28 (DAS28). Periodontitis was evaluated by probing depth (PD), gingival index (GI), clinical attachment level (CAL index), plaque index (PI), and panoramic X-ray. Statistical analysis included independent t-test and Mann-Whitney U test for quantitative, and chi square and OR for qualitative variables and evaluation of RA activity and periodontitis severity.

    Results
    The mean±SD of age and disease duration were 47.01±8.1 and 8.93±8.6 years, respectively and the mean±SD number of teeth was 20.70±6.8. Twenty-seven (36.5%) patients had moderate to severe disease. Forty-seven cases (63.5%) were found with periodontitis and 14 (12.2%) were identified to have moderate to severe periodontitis, unrelated to disease activity (p=0.22). For active/inactive periodontitis OR =1.33 (95% CI: 0.46 - 3.87) was computed. There was no association between RA disease activity and number of teeth, CAL, PI, PD, and GI, (p>0.05).

    Conclusion
    About 60% of RA patients suffered from periodontitis, but there was not any significant relation between RA disease activity and severity of periodontitis. Periodontitis may interfere with management and follow up of RA, so periodic periodontal examination is suggested in these patients.
    Keywords: Rheumatoid arthritis, Periodontal diseases, Disease activity score
  • Abbas Shamsalinia, Kiyan Norouzi, Masoud Fallahi-Khoshknab, Ali Farhoudian, Fatemeh Ghaffari Pages 256-262
    Background
    Substance abusers are not able to withdraw drugs eternally despite the abundance of different treatments; therefore, withdrawal programs are not quite successful and notwithstanding all the successes of methadone maintenance therapy, there are some defects found in the manner this treatment is applied. Thus, this study was conducted to explore the experience of drug abusers regarding methadone maintenance therapy.

    Methods
    This is a qualitative study using content analysis methodology. The research community includes drug abusers admitted to the treatment centers of the western cities of Mazandaran Province, Iran in 2016. The sampling was purposive and the data were collected by face-to-face single interviews with 20 patients. The interviews were continued up to data saturation. Finally, the Lundman and Grenheim method was used to analyze the interviews and the four criteria of Guba and Lincoln were applied to check data integrity.

    Results
    “Buying time,” “methadone dependence,” and “looking from a narrow view to the patient” were the main three categories that fit the results.

    Conclusion
    Governmental free services for drug abusers; paying attention to different aspects of treatment such as mental, emotional, and social recovery; lifelong support of the family and society members; and balance in prescribing and following the treatment process prescribed by health care providers can enhance both the quality and safety of the treatment process. Psychological consultation alongside social services can facilitate the recovery process in methadone maintenance therapy.
    Keywords: Methadone maintenance therapy, Substance abuse, Qualitative study
  • Mehrsadat Mahdizadeh, Mahnaz Solhi, Farbod Ebadifard Azar, Ali Taghipour, Aliasghar Asgharnejad Farid Pages 263-270
    Background
    Social networking has a dramatically increasing trend among adolescents. By creating novel models of content production, distribution, and reception, this space has introduced opportunities and threats for adolescents, which must be understood in relation with their health status. This study was conducted with the aim of describing the psychosocial experiences of Iranian adolescents in the Internet's virtual space.
    Methods
    The present qualitative formal content analysis was conducted in Mashhad a city Iran. The participants included 32 adolescents of 13-18 years of age. Data were collected through 32 semi-structured individual and group interviews with maximum variation. The data were recorded, transcribed, and then analyzed via MAXQ 10 software.
    Results
    In this study, 2 main themes of “moving towards constructiveness” and “perceiving social and psychological tensions” were formed. Accordingly, 9 subcategories were formulated including: increasing the social capital, a good feeling in life, escaping loneliness, being seen in the social network, intelligent selection of content, perceived threats, temptation, decline of behavioral values and principles, and emotional and social helplessness.
    Conclusion
    Adolescents’ positive and negative experiences in the Internet form based on personal and environmental factors. These experiences affect the mental and social dimensions of their health. These factors call for the attention of scholars and policymakers for developing enabling strategies for adolescents, and their families and for experts for promoting adolescents’ health.
    Keywords: Virtual space, Internet, Social networks, Adolescent, Health, Qualitative study, Content analysis
  • Iman Keliddar, Ali Mohammad Mosadeghrad, Mehdi Jafari, Sirizi Pages 271-277
    Background
    It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes.
    Methods
    The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis.

    Results
    Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles.

    Conclusion
    This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.
    Keywords: Health system, Health Care Rationing, Health resources, Patient selection, Critical review
  • Alireza Kazemini, Mohammad Reza Keramati, Mohammad Sadegh Fazeli, Amir Keshvari, Siavash Khaki, Ata Rahnemai-Azar Pages 278-282
    Background
    Acute appendicitis is the most common nonobstetric surgical problem in pregnancy. Common signs and symptoms of appendicitis are less reliable during pregnancy due to physiological changes; thus, the role of imaging becomes prominent. Thus, in the present study, we aimed at assessing the accuracy of sonography in diagnosing acute appendicitis during pregnancy.

    Methods
    In this prospective analytic study, among 1000 patients diagnosed and treated as acute appendicitis, clinical and sonographic findings of 58 consecutive pregnant patients, who underwent appendectomy, were recorded and analyzed. All surgically resected samples were evaluated and confirmed through histological evaluation. Sonographic criteria were utilized to judge the results for appendicitis. Diagnostic test performance characteristics (sensitivity, specificity, predictive values, and likelihood ratios) were calculated.

    Results
    The mean age of the patients was 27.1±4.9 years, and the most common clinical symptom was right lower quadrant pain. There was no significant difference in the mean leukocyte count between the appendicitis group and normal appendix group (p=0.768). Left shift was also unrelated with the appendix pathology (p= 0.549). The sensitivity, specificity, predictive values (positive and negative), and likelihood ratios (positive and negative) were 80%, 75%, 91.4%, 52.9%, 3.2, and 0.26, respectively during all trimesters of pregnancy.

    Conclusion
    Ultrasonography is the initially preferred imaging modality in pregnant women suspected of having acute appendicitis with an acceptable sensitivity; however, application of other imaging modalities such as CT scan or MRI is recommended after inconclusive ultrasonography results.
    Keywords: Appendicitis, Sonography, Surgical resection, Predictive value, Likelihood ratio
  • Firoozeh Derakhshanpour, Ahmad Hajebi, Leili Panaghi, Zohre Ahmadabadi Pages 283-288
    Background
    Child abuse is a significant public health and social problem worldwide. It can be described as a failure to provide care and protection for children by the parents or other caregivers. This study aimed at evaluating the effectiveness of psychosocial interventions in abused children and their families.

    Methods
    This quasi-experimental study was conducted in the psychosocial support unit of a pediatric hospital in Bandar Abbas, Iran, from 2012 to 2013. The participants consisted of child abuse cases and their parents who referred to the psychosocial support unit to receive services. Services delivered in this unit included parenting skills training, psychiatric treatments, and supportive services. The effectiveness of the interventions was assessed with Child Abuse Questionnaire, General Health Questionnaire (GHQ), and Strengths and Difficulties Questionnaires (SDQ). Participants were assessed at baseline, at 3, and 6 months follow-ups. ANOVA with repeated measures and Friedman test were used to evaluate the effect of the interventions.

    Results
    A total of 68 children and their parents enrolled in this study, of whom 53% were males. Post-intervention follow-ups revealed significant changes in mother's general health questionnaire (p
    Conclusion
    Our findings revealed that psychosocial interventions effectively improved child-parents interaction and mental health of parents. The effectiveness of interventions based on subgroup analysis and implications of the results have been discussed for further development of psychosocial interventions in the health system.
    Keywords: Child Abuse, Neglected, Psychosocial Intervention, Parenting Skills Training
  • Setare Akhavan, Soheila Aminimoghaddam*, Maryam Rahmani Pages 289-292
    Background
    Cervical cancer is the second most common type of cancer among women. Effective screening programs can help cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has been widely studied and clinically used for many types of cancer.

    Methods
    Two techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed via laparoscopy or laparotomy; former method is better and more accurate.
    Results
    Various researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied. Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis.

    Conclusion
    Hence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.
    Keywords: Biopsy, Sentinel lymph nodes, Cervical cancer, Blue dye
  • Shahin Soltani, Amirhossein Takian*, Ali Akbari Sari, Reza Majdzadeh, Mohammad Kamali Pages 293-299
    Background
    People with disability experience various problems to access to healthcare services. This study aimed to identify cultural barriers in access to healthcare services for people with disability in Iran.

    Methods
    We conducted a qualitative study using content analysis to identify the cultural barriers. We used semi-structured interviews to collect data. Participants were selected through purposeful sampling with maximum variation. 50 individual interviews were conducted with three groups of people with disability, healthcare services providers and policy makers, September to May 2015, at different locations in Tehran, Iran.

    Results
    We identified a number of different cultural barriers in access to health services for people with disability in Iran. These related to health service providers, namely reluctance to provide health services and disrespect; related to People with disability, namely denial of disability, disproportionate expectation, shame and insufficient sociocultural supports; and related to policy makers, namely lack of concern, little attention to the culture of disability and discrimination. We categorized misconception as a barrier that was observed at all levels of the society.

    Conclusion
    Disability is a reality that some human being may experience and live with it. The negative attitude towards people with disability has a close relationship with the cultural norms of a society. The culture of disability in different dimensions should be a priority for all policy makers. Removing cultural barriers in access to healthcare for people with a disability needs collective efforts and collaborations among all stakeholders.
    Keywords: Disability, Access, Healthcare, Culture
  • Shoaleh Bigdeli*, David Kaufman Pages 300-306
    Background
    Game-based education is fast becoming a key instrument in medical education.
    Method
    In this study, papers related to games were filtered and limited to full-text peer reviewed published in English.
    Results
    To the best of researchers’ knowledge, the concepts used in the literature are varied and distinct, and the literature is not conclusive on the definition of educational games for medical education.
    Conclusion
    This paper attempts to classify terms, concepts and definitions common to gamification in medical education.
    Keywords: Game, Simulation Game, Medical Education
  • Mahtab Roohi-Azizi, Leila Azimi, Soomaayeh Heysieattalab, Meysam Aamidfar Pages 307-312
    Background
    An electroencephalogram (EEG) is an accepted method in neurophysiology with a wide application. Different types of brain rhythms indicate that simultaneous activity of the brain cortex neurons depend on the person’s mental state.
    Method
    we have focus on reviewing the existing literature pertaining to changes of the brain’s bioelectrical activity that recorded from the scalp in different conditions such as cognition and some mental disorders.
    Result
    The frequency of brain waves may indicate sleep, consciousness, cognition, and some mental disorders. Slow brain waves are seen in some conditions such as sleep, coma, brain death, depression, autism, brain tumors, obsessive–compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and encephalitis, while rapid waves are generally reported in conditions such as epilepsy, anxiety, posttraumatic stress disorder (PTSD), and drug abuse.
    Conclusion
    Increase in the EEG rhythm is a marker of high brain activity that leads to high degrees of consciousness, while slow waves are suggestive of less brain activity. The pattern of EEG rhythm can be an indicator of some mental disorders, too.
    Keywords: Electroencephalogram, Cognition, Consciousness, Mental Disorders, Brain activity
  • Alireza Olyaeemanesh, Elahe Bavandpour*, Mohammadreza Mobinizadeh, Mansoor Ashrafinia, Maryam Bavandpour, Mojtaba Nouhi Pages 313-318
    Background
    Caesarean section (C-section) is the most common surgery among women worldwide, and the global rate of this surgical procedure has been continuously rising. Hence, it is significantly crucial to develop and apply highly effective and safe caesarean section techniques. In this review study, we aimed at assessing the safety and effectiveness of the Joel-Cohen-based technique and comparing the results with the transverse Pfannenstiel incision for C-section.
    Methods
    In this study, various reliable databases such as the PubMed Central, COCHRANE, DARE, and Ovid MEDLINE were targeted. Reviews, systematic reviews, and randomized clinical trial studies comparing the Joel-Cohen-based technique and the transverse Pfannenstiel incision were selected based on the inclusion criteria. Selected studies were checked by 2 independent reviewers based on the inclusion criteria, and the quality of these studies was assessed. Then, their data were extracted and analyzed.
    Results
    Five randomized clinical trial studies met the inclusion criteria. According to the exiting evidence, statistical results of the Joel-Cohen-based technique showed that this technique is more effective compared to the transverse Pfannenstiel incision. Metaanalysis results of the 3 outcomes were as follow: operation time (5 trials, 764 women; WMD 9.78; 95% CI:-14.49-5.07 minutes, p
    Conclusion
    According to the literature, despite having a number of side effects, the Joel Cohen-based technique is generally more effective than the Pfannenstiel incision technique. In addition, it was recommended that the Joel-Cohen-based technique be used as a replacement for the Pfannenstiel incision technique according to the surgeons’ preferences and the patients’ conditions.
    Keywords: Caesarean Section (C-section), Joel-Cohen, Pfannenstiel, Misgav-Ladach, Modified Misgav-Ladach
  • Majid Hassan-Ghomi, Bahareh Nikooyeh, Soudabeh Motamed, Tirang R. Neyestani* Pages 319-326
    Background
    In several disease conditions, patients must inevitably be nourished by enteral feeding (EF). Though in many countries, commercial formulas are routinely used for EF, in Iran still home-made formulas are commonly employed as commercial formulas are not covered by insurance. This may pose patients to malnutrition and bring about further costs. The aim of this study was to evaluate the efficacy of EF commercial formulas in comparison with home-made formulas and thus to make further evidence for insurance policy-making
    Methods
    Medline, Cochrane, Embass and Center for Review & Dissemination (CRD) as well as IranDoc and SID databases were searched. Keywords included formula, ICU, and enteral nutrition or tube feeding. No clinical trial study on the efficacy of EF formulas was found. Therefore, the compositions of available formulas and their cost-effectiveness were evaluated based on the clinical guidelines of scientific bodies such as American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and Enteral Nutrition (ESPEN) and relative articles available in PubMed. In addition, the expert opinions were also taken into consideration.
    Results
    Domestic commercial formulas seemed to less merit dietary recommended intakes, i.e. the amount of some nutrients were much higher, and some others were much lower than the recommended values. The amount of several micronutrients including vitamins B1, B6, C, D and K, as well as iron, calcium and magnesium were not sufficient to meet the body needs in most commercial formulas upon receiving 2000 kilocalories and less.
    Conclusion
    Clinical studies on the efficacy of commercial formulas in comparison with home-made formulas are needed. Meanwhile, making suitable conditions for increasing the diversity of artificial nutrition products in the market would help clinical nutritionists to make better choices according to their patients conditions and to reduce the costs, as well.
    Keywords: Enteral feeding, Enteral formula, Home-made formula, Intensive care unit
  • Ladan Haghighi*, Mandana Rashidi, Zahra Najmi, Homa Homam, Neda Hashemi, Alireza Mobasseri, Yousef Moradi Pages 327-331
    Background
    Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent.
    Methods
    This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December 2011 to November 2012. Three hundred and fifteen singleton pregnant women aged 18 yrs at 26-34 weeks’ gestation with the diagnosis of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant. IRCT registration number of this study is IRCT201112198469N1
    Results
    The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery, birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p
    Conclusion
    Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the NICU stay.
    Keywords: Progesterone, Nifedipine, Threatened preterm labor
  • Iman Hashemifar*, Faramarz Masjedian Jazi, Abbas Yadegar, Nour Amirmozafari Pages 332-335
    Background
    Human brucellosis is a zoonotic disease caused by Brucella melitensis, Brucella abortus, and Brucella suis. Brucella causes a chronic disease, which subverts the immune defense system of their hosts. In this study, the prevalence of an important Brucella virulence determinant, PrpA, which can modulate immune response, was determined in human isolates.
    Methods
    Polymerase chain reaction (PCR) assay was standardized and applied to 37 isolates obtained from patient’s specimens. Primers for prpA gene were designed and evaluated using bioinformatic tools. DNA sequencing was performed for further verification.
    Results
    In the 37 Brucella isolates (31 Brucella melitensis and 6 Brucella abortus), 32 (86.4%) carried prpA gene.
    Conclusion
    Presence of prpA gene in most isolates indicates the high prevalence of this gene among Iranian isolates and emphasizes its role in pathogenicity of this organism.
    Keywords: Brucella species, Brucellosis, Proline Racemase, PrpA
  • Hashem Fakhre Yaseri* Pages 336-338
    Background
    Prevalence of gastroesophageal reflux disease (GERD) has increased in the last decades, and it is now one of the most common chronic and recurrent diseases. The present study aimed at determining the frequency of gender (sex) and age in Iranian patients with GERD symptoms.

    Methods
    In this study, 803 patients aged 11 to 84 years, with erosive and nonerosive gastroesophageal reflux diseases, based on the questionnaire and esophagogastroduodenoscopy findings, participated. The female group was compared with the male group with respect to age, symptoms, esophageal injury, and hiatus hernia.

    Results
    Of the 803 participants, 60.5% (n= 486) were female, and 69.2% (n= 555) were younger than 50 years. Of those patients older than 50 years, 32.8% (n= 81) were female. Moreover, 31.0% (n= 249) of the patients had erosive esophagitis (ERD), and 69.0% (n= 254) had normal esophageal mucosa (NERD).The female to male ratio was 1/1.06 and 1.94/1 in ERD and NERD patients, respectively. Hiatal hernia was more prevalent in females than in males.

    Conclusion
    Nonerosive reflux disease, as a gastroesophageal reflux disease (GERD), was more common in females than in males. GERD became more prevalent with increase in age. Gender and hiatal hernias were 2 potential risk factors of GERD.
    Keywords: Esophageal Disease, Gastroesophageal Reflux Disease, Esophageal Reflux, Heartburn
  • Enayatollah Homaie Rad, Zahra Kavosi, Mohammad Taghi Moghadamnia, Masoud Arefnezhad, Masoumeh Arefnezhad, Banfashe Felezi Nasiri Pages 339-343
    Background
    Studies have shown that people using complementary health insurances have more access to health services than others. In the present study, we aimed at finding the differences between out- of- pocket payments and health service utilizations in complementary health insurances (CHIs) users and nonusers.

    Methods
    Propensity score matching was used to compare the 2 groups. First, confounder variables were identified, and then propensity score matching was used to compare out- of- pocket expenditures with dental, general physician, hospital inpatient, emergency services, nursing, midwifery, laboratory services, specialists and rehabilitation services utilization.

    Results
    Our results revealed no significant differences between the 2 groups in out- of- pocket health expenditures. Also, the specialist visits, inpatient services at the hospital, and dental services were higher in people who used CHIs compared to nonusers.
    Conclusion
    People did not change their budget share for health care services after using CHIs. The payments were equal for people who were not CHIs users due to the increase in the quantity of the services.
    Keywords: Complementary insurances, Propensity scoring matching method, Out- of- pocket expenditures, General physicians, Dental services, Specialists
  • Sara Soleimani Asl, Mohammad Bakhtiar Hesam Shariati, Mehdi Medizadeh, Mohammad Ahmadpanah, Maryam Sohrabi Pages 344-348
    Background
    3,4- methylenedioxymethamphetamine (MDMA) is a chemical derivative of amphetamine that can induce learning and memory impairment. Due to the effect of neurotrophins on memory and learning, the impact of MDMA was evaluated on the brain - derived neurotrophic factor (BDNF), neurotrophin- 4 (NT-4), and tropomyosin- related kinase B (Trk- β) expression in the hippocampus.

    Methods
    In this study, 20 adult male Wistar rats (200-250 g) received saline (1 mL) or 10 mg/kg of MDMA intraperitoneally as single or multiple injection for 2 consecutive days per week for 2 months. Expression of BDNF, Trk-β, and NT4 were assessed using Western blotting and RT PCR methods.

    Results
    Our results revealed that the expression of BDNF, Trk- β, and NT4 proteins and genes significantly decreased in MDMA groups compared to the sham group (p
    Conclusion
    The results of the present study suggest that ecstasy administration may downregulate the expression of BDNF, Trk- β, and NT-4 in hippocampus, which is more extensive in case of acute treatment. It seems that in the chronic group, hippocampus was able to compensate the ecstasy- induced neurotoxicity.
    Keywords: Ecstasy, BDNF, Trk-β, NT4
  • Maryam Nikravesh, Zahra Jafari*, Masoud Mehrpour, Roozbeh Kazemi, Younes Amiri Shavaki, Shamim Hossienifar, Mohammad Parsa Azizi Pages 349-354
    Background
    The paced auditory serial addition test (PASAT) was primarily developed to assess the effects of traumatic brain injury on cognitive functioning. Working memory (WM) is one of the most important aspects of cognitive function, and WM impairment is one of the clinically remarkable signs of aphasia. To develop the Persian version of PASAT, an initial version was used in individuals with aphasia (IWA).

    Methods
    In this study, 25 individuals with aphasia (29-60 years) and 85 controls (18-60 years) were included. PASAT was presented in the form of recorded 61 single-digit numbers (1 to 9). The participants repeatedly added the 2 recent digits. The psychometric properties of PASAT including convergent validity (using the digit memory span tasks), divergent validity (using results in the control group and IWA group), and face validity were investigated. Test-retest reliability was considered as well.

    Results
    The relationship between the PASAT and digit memory span tests was moderate to strong in the control group (forward digit memory span test: r= 0.52, p
    Conclusion
    According to our results, the PASAT is a valid and reliable test to assess working memory, particularly in IWA. It could be used as a feasible tool for clinical and research applications.
    Keywords: Paced Auditory Serial Addition Test, Aphasia, Working Memory, Validity, Reliability
  • Mohammad Rafiei, Faezeh Kiani, Fatemeh Sayehmiri, Kourosh Sayehmiri, Abdolkarim Sheikhi, Mona Zamanian Azodi Pages 355-362
    Background
    The mouth cavity hosts various types of anaerobic bacteria including Porphyromonas gingivalis, which causes periodontal inflammatory diseases. P. gingivalis is a gram-negative oral anaerobe and is considered as a main etiological factor in periodontal diseases. Several studies have reported a relationship between P. gingivalis in individuals with periodontal diseases and a critical role of this bacterium in the pathogenesis of periodontal diseases. The present study aimed at estimating this probability using a meta-analysis.
    Methods
    We searched several databases including PubMed, Scopus, Google Scholar, and Web of Science to identify case-control studies addressing the relationship between P. gingivalis with periodontal diseases. A total of 49 reports published from different countries from 1993 to 2014 were included in this study. I² (heterogeneity index) statistics were calculated to examine heterogeneity. Data were analyzed using STATA Version 11.
    Results
    After a detailed analysis of the selected articles, 49 case-control studies with 5924 individuals fulfilled the inclusion criteria for the meta-analysis. The healthy controls included 2600 healthy individuals with a Mean±SD age of 36.56±7.45 years. The periodontal diseases group included 3356 patients with a mean age of 43.62±8.35 years. There was a statistically significant difference between P. gingivalis in periodontal patients and healthy controls; 9.24 (95% CI: 5.78 to 14.77; P = 0.000). In the other word, there was a significant relationship between the presence of P. gingivalis and periodontal diseases.
    Conclusion
    Analyzing the results of the present study, we found a strong association between the presence of P. gingivalis and periodontal diseases. This result suggests that another research is needed to further assess this subject.
    Keywords: Porphyromonas gingivalis, Periodontal Diseases, Chronic Periodontitis, Aggressive Periodontitis, Gingivitis
  • Ali Akbari Sari, Satar Rezaei*, Mohammad Arab, Behzad Karami Matin, Reza Majdzadeh Pages 363-367
    Background
    Smoking is recognized as one of the main public health problems worldwide and is accounted for a high financial burden to healthcare systems and the society as a whole. This study was aimed at examining the effect of smoking status on cost of hospitalization among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014.

    Methods
    A total of 1,271 patients (consisting of 415 LC, 427 COPD and 429 IHD patients) were included in the study. Data on age, sex, and insurance status, length of hospital stay and cost of hospitalization were extracted from the medical records of the patients. The smoking status of the patients was obtained through a telephone survey. A generalized linear model (GLM) was used to compare the costs of hospitalization of current, former and never smokers. The analysis was done using Stata v.12.

    Results
    The mean±SD cost of hospitalization per patient was 45.6 ± 41.8 million IR for current smokers, 34.8±23 million IR for former smokers and 27.6±24.6 million IR for never smokers, respectively. The findings indicated that the cost of hospitalization for current and former smokers was 65% and 26% in the unadjusted model and 35% and 24% in the adjusted model higher than for never smokers.

    Conclusion
    The findings revealed that smoking drains a large hospital resource and imposes a high financial burden on the health system and the society. Therefore, efforts should focus on reducing the prevalence of smoking and the negative economic consequences of smoking.
    Keywords: Smoking Status, Cost of Hospitalization, Generalized Linear Model, Iran
  • Ayoob Rastegar, Shahram Nazari, Ahmad Allahabadi, Farahnaz Falanji, Fakhreddin Akbari Dourbash, Zahra Rezai, Soudabeh Alizadeh Matboo, Reza Hekmat-Shoar, Seyed Mohsen Mohseni, Gharib Majidi Pages 368-376
    Background
    Nanoscale poly (amidoamine) dendrimers have been investigated for their biological demands, but their antibacterial activity has not been widely discovered. Thus, the sixth generation of poly (amidoamine) dendrimer (PAMAM-G6) was synthesized and its antibacterial activities were evaluated on Gram-negative bacteria; P. aeruginosa, E. coli, A. baumannii, S. typhimurium, S. dysenteriae, K. pneumoniae, P. mirabilis, and Gram-positive bacteria, and S.aureus and B. subtilis, which were isolated from different clinical specimens and standard strains of these bacteria.

    Methods
    In this study, 980 specimens including urine (47%), blood (27%), sputum (13%), wounds (8%), and burns (5%) were collected from clinical specimens of 16 hospitals and clinics in city of Sabzevar, Iran. Then, the target bacteria were isolated and identified using standard methods. Minimum inhibitory concentration and minimum bactericidal concentrations against Gram-positive and Gram-negative bacteria were determined according to guidelines described by clinical and laboratory standards institute (CLSI). Standard discs were prepared using 0.025, 0.25, 2.5, and 25 μg/mL concentrations of PAMAM-G6 on Mueller-Hinton agar plates to determinate the zone of inhibition. The cytotoxicity of PAMAM-G6 dendrimer was evaluated in HCT116 cells by MTT assay.
    Results
    The most important isolated bacteria were E. coli (23.65%), S. aureus (24.7%), P. aeruginosa (10.49%), B. subtilis (7.7%), S. typhimurium (8.87%), A. baumannii (7.02%), K. pneumoniae (7.1%), P. mirabilis (6.46%), and S. dysenteriae (3.6%). Moreover, it was found that poly (amidoamine)–G6 exhibited more antibacterial efficacy on standard strains than isolated bacteria from clinical samples (p
    Conclusion
    The PAMAM-G6 dendrimer showed a positive impact on the removal of dominant bacterial isolated from clinical specimens and standard strains.
    Keywords: Antimicrobial resistance, Cytotoxicity, Poly (amidoamine)-G6, Health care-associated infections, Nosocomial pathogens, Novel antibacterial, Synthesis
  • Kiarash Tanha, Neda Mohammadi, Leila Janani* Pages 377-378
    The misinterpretation and misuse of p-value have been increasing for decades. In March 2016, the American Statistical Association released a statement to warn about the use and interpretation of p-value. In this study, we provided a definition and discussion of p-value and emphasized the importance of its accurate interpretation.
    Keywords: Statistical significance, Hypothesis testing, P-value
  • Fatemeh Ahmadi, Ataallah Ghadiri, Roohangiz Nashibi, Fatemeh Roozbeh, Reza Alizadeh-Navaei Pages 379-382
    Background
    Lectin pathway mediates complement activation, which is activated by many microorganisms. This study aimed at determining the serum levels of mannose-binding lectin (MBL) in patients with pulmonary tuberculosis, assessing its relationship to antiuberculosis treatment response, and comparing them with a control group.

    Methods
    This cross-sectional study was conducted on patients with pulmonary tuberculosis during 2012 and 2013 in South West of Iran. PPD-ST-negative individuals were selected as controls from healthy relatives of patients. Serum MBL levels were measured using ELISA kit (Human MBL HK323, Hycultbiotech Company, Netherlands). All patients were followed- up for response to treatment. We applied Mann-Whitney and Fisher’s exact tests and used SPSS Version 17 software for statistical analysis.

    Results
    The study included 62 patients as the case group and 63 noninfected TB patients as the control group. The MBL (ng/mL) in patients with pulmonary tuberculosis (median = 1012) was significantly (p= 0.037) higher than that of the control group (median= 296.2). No significant difference was found in the MBL level (ng/mL) between patients with response to antituberculosis treatment (median= 1012) and patients with treatment failure (median= 798.9) (p= 0.84).
    Conclusion
    MBL may be involved in the pathogenesis of tuberculosis and in the low values that are protective against tuberculosis, and it seems that it has no effect on the antituberculosis treatment response.
    Keywords: Tuberculosis, Mannose Binding Lectin, Immune System
  • Reza Safdari, Alireza Firoz, Hoorie Masoorian Pages 383-390
    Background
    Psoriasis is a complex disease with lifelong emotional and social consequences for affected patients. It also reduces the patients’ quality of life and requires a long-term management. Therefore, in addition to appropriate treatment of the disease, self-management strategies to improve patient health and quality of life are essential. On the other hand, smartphone-based applications alter the way people interact with health care and public health systems. This study aimed at identifying training and informational components to develop a psoriasis self- management application.

    Methods
    This descriptive-analytic study was conducted on 100 patients with psoriasis and 26 dermatologists who were selected randomly, using Morgan table. The data were collected using a researcher- made questionnaire, which included demographic and clinical information, lifestyle training and management, and application capabilities in psoriasis self-management. A group of experts and a test-retest method were used to confirm the validity and reliability of the questionnaire, respectively.

    Results
    The mean scores for demographic and clinical information, lifestyle training and management, and application capabilities in self-management were 80.55%, 85.7%, and 88.8% from the patients’ perspective, and 83.7%, 71%, and 75% from the specialists’ viewpoint, respectively.

    Conclusion
    Determining self-management components by patients as persons who are suffering from the disease and physicians as specialists in the field will be helpful in efficient psoriasis self-management. It is more likely that self-reliant patients, who are aware of the benefits and risks of their disease management application, will follow their treatment plan and pursue the management of their disease more seriously.
    Keywords: Psoriasis, Self-management, Application
  • Khosro Keshavarz, Behzad Najafi, Yaghob Andayesh, Aziz Rezapour, Masoud Abolhallaj, Ali Sarabi Asiabar, Amir Hashemi Meshkini, Ehsan Sanati, Iman Mirian, Shekoofeh Nikfar, Farhad Lotfi Pages 391-395
    Background
    Socioeconomic indicators are the main factors that affect health outcome. Health price index (HPI) and households living costs (HLC) are affected by economic reform. This study aimed at examining the effect of subsidy targeting plan (STP) on HPI and HLC.

    Methods
    The social accounting matrix was used to study the direct and indirect effects of STP. We chose 11 health related goods and services including insurance, compulsory social security services, hospital services, medical and dental services, other human health services, veterinary services, social services, environmental health services, laundry& cleaning and dyeing services, cosmetic and physical health services, and pharmaceutical products in the social accounting matrix to examine the health price index. Data were analyzed by the I-O&SAM software.

    Results
    Due to the subsidy release on energy, water, and bread prices, we found that (i) health related goods and services groups’ price index rose between 33.43% and 77.3%, (ii) the living cost index of urban households increased between 48.75% and 58.21%, and (iii) the living cost index of rural households grew between 53.51% and 68.23%. The results demonstrated that the elimination of subsidy would have negative effects on health subdivision and households’ costs such that subsidy elimination increased the health prices index and the household living costs, especially among low-income families. The STP had considerable effects on health subdivision price index.

    Conclusion
    The elimination or reduction of energy carriers and basic commodities subsidies have changed health price and households living cost index. Therefore, the policymakers should consider controlling the price of health sectors, price fluctuations and shocks.
    Keywords: Subsidy Targeting, Social Accounting Matrix, Price Index, Health Sector, Economic Reform, Iran
  • Mohammad Khammarnia, Roxana Sharifian, Farid Zand, Omid Barati, Ali Keshtkaran, Golnar Sabetian, Nasim Shahrokh, Fatemeh Setoodezadeh Pages 396-400
    Background
    One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital.

    Methods
    We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used.

    Results
    The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p
    Conclusion
    In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals.
    Keywords: Computerized physician order entry, Prescription error, Public hospital
  • Seyed Abbas Mirabedini*, Seyed Mohammad Esmaeil Fazl Hashemi, Ali Sarabi Asiabar, Aziz Rezapour, Saber Azami-Aghdash, Hassan Hosseini Amnab Pages 401-409
    Background
    Out-of-pocket and informal payments are considered as 2 most important topics for equity in health care financing. Therfore, this study was conducted to systematically review and meta-analyze the status of these payments in Iran's health care system.

    Methods
    Required data were collected through searching the following key terms: "Unofficial", "Informal Payment", "Iran", "Health Financing", "Health expenditure", and "Out-of-pocket" on Scopus, PubMed, IranMedex, SID, and Google Scholar databases. After extracting and screening previous studies, data were collected from the articles using PRISMA pattern. To perform the meta-analysis, Comprehensive Meta-Analysis (CMA: 2) software was used.

    Results
    A total of 15 studies were entered in this review. Overall, the rate of out-of-pocket payments was estimated to be 50% (95% CI: 45-57%). A significant correlation was found between gender and the rate of out-of-pocket payments (p≤0.05). Moreover, the overall rate of informal payments was found to be 35%. Most of the informal payments were in form of cash, and the main reasons for informal payments were appreciating the staff and medical team as well as requests made by the hospital staff. Length of stay, marital status, employment status, income, and insurance coverage were key factors in the field of informal payments.

    Conclusion
    According to the results of the present study, out-of-pocket and informal payments are more prevalent in Iran. Considering the negative effects of these payments on the health care system, it is of prime importance to implement extensive interventions to reduce or even prevent these payments.
    Keywords: Out-of-pocket, Informal payments, Health financing, Health system, Equity
  • Bahman Khosravi, Shahin Soltani, Javad Javan-Noughabi, Ahmad Faramarzi Pages 410-413
    Background
    In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries.

    Methods
    A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties.

    Results
    Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%.

    Conclusion
    Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure.
    Keywords: Health Expenditure, Iran, Per Capita, Out of Pocket
  • Mahboobeh Sajadi, Neda Fayazi, Andrew Fournier, Ahmad Reza Abedi Pages 414-418
    Background
    The most important responsibilities of an education system are to create self-directed learning opportunities and develop the required skills for taking the responsibility for change. The present study aimed at determining the impact of a learning contract on self-directed learning and satisfaction of nursing students.
    Methods
    A total of 59 nursing students participated in this experimental study. They were divided into six 10-member groups. To control the communications among the groups, the first 3 groups were trained using conventional learning methods and the second 3 groups using learning contract method. In the first session, a pretest was performed based on educational objectives. At the end of the training, the students in each group completed the questionnaires of self-directed learning and satisfaction. The results of descriptive and inferential statistical methods (dependent and independent t tests) were presented using SPSS.

    Results
    There were no significant differences between the 2 groups in gender, grade point average of previous years, and interest toward nursing. However, the results revealed a significant difference between the 2 groups in the total score of self-directed learning (p= 0.019). Although the mean satisfaction score was higher in the intervention group, the difference was not statistically significant.

    Conclusion
    This study suggested that the use of learning contract method in clinical settings enhances self-directed learning among nursing students. Because this model focuses on individual differences, the researcher highly recommends the application of this new method to educators.
    Keywords: Clinical teaching, Learning contract, Self-directed learning, Learning Methods, Training, Autonomous learning, Education, Active learn-ing, self-confidence, Training activity, support, Collaborative learning
  • Zahra Fatehi, Hamid Reza Baradaran *, Mohammad Asadpour, Mohsen Rezaeian Pages 419-423
    Background
    Individuals’ listening styles differs based on their characters, professions and situations. This study aimed to assess the validity and reliability of Listening Styles Profile- Revised (LSP- R) in Iranian students.

    Methods
    After translating into Persian, LSP-R was employed in a sample of 240 medical and nursing Persian speaking students in Iran. Statistical analysis was performed to test the reliability and validity of the LSP-R.
    Results
    The study revealed high internal consistency and good test-retest reliability for the Persian version of the questionnaire. The Cronbach’s alpha coefficient was 0.72 and intra-class correlation coefficient 0.87. The means for the content validity index and the content validity ratio (CVR) were 0.90 and 0.83, respectively. Exploratory factor analysis (EFA) yielded a four-factor solution accounted for 60.8% of the observed variance. Majority of medical students (73%) as well as majority of nursing students (70%) stated that their listening styles were task-oriented.

    Conclusion
    In general, the study finding suggests that the Persian version of LSP-R is a valid and reliable instrument for assessing listening styles profile in the studied sample.
    Keywords: Validity, Reliability, Listening Style Profile, Persian, Iran
  • Mohammad-Taghi Shakeri, Ali Taghipour, Masoumeh Sadeghi *, Hossein Nezami, Ali-Reza Amirabadizadeh, Hossein Bonakchi Pages 424-427
    Background
    Writing, designing, and conducting a clinical trial research proposal has an important role in achieving valid and reliable findings. Thus, this study aimed at critically appraising fundamental information in approved clinical trial research proposals in Mashhad University of Medical Sciences (MUMS) from 2008 to 2014.

    Methods
    This cross-sectional study was conducted on all 935 approved clinical trial research proposals in MUMS from 2008 to 2014. A valid and reliable as well as comprehensive, simple, and usable checklist in sessions with biostatisticians and methodologists, consisting of 11 main items as research tool, were used. Agreement rate between the reviewers of the proposals, who were responsible for data collection, was assessed during 3 sessions, and Kappa statistics was calculated at the last session as 97%.

    Results
    More than 60% of the research proposals had a methodologist consultant, moreover, type of study or study design had been specified in almost all of them (98%). Appropriateness of study aims with hypotheses was not observed in a significant number of research proposals (585 proposals, 62.6%). The required sample size for 66.8% of the approved proposals was based on a sample size formula; however, in 25% of the proposals, sample size formula was not in accordance with the study design. Data collection tool was not selected appropriately in 55.2% of the approved research proposals. Type and method of randomization were unknown in 21% of the proposals and dealing with missing data had not been described in most of them (98%). Inclusion and exclusion criteria were (92%) fully and adequately explained. Moreover, 44% and 31% of the research proposals were moderate and weak in rank, respectively, with respect to the correctness of the statistical analysis methods.

    Conclusion
    Findings of the present study revealed that a large portion of the approved proposals were highly biased or ambiguous with respect to randomization, blinding, dealing with missing data, data collection tool, sampling methods, and statistical analysis. Thus, it is essential to consult and collaborate with a methodologist in all parts of a proposal to control the possible and specific biases in clinical trials.
    Keywords: Critical Appraisal, Clinical Trial, Proposal, Assessment, Mashhad
  • Amin Doosti-Irani, Hossein Moameri Hossein Moameri, Hasan Ahmadi-Gharaei, Kourosh Holakouie-Naieni * Pages 428-433
    Background
    Depression is the most common mental disorder in individuals with HIV and AIDS (PLWHA), and comorbidity with depression exacerbates the disease. Several studies have estimated the prevalence of depression in HIV and AIDS patients so far, but there is no consensus about the prevalence of depression among these patients. Thus, we aimed at estimating the overall prevalence of depression among Iranian PLWHA.

    Methods
    The international and national databases including Web of Science, Scopus, Medline, Science Direct, MagIran, Scientific Information Database (SID), IranMedex, and Medlib were searched until June 2016. The quality of included studies was assessed using Newcastle-Ottawa Scale.

    Results
    Out of 591 references, 9 cross-sectional studies met the eligibility criteria and were included in the review. The lowest and highest reported prevalence of depression among people with HIV was 22% (95% CI: (11, 33)) and 76% (95% CI: (71, 81)), respectively. Prevalence of depression in people with HIV in the north, west, and south of Iran was 45% (95% CI: (23, 67)), 30% (95% CI: (15, 45)), and 56% (95% CI: (35, 77)), respectively. Prevalence of depression among addict and non-addict patients was 25% (95% CI: (21, 30)) and 58% (95% CI: (40, 77)), respectively.

    Conclusion
    According to the results of this systematic review, the prevalence of depression is considerable among Iranian PLWHA. Prevalence in the southern regions of Iran is more than the western and northern regions of Iran. This evidence may be useful for Iranian health policymakers to design suitable preventive and therapeutic interventions in PLWHA to prevent and control depression among these people in Iran.
    Keywords: Depression, HIV, Acquired Immunodeficiency Syndrome, Prevalence, Systematic Review
  • Hamid Ravaghi, Russel Mannion, Haniye Sajadi * Pages 434-444
    Background
    Existing evidence with regards to the organizational failure and turnaround are derived from the private sector. There is few corresponding review of the empirical evidence in the public sector. This review aimed at providing a summary of the research investigating the above items in the public sector.

    Methods
    A search strategy was developed to identify empirical studies relating to organizational failure or turnaround process in public sector services on HMIC, Medline; SSCI, ASSIA, Business Source Premier, The SIEGLE and the ASLIB Index. A total of 11 673 studies were identified initially. After screening process of the articles, 23 studies were included in the systematic review. The selected studies were appraised and findings were synthesized.

    Results
    Symptoms of organizational failure along with secondary and primary causes of failure within different public organizations were identified. Factors that trigger organizational change were extracted. The review revealed that most of the studies employed turnaround strategies including reorganization, retrenchment, and repositioning, which are referred to “3Rs” strategies. The role of contextual factors in turnaround and the impact of turnaround strategies on organizational performance were explored. Furthermore, the key similarities and differences between 2 sectors in organizational failure and the turnaround process were demonstrated.

    Conclusion
    This review highlighted the gap in the literature in organizational failure and turnaround interventions within the public sector.
    Keywords: Organizational Failure, Turnaround, Public Sector, McKiernan's Model, Stage Framework
  • Farbod Ebadifard Azar, Aziz Rezapour, Haleh Mousavi Isfahani, Saber Azami-Aghdash, Khalil Kalavani, Feridun Mahmoudi * Pages 445-450
    Background
    Evidence- Based Medicine (EBM) refers to the ability and skill in the use and integration of the best evidence obtained from repeatable bias-free clinical trials with the patients’ preferences and conditions. Considering this fact that few large-scale studies have been done in this field in Iran, the present study aimed at comprehensively reviewing the status of EBM performance among health care providers in Iranian hospitals.

    Methods
    This cross-sectional study was conducted during 2014 and 2015. Study participants consisted of 2800 health care providers (physicians, nurses, midwives, and paramedical personnel) in active hospitals in Iran. Data collection tool was a self-made questionnaire. Content validity of the questionnaire was improved by comments of 10 experts. The reliability of the questionnaire was assessed using test-retest method (α= 0.85).

    Results
    The results revealed that only 12.7% and 15.8% of the participants were highly familiar with EBM databases and terminologies, respectively. Most participants believed that EBM-related workshops and practical involvement in EBM-related programs and activities can have a more effect on the improvement of EBM performance. Most participants had a positive view of the EBM. About 47% of the participants reported that their EBM knowledge and skills is high. Among the demographic variables, there were only significant relationships between work experience and attitude, gender and attitudes, and between knowledge and skills (p
    Conclusion
    According to the results of the present study, it seems that holding EBM-related workshops and practical participation in EBP-related programs and activities as well as improving facilities such as manpower, equipment, and access can have a significant effect on improving EBM- related activities.
    Keywords: Evidence- based medicine, Health care providers, Attitudes, Knowledge, Skills
  • Nahal Ahmadzadeh, Aziz Rezapoor, Zahra Ghanavatinejad, Mojtaba Nouhi, Somayeh Karimi, Alireza Saravani, Ahmadreza Nasre Tahooneh, Reza Jahangiri * Pages 451-456
    Background
    Tremendous difficulties are imposed on families with preterm and premature babies, both at birth and during their lifetime. The present study aimed at evaluating the potential economic impact of preterm and premature birth in Iran.

    Methods
    In this descriptive cross-sectional study (2014-2015), we studied preterm and premature newborns, who have been subjected to hospitalization in Ali-Asghar hospital. We followed social perspective to estimate the economic consequences of preterm and premature birth in 3 categories of direct medical, direct non-medical, and indirect costs. Required data were collected from documents in the NICU, and studying medical records, and interviewing their parents. Data were analyzed by Microsoft Excel.

    Results
    Direct medical, direct non-medical and indirect affairs were 84%, 6%, and 10% of the total cost, respectively. The estimated social costs were 373, 529, 189; 508, 774, 181; and 529, 481, 996 US dollars (according to their corresponding incidence of 5.8%, 7.9%, and 9.9%). We also found that 75% of the direct medical costs of initial hospitalization were due to intensive care beds.

    Conclusion
    The economic burden of preterm and premature birth in Iran is considerable and to decrease the costs, it is necessary to implement preventive programs for preterm and premature newborns and to provide management care and support for families dealing with this problem.
    Keywords: Premature, preterm infants, Neonatal Intensive Care Unit (NICU), Economic burden
  • Seyed Mohammad Esmaeil Fazl Hashemi, Ali Sarabi Asiabar, Aziz Rezapour, Saber Azami-Aghdash, Hassan Hosseini Amnab, Seyed Abbas Mirabedini * Pages 457-464
    Background
    Waiting time in emergency department is a key indicator in measuring the quality of hospital services and has a significant impact on patient satisfaction The purpose of this study was to conduct a systematic review and meta-analysis of the patient's waiting time in hospital emergency departments in Iran.

    Methods
    Data were collected from databases of Web of Science, Embase, PubMed, Scopus, Google scholar, SID, and Iran Medex using the following key words: “emergency ward”, “emergency room”, “waiting time”, ” time delay”, “first visit”, “first treatment” , “emergency department”, “Iran”, and their Persian equivalents. The timeframe of 2000 to 2016 was selected to search the articles. CMA 2 (Comprehensive Meta-Analysis) software was used in this meta-analysis.

    Results
    A total of 236 articles were extracted from databases and other sources, and finally 17 articles were included in the analysis. In total, waiting time in different parts of the emergency department was measured for 15 943 patients. Mean±SD waiting time was 5.9 ± 0.6 minutes from the arrival to the first visit by a physician, it was 45 ± 5 minutes between the first visit and the first therapeutic steps, 94± 33.9 minutes between referring to the laboratory and receiving the result, 23.2 ± 3 minutes between referring to the radiology and receiving the result, and 32.2 ± 7 minutes between referring to ECG and receiving the result; moreover, waiting time for the first specialist consultation was 99.3 ± 32.8 minutes.

    Conclusion
    The results demonstrated that waiting time in the emergency rooms of Iranian hospitals was higher than the national and international standards. According to the high rate of heterogeneity in the results and probability of publication bias, we highly recommend that readers use the results of this study and pay sufficient attention to this issue.
    Keywords: Emergency, Waiting time, Timing, Quality
  • Mohammad Rezapour, Elnaz Payani, Masoumeh Taran, Ali Rajabzadeh Ghatari, Morteza Khavanin Zadeh * Pages 465-471
    Background
    A growing number of patients with End-Stage Renal Disease (ESRD) are undergoing long-term hemodialysis (HD). HD needs a vascular access (VA) and complications of VA account for a sizable proportion of its costs. One of the important cardiovascular diseases (CVD) is atherosclerosis, which is a major cause of premature deaths in the world. So, it is essential to find the risk factors to treat them before they cause an obvious CVD.

    Methods
    We analyzed data from 174 ESRD patients who were candidate for Arterio Venous Fistula (AVF) creation from April 2008 to March 2009 in Hasheminejad Kidney Center by convenient sampling. X-ray images were used and C 4.5 algorithm of data mining techniques revealed the roles of two risk factors for atherosclerosis of diabetic ESRD patients. Pearson coefficient was also used to measure the correlation between the parameters.

    Results
    Diabetic patients had significantly more calcified arteries in their forearm X-ray than other patients (p
    Conclusion
    This study investigates the role of high plasma levels of TG and phosphorous in the development of atherosclerosis in diabetic HD patients. Although many studies showed that hypertriglyceridemia plays a promoting role in the development of CVD, our study also found an inverse effect of plasma levels of TG on the atherosclerotic involvement of radial and ulnar arteries in diabetic patients, and therefore our results support this suspicion that hypertriglyceridemia plays a significant role in developing atherosclerosis.
    Keywords: Image Mining, X-ray, Arterial Calcification, Atherosclerosis, Diabetes Mellitus, Triglyceride, Phosphorus, inverse effect
  • Nahid Aboutaleb, Mitra Zarrati, Elhameh Cheshmazar, Raheleh Shokouhi Shoormasti, Elham Razmpoosh, Farinaz Nasirinezhad* Pages 472-477
    Background
    Oxidative stress in obese people is an important pathogenic mechanism of an obesity-associated metabolic syndrome. We evaluated the association between circulating leptin levels with biomarkers of oxidative stress in overweight and obese participants.

    Methods
    This study was performed on 189 overweight and obese people aged 18-60 years old. Serum leptin, superoxide dismutase (SOD), high-sensitivity C-reactive protein (hs-CRP), homocysteine (Hcy), thiobarbituric acid reactive substances (TBARS) and amyloid A (SAA) concentrations were measured. Pearson correlation and multiple linear regressions were used to assess the relationships.

    Results
    We found that among the biomarkers of oxidative stress and inflammation in participants, serum hs-CRP and SAA were positively correlated with BMI (β=0.003, P
    Conclusion
    Overall, the current study demonstrated that serum hs-CRP and SAA levels were independently correlated with BMI. Furthermore, serum hs-CRP was positively correlated with leptin. Focusing on such strategies may lead to promises for alleviating obesity and its co-morbidities.
    Keywords: Leptin, Obesity, Oxidative stress, Inflammation
  • Mostafa Hosseini Golkar*, Seyed Sepehr Ghazinoory, Fatemeh Saghafi, Mohammad-Rahim Eivazi, Atousa Poursheikhali, Reza Dehnavieh Pages 478-483
    Background
    Scenario is the primary method in futures studies, and thus its improper use can undermine the credibility and claims of the results. There are many scenario types, and here we aimed at understanding whether these scenarios are being used properly in the health field.

    Methods
    In this study, a combination method was used in 3 phases, and 8 2 steps were considered to accommodate the needs of the health sector with capabilities of the main types of scenarios. One of the appropriate methods of futures studies was used at each step.

    Results
    Scenario planning has evolved along with futures studies paradigms. Trend-based scenarios, intuitive logic, and structural analysis approaches have had the most use in futures scenarios and health section. Quantitative techniques, which are close to the positivist paradigm, have been most widely used; however, participatory methods of futures studies paradigm have been used the least in the health sector.

    Conclusions
    Health scenario writing in its current state is targeting short- to medium- term futures and does not respond to all requirements. Thus, other backup methods should also be considered.
    Keywords: Futures Studies, Health Section, Types of Scenarios, Methodology, Survey
  • Mohammad Khoshroo, Mohammad Ebrahim Khamseh, Ali Akbar Amir Zargar, Mojtaba Malek, Reza Falak, Mehdi Shekarabi * Pages 484-491
    Background
    Both genetic and environmental factors are important in pathogenesis of diabetes. Non HLA (Human Leukocyte Antigen) genes such as INS-VNTR and CTLA-4 in addition of HLA genes have influence on genetic susceptibility for diabetes mellitus. In this study the association of A/G CTLA-4 and -23 A/T INS-VNTR polymorphisms with diabetes and their association with islet autoantibodies were investigated.
    Methods
    Thirty four autoantibody positive adult persons with diabetes mellitus and 39 persons with Type 1diabetes mellitus (T1DM), 40 autoantibody negative Type 2 diabetes mellitus (T2DM) patients and 40 healthy controls were studied using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique.
    Results
    The frequencies of -23 A/T INS-VNTR genotypes were not significantly different among study groups. It was shown that the distribution of the  CTLA-4 allele and genotype frequencies did not differ between T1DM patients, autoantibody positive adult patients and controls. With increasing CTLA-4 G allele and GG/AG genotypes, the frequency of Glutamic Acid Decarboxylase Autoantibody (GADA), Islet Cell Autoantibody (ICA) and Islet Antigen 2 Antibody (IA2A) positive patients were increased.
    Conclusion
    Our results suggest that susceptibility allele A of -23A/T INS-VNTR does not have any role in the pathogenesis of diabetes in our patients and susceptibility allele G of A/G CTLA-4 if not, has a small role in pathogenesis of diabetes in T1DM and autoantibody positive adult patients and in spite of significant increase in autoantibody negative T2DM group it does not have any role in disease pathogenesis.
    Keywords: CTLA-4, INS-VNTR, Diabetes Mellitus, Autoantibodies, Polymorphism
  • Aliakbar Haghdoost, Samira Sadat Pourhosseini, Mozhgan Emami, Reza Dehnavieh, Tahmineh Barfeh, Mohammad Hossein Mehrolhassani Pages 492-499
    Background
    Development in health is not possible without progress of science. Rapid changes in the various areas make the future health system more complex and risky. Therefore, foresight of health sciences is very important.

    Methods
    This futures studies was conducted in 4 steps; also, literature and documents review, statistics and information review, focus group discussions, working group, and scenario planning were used. Cause level analysis was used for data analysis and syntactic as main frameworks.

    Results
    The findings in legal health sciences documents revealed that the value system was not defined clearly and coherently and that logical linkage among myths, discourse, and social structural layers was ambiguous. In trend analysis, 24 trends were recognized; however, political and economic streams were strong, independent, and uncertain factors which created 4 main scenarios although the social and environmental factors divided them into 16 subscenario tunnels. Postmodern discourse in probability scenarios will be dominant and science will be understood as tools for generation of wealth. University structure will be decentralized and transformed into similar R&D to join the health industry, and our quantitative growth (articles, disciplines, and students) in health sciences will decrease.

    Conclusion
    If the current trends (probability scenarios) continue, we will move to an undesirable situation. The main challenge in this regard is the lack of a unique and dominant discourse in health sciences based on the Islamic Republic of Iran doctrine. Therefore, in this study, shifting the paradigm by a new approach and discipline in the health sciences is suggested.
    Keywords: Casual layered analysis, Health sciences, High level documents, Foresight
  • Azadeh Safaiean, Nahid Jalilevand*, Mona Ebrahimipour, Elham Asleshirin, Mehran Hiradfar Pages 500-504
    Background
    Intelligibility refers to understandability of speech; and lack of it can negatively affect children’s overall communication effectiveness. Children with repaired cleft lip and/or cleft palate (CL/P) may experience poor speech intelligibility. This study aimed at evaluating speech intelligibility in children with repaired CL/P who had not been referred to speech-language pathology clinics for early intervention.

    Methods
    Sixty-four monolingual Persian-speaking children, 32 children with repaired CL/P, and 32 controls aged 3 to 5 years participated in this survey. Their speech intelligibility was evaluated through the Persian Speech Intelligibility Test and was normalized on children 3 to 5 years. Each speech sample was heard by a speech and language pathologist (SLP), as well as 2 nonprofessional listeners. Two objective measures of speech intelligibility including Percentage of Consonants Correct (PCC) and Percentage of Intelligible Words (PIW) were used in this research.

    Results
    Children with CL/P were significantly outperformed by their peers in PCC (p= 0.0001) and PIW (p= 0.0001). More than half of the case group had compensatory errors and 40.6% had obligatory errors. The PCC and the PIW were statistically different in children with different rates of hyper nasality (p= 0.001).

    Conclusion
    Speech intelligibility of children with CL/P is impaired due to their articulation disorders (obligatory and compensatory errors). This survey documents the necessity for speech therapy for increasing speech intelligibility in this population.
    Keywords: Speech Intelligibility, Percentage Intelligible Words, Percentage Consonants Correct, Cleft Lip and-or Palate
  • Ebrahim Jaafaripooyan, Sara Emamgholipour *, Behzad Raei Pages 505-511
    Background
    Literature abounds with various techniques for efficiency measurement of health care organizations (HCOs), which should be used cautiously and appropriately. The present study aimed at discovering the rules regulating the interplay among the number of inputs, outputs, and decision- making units (DMUs) and identifying all methods used for the measurement of Iranian HCOs and critically appraising all DEA studies on Iranian HCOs in their application of such rules.

    Methods
    The present study employed a systematic search of all studies related to efficiency measurement of Iranian HCOs. A search was conducted in different databases such as PubMed and Scopus between 2001 and 2015 to identify the studies related to the measurement in health care. The retrieved studies passed through a multi-stage (title, abstract, body) filtering process. Data extraction table for each study was completed and included method, number of inputs and outputs, DMUs, and their efficiency score.

    Results
    Various methods were found for efficiency measurement. Overall, 122 studies were retrieved, of which 73 had exclusively employed DEA technique for measuring the efficiency of HCOs in Iran, and 23 with hybrid models (including DEA). Only 6 studies had explicitly used the rules of thumb.

    Conclusion
    The number of inputs, outputs, and DMUs should be cautiously selected in DEA like techniques, as their proportionality can directly affect the discriminatory power of the technique. The given literature seemed to be, to a large extent, unsuccessful in attending to such proportionality. This study collected a list of key rules (of thumb) on the interplay of inputs, outputs, and DMUs, which could be considered by most researchers keen to apply DEA technique.
    Keywords: Healthcare, Efficiency Measurement, Data Envelopment Analysis (DEA), Rule of Thumb, Iran
  • Mohamadreza Golbakhsh, Arash Mottaghi *, Mohamadreza Zarei Pages 512-514
    Thoracic disk herniation comprises 0.15% of all disk herniation and has various and confusing manifestations. Among them, radicular pain down the leg could be the rarest presentation, especially if it is the only complaint. On the other hand, finding the relationship between clinical and paraclinical needs require high index of suspension and it is demanding. A 34-year-old patient, who had a history of intermittent back pain, with lower thoracic disk herniation presented by acute leg sciatica-like pain, is reported. He suffered 3 weeks of acute back pain prior to admission, which radiated down to buttock and leg, with a vague left abdominal pain, whose clinical examination indicated a distal lumbar problem. MRI showed T-12 L-1 disk herniation. Lower thoracic disc herniation can compress lumbosacral roots immediately after exiting from cord thickening in the lower thoracic area, so they can incite lower lumbar radiculopathy and cause discordance between MRI findings and clinical presentation, suggesting a lumbar problem, and this can lead to delayed diagnosis. However, the acute pain was completely improved after open discectomy.
    Keywords: Thoracic disc herniation, Leg radiculopathy, Lumbar disk herniation
  • Majid Davari, Bahman Amani, Fariborz Mokarian, Mohsen Hoseini, Arash Akbarzadeh, Nastaran Heidarzadeh Khoramabadi Pages 515-520
    Background
    Trastuzumab in combination with chemotherapy has long been established as a standard treatment for HER2-positive patients in early stage breast cancer (BC). The present study aimed at assessing the effectiveness of trastuzumab adjuvant therapy in early stage BC in overall survival (OS) and disease-free survival (DFS).

    Methods
    A systematic review and meta-analysis was performed to evaluate the effectiveness of trastuzumab adjuvant therapy. PubMed, Cochrane library, Scopus, Web of Science, and Embase databases were searched for relevant RCTs from the beginning to February 2017. Quality assessment of studies was conducted using the Cochrane Risk of Bias Tool. The desired outcomes were OS and DFS.

    Results
    A total of 1818 articles were identified first, however, only 11 studies were eligible to be included in this study. Our findings and meta-analysis results revealed that trastuzumab is effective in increasing OS (OS hazard ratio: -0.286 ± 0.049, 95%CI (-0.381, -0.191)) and improving DFS (DFS hazard ratio: -0.419± 0.077, 95%CI (-0.569, -0.269)). The most serious but negligible side effect of trastuzumab is congestive heart failure.

    Conclusion
    Adding trastuzumab as adjuvant therapy in early stages of BC in HER2 positive patients could increase OS and DFS of the patients effectively.
    Keywords: Trastuzumab, Breast Cancer, Herceptin, Meta-analysis, Adjuvant Therapy
  • Masood Abolhallaj, Seyed Mohammadreza Hosseini *, Mehdi Jafari, Fatemeh Alaei Pages 521-524
    Background
    Sukuk is a type of financial instrument backed by balance sheet and physical assets. This applied and descriptive study aimed at providing solutions to the problems faced by insurance companies in the health sector.

    Methods
    In this study, we achieved operational models by reviewing the release nature and mechanism of any of the securities and combining them.

    Results
    According to the model presented in this study, 2 problems could be solved: settling the past debts and avoiding future debts. This model was deigned based on asset backed securities.

    Conclusion
    Utilizing financing instruments (such as Sukuk), creating investment funds, and finding a solution to this problem, this study was conducted in 2 aspects: (1) models that are settling old debts of the organization, and (2) models that prevent debts in the future.
    Keywords: Health insurance, Organization's debt, Service delivery
  • Ali Javani *, Masoud Abolhallaje, Javad Jafari, Seyed Mohammad Esmaeil Fazl Hashemi Pages 525-529
    Background
    Achieving organizational objectives depends on the effectiveness of administrators. However, managerial efficacy largely depends on the knowledge and skills of managers. This study aimed at assessing the skills of financial and budget management of the Ministry of Health from the perspective of resource development assistants of universities of medical sciences nationwide.

    Methods
    This cross- sectional study was conducted in 2012. Study participants were resource development assistants of universities of medical sciences in Iran. We adopted simple random sampling method in locating participants. Data were collected using pretested questionnaires and analyzed using descriptive statistics and Mann-Whitney test (as a non-parametric test) and Friedman test.

    Results
    The highest mean recorded under financial management skills was technical skills (3.58±0.50), followed by human skills (3.50±.048), and perceptual skills (3.32±0.52). With regards to financial and budget management and performance monitoring, the means of technical skills, as prioritized by directors, was 3.72±0.71, followed by human skills (3.72±0.70), and perceptual skills (3.66±0.75). A significant association was found between perceptual skills of financial managers and budgeting and performance monitoring managers (p= 0.014).

    Conclusion
    Operational level managers, such as financial and budgetary managers, need to acquire more technical skills. Therefore, we support activities that promote technical skills and awareness of managers within organizations, such as organizational training courses and distribution of educational materials like brochures.
    Keywords: Managerial skills, Financial management, Medical universities
  • Roghaye Farhadi Hassankiadeh, Anoshirvan Kazemnejad *, Mohammad Gholami Fesharaki, Siamak Kargari, Nasim Vahabi Pages 530-534
    Background
    The effective use of limited health care resources is of prime importance. Assessing the length of stay (LOS) is especially important in organizing hospital services and health system. This study was conducted to identify predictors of LOS among patients who were admitted to a general surgical unit.

    Methods
    In this cross-sectional study, the sample included all patients who were admitted to the general surgical unit of Shariati hospital in 2013 (n= 334). To determine the factors affecting LOS, Zero-inflated Poisson (ZIP), zero-inflated negative binomial (ZINB), and zero-inflated generalized Poisson (ZIGP) regression models were fitted using R software, and then the best model was selected.

    Results
    Among all 334 patients, the mean (±SD) age of the patients was 45.2 (±16.47) years and 220 (65.9%) of them were male. The results revealed that based on ZIGP model, type of surgery (appendicitis, abdomen and its contents, hemorrhoids, lung, and skin), type of insurance, comorbid diseases (hypertension, heart disease, and hyperlipidemia), place of residence (local and non-local), age, and number of tests had significant effects on the LOS of GS patients.

    Conclusion
    According to the Akaike information criterion (AIC) in each fitted model, it was found that ZIGP regression model is more appropriate than ZIP and ZINB regression models in assessing LOS in GS patients, especially due to the presence of excess zeros and overdispersion in count data.
    Keywords: Length of stay, General surgical unit, Zero-inflated generalized Poisson regression
  • Shayesteh Hajizadeh, Fahimeh Ramezani Tehrani *, Masoumeh Simbar, Farshad Farzadfar Pages 535-542
    Background
    LBW is an important factor that can affect infant mortality and represents an index of economic and social development. It is expected that an increase in the density of midwives attending family physician programs will lead to a decrease in LBW in health centers. This study aimed to compare the percentage of LBW infants before and after the implementation of the family physician program in health centers with and without an increase in midwives density.
    Methods
    This cross-sectional study compared the percentage of LBW infants before and after the implementation of family physician programs in rural health centers with and without changes in midwives density in Kurdistan. In this study, we included 668 mothers of 2-month-old children and administered structured interviews in 2005 and 2013. Data were analyzed using the difference-in-differences and the Matchit statistical models.
    Results
    The Matchit model showed a significant average percentage increase 0.08 (0.006–0.17) in LBW infants born between 2005 and 2013 in health centers where the density of midwives increased compared with those where it remained unchanged. The difference-in-differences model showed that the odds ratio of LBW infants is increased by more than twice among participants who had a history of caesarean section.
    Conclusion
    The results of this study showed that an increase in the density of midwives in a family physician program did not have an impact on reducing the percentage of LBW infants born between 2005 and 2013, in health centers where the density of midwives augmented compared to those where it remained unaltered; it indicated that the increase in the density of midwives alone was not efficient. On the other hand, the results of our study show an increase in the risk of infants born at a LBW due to caesarean section. It is recommended that obstetricians and gynecologists must strictly control pregnancies and avoid unnecessary termination of pregnancy.
    Keywords: Low birth weight, Delivery of health care, Outcome assessment, Kurdistan, Iran
  • Mandana Rashidi Meibodi, Elaheh Mossayebi, Zahra Najmi, Yousef Moradi, Azadeh Afzalzadeh* Pages 543-547
    Background
    Fetal male gender may affect the progression of labor and could be a risk factor for labor arrest. This study was conducted to evaluate the effect of fetus gender on labor curve.

    Methods
    In this cohort study, 1550 singleton term pregnant women in labor phase (either spontaneous or by induction) were enrolled. Results of regular cervical examination, dilation, length of labor stages, mode of delivery, and sex of the fetus, and birth weight were recorded for all participants. Labor progression curve was compared between two sex groups with independent t test and chi2 test.

    Results
    Finally, 1527 women completed the study (47.8% female and 52.1% male). Mean duration from beginning of the active phase up to full dilatation, from 4 to 6 cm, 6 to 8 cm, and 8 to 10 cm dilatations, were significantly longer in the male sex group compared to the female (p˂0.05). All durations were also significantly different when parity was considered (p˂0.05). We could not show fetal sex as an independent risk factor for active phase arrest (OR Adjusted: 1.18, CI 95% 1.01:1.42).

    Conclusion
    Active phase stage was slower and longer in women who carried male fetuses compared to those carrying female fetuses; however, fetal sex did not increase the risk of active phase arrest.
    Keywords: Fetus Gender, Labor Curve, Cohort
  • Hosein Shabaninejad, Asra Asgharzadeh *, Aziz Rezapour, Nima Rezaei Pages 548-554
    Background
    Economic evaluation of subcutaneous immunoglobulin therapy (SCIG) is important, and it has recently been used for treatment of patients with primary immunodeficiency (PID) diseases, and can improve allocation of resources in health care systems. The present research aimed at providing an economic assessment of SCIG and IVIG (intravenous immunoglobulin therapy) administration in Iran.

    Methods
    Data related to clinical effectiveness were obtained from a meta-analysis. Economic analysis was performed taking into account the perspective of health care providers. Incremental cost-effectiveness ratio (ICER) was applied for economic evaluation of the 2 methods, and GDP per capita was considered as a threshold.

    Results
    The results of meta-analysis suggested a higher effectiveness of SCIG compared to IVIG in serum immunoglobulin (Ig) levels (SMD= 0.336) and adverse effects (OR= 0.497), while the cost of IVIG was higher than SCIG ($1370 vs. $121). The ICER obtained in this paper ($2939 for adverse effects and $4348 for serum Ig level) was less than the GDP per capita in Iran ($4,916.10), and thus SCIG is a more cost-effective therapy for PID patients.

    Conclusion
    Switching from IVIG to SCIG is cost-effective for PID patients and is approved by the health care providers’ points of view in this study.
    Keywords: Subcutaneous immunoglobulin, Intravenous immunoglobulin, Primary immunodeficiency, Cost-effectiveness
  • Yasaman Saeidi, Abazar Pournajaf, Mehrdad Gholami, Meysam Hasannejad-Bibalan, Sajjad Yaghoubi, Mahmoud Khodabandeh, Behzad Emadi, Elaheh Ferdosi-Shahandashti, Ramazan Rajabnia * Pages 555-559
    Background
    Helicobacter pylori (H. pylori or Hp) has been strongly associated with the peptic ulcer diseases, chronic gastritis, ulcers, and gastric cancer. Genes associated with pathogenicity have been designated for H. pylori, and some of them appear to be related to more severe clinical consequences of the infection. The present study was conducted to determine cagA, vacA, cagE, iceA1, oipA, and iceA2 genes in H. pylori strains isolated from gastroduodenal patients, who referred to Shariati hospital in Tehran, Iran.

    Methods
    Gastric biopsy specimens were collected during endoscopy from patients, who referred to the Shariati hospital in Tehran, Iran during January and November 2015. After isolation of H. pylori from the biopsy culture, genomic DNA was extracted and subsequently used to identify H. pylori and virulence genes using specific primers.

    Results
    The isolation rate of H. pylori strains was 65.7% (169/257). The frequency of cagA, vacA, cagE, iceA1, oipA, and iceA2 was 143 (% 84.6), 169 (100%), 131 (77.5%), 97 (57.3%), 89 (52.6%), and 72 (42.6%), respectively.

    Conclusion
    In this study, a significant difference was observed between investigated genes and strains isolated from PUD and GC patients (p
    Keywords: Helicobacter pylori, Iran, Virulence factors, Multiplex PCR, Duodenal ulcers
  • Maryam Ghiasipour, Ali Mohammad Mosadeghrad, Mohammad Arab, Ebrahim Jaafaripooyan* Pages 560-567
    Background
    Effective leadership is a vital component of health care systems and has an extensive range of functions in improving organizational effectiveness and efficiency. This study aimed at exploring leadership challenges encountered by leaders in Iranian hospitals.

    Methods
    This qualitative study was conducted on a purposeful sample of 27 members of hospital management team in Tehran using face-to-face semi-structured interviews and in-depth interviews. Thematic analysis was used to analyze and report the data.

    Results
    In this study, 5 main themes emerged upon the challenges of leadership in health care organizations as follow: organizational structure (complexity, centralization, and bureaucracy); human resources (the number and distribution of human resources, staff empowerment, and education, motivational mechanisms, and staff diversity); work nature (sensitivity, stress and tension, customer diversity, and team- oriented); leaders (knowledge and skills, appointment, superiors and colleagues, and time); and context (regulations and programs, cultural issues, social issues, and economic issues).

    Conclusion
    The results of this study shed some light on the leadership challenges in a culturally specific developing country. The results also proved the importance of using educated leaders who are capable of understanding, analyzing, and dealing with such complex challenges.
    Keywords: Leadership, Challenge, Hospital, Health Care organization, Iran
  • Enayatollah Bakhshi, Reza Ali Akbari Khoei, Azita Azarkeivan, Maryam Kooshesh, Akbar Biglarian* Pages 568-571
    Background
    Thalassemia major (TM) is a severe disease and the most common anemia worldwide. The survival time of the disease and its risk factors are of importance for physicians. The present study was conducted to apply the semi-parametric Cox PH model and use parametric proportional hazards (PH) and accelerated failure time (AFT) models to identify the risk factors related to survival of TM patients.

    Methods
    The data of this historical cohort study (296 patients with TM) were collected during 1994 and 2013 in Zafar Clinic in Tehran. Gompertz PH and Weibull AFT models were used for survival analysis (SA) of these patients. Data analysis was performed using R3.2.2 software.

    Results
    153 (51.7%) of patients were female; the mean (±SD) age of the patients was 29.11 (±0.47) years. One-year survival rate for males and females was 0.963±0.007 and 0.973±0.013, respectively; and 3-year survival rate for males and females was 0.711±0.057 and 0.733±0.114, respectively. In the Gompertz model, birthplace and age at onset of the disease were significant factors (p= 0.035, and p= 0.005) in survival time. Also, in the Weibull model, birth place and age at onset of the disease were significant factors (p= 0.013, and p= 0.008) in survival time. The Akaike Information Criterion (AIC) for Weibull model was 158.51, which was lower than other parametric models.

    Conclusion
    According to the results, the Weibull AFT model was found to be a better model for identifying the risk factors related to survival of patients with TM disease. Informing parents, especially mothers and paying attention to blood screening for early diagnosis may increase the survival rate of patients.
    Keywords: Survival analysis, Accelerated failure time model, Proportional hazards models, Thalassemia major
  • Ali Bashiri Dezfouli, Ali Akbar Pourfathollah, Jamileh Salar-Amoli *, Mohammad Khosravi, Mahin Nikogoftar-Zarif, Mina Yazdi, Tahereh Ali-Esfahani Pages 575-578
    Background
    Doxorubicin, by aggregating in bone marrow, causes genotoxic effects, and thus reduces the repair ability of cells. The present study was conducted as an in vitro evaluation of age effects on the cytotoxicity induced by doxorubicin in mesenchymal stem cells (MSCs).

    Methods
    The MSCs of female BALB/c mice aged 1, 8, and 16 months were separated, characterized, and subsequently evaluated in cellular growth media. After 24 hours, exposure of the MSCs of the 3 groups of mice to doxorubicin (25, 50, 100, 200, 400, 800, 1200 nM) and cytotoxicity were assessed, and the sublethal dose was determined using flow cytometry technique and lactate dehydrogenase (LDH) release assay.

    Results
    The IC50 values determined by flow cytometry for the separated MSCs of 1 young, 8 middle- aged, and 16 old mice were and respectively. Interestingly, the results of these 2 methods in determining cytotoxicity were in agreement, and a concentration of approximately 25 nM was considered to be the shared sublethal dose for different ages.

    Conclusion
    The results indicated that MSCs of middle-aged mice were more resistant to the toxic effects of the drug. Besides, MSCs separated from the old mice were the most sensitive to chemotherapy and its side effects such as disruptions of cell proliferation and viability. These disruptions can be ascribed to the alteration of function and physiological processes with age. Determining proper concentration of doxorubicin drug to destruct cancerous cells based on age and individual sensitivity can minimize the amount of toxicity.
    Keywords: Doxorubicin, Mesenchymal Stem Cells, Cytotoxicity, Age
  • Foroogh Sabzghabaei, Mahla Salajeghe *, Seyed Kamran Soltani Arabshahi Pages 579-585
    Background
    In this study, ambulatory care training in Firoozgar hospital was evaluated based on Iranian national standards of undergraduate medical education related to ambulatory education using Baldrige Excellence Model. Moreover, some suggestions were offered to promote education quality in the current condition of ambulatory education in Firoozgar hospital and national standards using the gap analysis method.

    Methods
    This descriptive analytic study was a kind of evaluation research performed using the standard check lists published by the office of undergraduate medical education council. Data were collected through surveying documents, interviewing, and observing the processes based on the Baldrige Excellence Model. After confirming the validity and reliability of the check lists, we evaluated the establishment level of the national standards of undergraduate medical education in the clinics of this hospital in the 4 following domains: educational program, evaluation, training and research resources, and faculty members. Data were analyzed according to the national standards of undergraduate medical education related to ambulatory education and the Baldrige table for scoring. Finally, the quality level of the current condition was determined as very appropriate, appropriate, medium, weak, and very weak.

    Results
    In domains of educational program 62%, in evaluation 48%, in training and research resources 46%, in faculty members 68%, and in overall ratio, 56% of the standards were appropriate.

    Conclusion
    The most successful domains were educational program and faculty members, but evaluation and training and research resources domains had a medium performance. Some domains and indicators were determined as weak and their quality needed to be improved, so it is suggested to provide the necessary facilities and improvements by attending to the quality level of the national standards of ambulatory education.
    Keywords: Ambulatory care training, Program evaluation, Iranian national standards of undergraduate medical education
  • Nasibeh Zanjari, Maryam Sharifian-Sani *, Meimanat Hosseini-Chavoshi, Hassan Rafiey, Farahnaz Mohammadi-Shahboulaghi Pages 686-691
    Background
    Successful aging as an umbrella term with a large amount of literature has emerged with a variety of meanings and dimensions in different studies. This article aims at determining what dimensions contribute to constructing the concept of successful aging.

    Methods
    The method used in this study is an integrative review of published literature related to successful aging. This method includes both qualitative and quantitative studies. Data searching was conducted during November and December 2014 and was then updated in October 2015. First, 2543 articles were identified, and after the screening phase, 76 articles were eligible for inclusion in the integrative review.

    Results
    The results specified 14 subcategories and 5 main categories of successful aging: social well-being, psychological well-being, physical health, spirituality and transcendence, and environment and economic security.

    Conclusion
    The present study provides a thorough understanding of successful aging dimensions and proposes the importance of the multidimensional concept of successful aging at the individual, interpersonal, and environmental levels for future studies and policymaking on population aging.
    Keywords: Successful aging, Integrative review, Multidimensional, Well-being
  • Azita Chegini, Maryam Maryam Zadsar *, Mojgan Shaiegan Pages 690-692
  • Samaneh Gholami, Koroush Goodarzvand Chegini, Nematollah Gheibi, Kobra Mokhtarian, Mohsen Mohamadi, Reza Falak * Pages 693-698
    Background
    Betatrophin, a novel secretory protein from liver and fatty tissues, is believed to be involved in lipid and glucose metabolism. However, its precise physiological role remains unclear. Here, we report the cloning, expression, and purification steps of mouse betatrophin in a prokaryotic system, followed by its structural analysis.

    Methods
    Specific cloning primers were used to amplify the coding sequence of mouse liver betatrophin. The product was cloned into pET28 and expressed in E.coli BL21 (DE3) cells. The suitability of the refolding procedure was assessed by determining secondary structures of the initial and refolded proteins using circular dichroism spectroscopy.

    Results
    The polymerase chain reaction resulted in a 549 bp nucleotide sequence, encoding a 183 amino acid polypeptide, with an apparent molecular weight of 21 kDa, which was expressed in an inclusion body. Following an optimization and refolding procedure, the recombinant protein was purified by anion exchange and metal affinity chromatography. CD spectra revealed that the refolded protein has suitable configuration.

    Conclusion
    We believe that the produced betatrophin is suitable for further biochemical studies on glucose and lipid metabolism.
    Keywords: Mouse betatrophin, Recombinant protein, Refolding, CD spectroscopy, Chromatography
  • Somayeh Athari Nik Azm, Abolghassem Djazayeri, Majid Safa, Kian Azami, Mahmoud Djalali, Mohammad Sharifzadeh, Mohammadreza Vafa * Pages 699-704
    Background
    Nowadays, Alzheimer’s disease (AD) is considered as Type 3 diabetes in which insulin resistance is the common cause of both diseases. Disruption of insulin signaling cascade and insulin resistance can induce AD; and central insulin resistance causes systemic alterations in serum insulin, FBS levels, and lipid profile. Studies have shown that probiotics (Lactobacillus and Bifidobacterium species) can be used as a nutritional approach to improve these metabolic changes. We assessed the probiotic effect (4 species of Lactobacillus and Bifidobacterium) on insulin resistance biomarkers in an experimental model of AD.

    Methods
    A total of 60 rats were divided into 5 groups: (1) a control group without surgical and dietary intervention; (2) a control-probiotics group receiving probiotics for 8 weeks, but not receiving any surgical intervention; (3) a group receiving a sham operation in which PBS was injected intrahippocampus but without dietary intervention; (4) an Alzheimer group for which Amyloid-ß (Aß) 1-42 was injected intrahippocampus but without dietary intervention; (5) and an Alzheimer-probiotics group for which Aß1-42 was injected intrahippocampus and given 2g probiotics for 8 weeks. The FBS levels and lipid profile were measured by a calorimetric method, insulin levels were detected by an ELISA kit, and HOMA-IR was calculated using a formula. ANOVA (one way analysis of variance followed by Bonferroni comparisons post hoc) was used to compare all the variables between groups.

    Results
    Serum glucose, insulin levels, and HOMA-IR index increased in the Alzheimer group compared to the control (p
    Conclusion
    It seems that probiotics play an effective role in controlling glycemic status of Alzheimer’s disease.
    Keywords: Alzheimer Disease, Lactobacillus, Bifidobacterium, Insulin, HOMA
  • Parisa Torabi, Masoumeh Azimirad, Zahra Hasani, Leili Afrisham, Masoud Alebouyeh *, Amir Houshang Mohammad Alizadeh, Mohammad Reza Zali Pages 705-708
    Background
    This study aimed at analyzing microbial contamination in medical equipment, environment, and staff of a gastroenterology unit.

    Methods
    Samples of gastrointestinal imaging devices, the environment, and staff were collected using standard swab-rinse technique and biochemical or molecular characteristics of the isolates, their susceptibility to antibiotics, and similarity of the resistance patterns were investigated.

    Results
    Out of 107 samples, bacterial contamination was detected in the hands of staff (54.1%), imaging devices (56.7%), and in the environment (54.5%). While Pseudomonas spp. were detected only in the imaging devices (13.5%), Bacillus spp. (32.4% and 31.5%), Enterococcus spp. (14.3% and 5.9%), Clostridium difficile (10.8% and 10.5%), and Staphylococcus epidermidis (5.4% and 15.9%) were orderly the most common isolates from samples of the imaging devices and the environment. Nearly, 40% of P. aeruginosa strains were resistant to cefepime, while resistance to cephalosporins and β-lactamase inhibitor was detected in 33% and 75% of S. aureus strains, respectively. Homology of resistance patterns was detected between the imaging devices and hands of the staff.

    Conclusion
    Our results proposed biofilm and spore forming bacteria as main contaminants of imaging devices in this hospital. Homology of the resistance patterns proposed involvement of staff in contamination of the equipment.
    Keywords: Imaging devices, Gastroenterology unit, Bacterial contamination, Antimicrobial Resistance, Cross-contamination
  • Mahin Ghafari, Zahra Cheraghi, Amin Doosti-Irani * Pages 709-710
  • Behzad Damari, Abass Vosoogh Moghadam, Narges Rostamigooran* Pages 711-717
    Background
    Stewardship, resource generation, financing, and providing services are the 4 main functions in any health system. Using intelligence and common sense in making policies and decisions is a subcomponent of the stewardship. The present study aimed at designing a model that provides better access to the stakeholders’ wisdom.

    Methods
    This was a qualitative study in which the data were collected through reviewing documents and references, focused group discussions with experts, and interviewing the stakeholders. The data were analyzed and summed up as a conceptual framework. Then, the framework was developed as a health policy-making stakeholder's network protocol, which included the goal, structure, system process, procedures and standards, management style, and resources.

    Results
    The goal of establishing this network was to facilitate and accelerate the access of policy-makers to the stakeholders’ opinions. Members of the network were divided into 2 groups of thematic experts and administrative managers, as real or legal persons. Health policy issues were categorized into 4 fields and defined in 18 subfields. The network was established through forming a national secretariat, under the supervision of the Minister of Health, with the presence of trained experts, and with an exclusive budget. The stakeholders participated in the network both actively and passively. The website and email were the first communication methods although there were also other policy dialogue means, which were publicly declared through the annual calendar. Stakeholders were motivated by being invited to meetings, keeping up their intellectual ownership, and encouraging them.

    Conclusion
    Strengthening the health system stewardship depends on using common sense and information in addition to vision formation and establishment of controlling mechanisms. The stakeholders’ network could help establish the 2 last components sustainably. Annual evaluation of the network and its consolidation has also been suggested in this study.
    Keywords: Health policy-making, Stakeholder's network, Iran, Developing countries
  • Ebrahim Abasi, Sadighe Kahrizi *, Mohammad Razi, Soghrat Faghihzadeh Pages 718-727
    Background
    Whole-Body Vibration Training (WBVT) is a novel neuromuscular training method that has been recently developed as a rehabilitation tool. The purpose of this study was to determine whether WBVT is effective on electromyographic activity of the muscles of the lower limbs in patients with knee osteoarthritis.
    Methods
    The study was designed as a single blinded randomized clinical trial (IRCT201601171637N5), 45 patients with knee osteoarthritis were randomly assigned to three groups; WBVT (n = 15) receiving 12 sessions vibration therapy, control group (n =15) doing two exercise in the home and placebo (n =15) doing exercise like WBVT group on-off vibration system. Electromyographic activities of vastus lateralis and vastus medialis, semitendinosus, gastrocnemius and soleus were evaluated pre and post intervention. The paired- samples t-test and ANOVA were applied respectively to determine the differences in each group and among the groups (P≤0.05).
    Results
    The RMS value of vastus medialis in semi squat position in placebo group (p=0.024), vastus lateralis in SLR position in WBVT group (p=0.037), soleus in knee flexion in WBVT group (p=0.018), semitendinosus in knee flexion in WBVT group (p=0.007) and RMS response of Semitendinosus in ankle plantar flexion in control group (p=0.047) were revealed significant differences between the pre- and post- intervention. The ANOVA test confirmed the significant differences between the studied groups according to the EMG activity of vastus medialis in semi squat position (p=0.045), semitendinosus in semi squat position (p=0.046) and in plantar flexion position (p=0.015) and also soleus in plantar flexion position (p=0.003).
    Conclusions
    The findings of this study showed the beneficial effects of WBVT in the improvement of the muscles RMS values in the patients with knee OA especially muscle's progression rates in a four-week period.
    Keywords: Knee osteoarthritis, Whole body vibration training, Electromyography, Randomized clinical trial
  • Maryam Karimian*, Abbas Motevalian, Maryam Damghanian, Afarin Rahimi-Movaghar, Vandad Sharifi, Masoumeh Amin-Esmaeili, Ahmad Hajebi Pages 728-734
    Background
    Drug use disorders are one of the major health problems in societies, which cause physical, psychological, and social damages to individuals. Socioeconomic status is often inversely associated with drug use disorders. The present study aimed at determining the effect of socioeconomic inequality on the prevalence of drug use disorders and identifying its determinants in Iran.

    Methods
    Data of 7886 individuals aged 15 to 64 years were collected from Iran Mental Health Survey (IranMHS). Initially, the socioeconomic status of the participants was determined by principal component analysis. Later, socioeconomic inequality was measured using the concentration index, and the factors influencing the gap between the high and low socioeconomic groups were identified using the Oaxaca-Blinder Decomposition.

    Results
    The concentration index for drug use disorders in Iran was -0.29 (standard error= 0.06). The results of decomposition technique revealed that 1.14% and 2.7% of the participants with high and low socioeconomic status were affected by drug use disorders, respectively. In addition, the gap between these 2 groups was found to be 1.65%. Among the studied variables, occupation, marital status, and gender accounted for the highest contribution to inequality, respectively.

    Conclusion
    There is inequality in the prevalence of drug use disorders in Iran; these disorders are more common in lower socioeconomic group. Based on the findings, it is suggested that improvement in the socioeconomic status of the households, especially for males, the divorced or widowed individuals, and the unemployed may lead to a reduction in inequality in drug use disorders.
    Keywords: Drug use disorders, Socioeconomic inequality, Oaxaca-Blinder Decomposition
  • Leila Jamshidi, Mojdeh Ramezani *, Seyed Sajad Razavi, Leila Ghalichi Pages 735-739
    Background
    Providing fair access to high-quality healthcare services is one of the most important goals of health systems. This study was conducted between 2012 and 2013 to determine the level of equity in the quality of hospital services in Iran.

    Methods
    In this cross-sectional study, 1,003 patients were chosen from 100 hospitals in Iran with multi-stage random cluster sampling. Concentration index was calculated to determine equity of healthcare quality from patients’ viewpoint. Furthermore, the equity of hospital services’ quality was investigated from experts’ perspective by calculating Gini index based on the hospitals’ accreditation scores. Analyzing the related factors was done by logistic regression. The significance level was set at α=0.05. Data were analyzed using Excel v.2010, SPSS v.21, and Stata v.8.

    Results
    There was a significant inequity in the quality of hospital services in both patients’ and experts’ point of view. In fact, concentration index (95% confidence interval) for the quality of healthcare was significant, 0.128 (0.080, 0.176), indicating better quality of services for those with higher economic status from patients’ point of view. Furthermore, Gini index (95% confidence interval) for hospitals’ accreditation scores was 0.166 (0.156, 0.176), meaning that there was inequity in hospital services quality from experts’ point of view.

    Conclusion
    The significant inequality observed in the quality of hospital care based on the economic status of the patients highlights the necessity of the supportive policies aiming at reduction of this condition.
    Keywords: Equity, Equality, Quality, Socio-economic status, Iran, Hospital, Healthcare services
  • Sepideh Soltani, Mohammadreza Vafa * Pages 740-742
  • Guita Movallali, Mohsen Amiri *, Abas Nesayan, Roghaye Assady Gandomani Pages 743-748
    Background
    Externalizing behavior in deaf children causes many psychological problems for their parents. Aggression and rule breaking behaviors in children with severe hearing loss may cause psychological problems in parents and in managing children's behavior. Consequently, the present study aimed at investigating the effect of parental behavioral training of mothers on reducing the externalized behaviors (aggression and rule breaking behavior) of their 9- to 10- year old children with severe hearing loss.

    Methods
    This was an experimental study with pretest, posttest, and a control group. The research population included all students with severe hearing loss and their mothers. Thus, 30 mothers whose children had the most severe hearing loss were selected as our main sample among 80 mothers who had completed the Child Behavior Checklist. Then, they were placed into the experimental (n=15) and control groups (n=15) after being matched based on age, educational level, and socioeconomic status. The research tool was Child Behavior Checklist-Persian Version. The parental behavior training was provided for the experimental group in nine 90-minute sessions.

    Results
    The results of the present study indicated the effectiveness of experimental treatment on decreasing the aggressive behaviors of children of mothers in the experimental group compared to mothers of the control group (p=0.001). Moreover, the results revealed a decrease in rule breaking behaviors (p= 0.007) in children of mothers of the experimental group compared to mothers of the control group.

    Conclusion
    Parents’ behavioral training is important in decreasing the aggressive and offensive behaviors in children with severe hearing loss who are at risk of behavioral problems. Furthermore, some research has highlighted the necessity of such trainings for parents of these children. Thus, the present study, emphasizing the importance of childhood problems, found that mothers’ behavioral training could prevent behavioral problems of school-aged children with hearing loss and reduce the recurrence of such problems.
    Keywords: Children with severe hearing loss, Parent behavioral training, Aggression, Rule breaking behaviors
  • Bahram Delgoshaei, Mohammadreza Mobinizadeh, Reyhaneh Mojdekar *, Elham Afzal, Jalal Arabloo, Efat Mohamadi Pages 754-761
    Background
    Telemedicine is an expanded term in health information technology that comprises procedures for transmitting medical information electronically to improve patients’ health status. The objective of this research is to evaluate the cost-effectiveness of telemedicine interventions in various specialty areas.

    Methods
    The Cochrane Library and Centre for Review and Dissemination were searched up to February 2013 using Mesh. Studies that compared any kind of telemedicine with any other routine care technique and used cost per health utility unit’s outcomes were included.

    Results
    Twenty-one articles were included. According to the included studies, it seems that using telemedicine in cardiology can be effective and cost-effective enough but pre-hospital telemedicine diagnostics program are likely to have little impact on acute myocardial infarction fatality. In pulmonary, telemedicine can be a cost-effective strategy for delivering outpatient pulmonary care to rural populations which have limited access to specialized services, but telemedicine is not cost- effective in asthma and airways cancer. In ophthalmology, especially in the diagnosis of diabetic retinopathy, the use of telemedicine is a cost-effective tool. In dermatology, telemedicine is not cost-effective enough in comparison of conventional cares. In other fields such as physical activity and diet, eating disorder, tele-ICU, psychotherapy for depression and telemedicine on ships, telemedicine can be used as a cost-effective tool for treatments or cares.

    Conclusion
    Most of the included studies confirmed that telemedicine is cost-effective for applying in major medical fields such as cardiology; but in dermatology, papers could not confirm the positive capability of telemedicine.
    Keywords: Telemedicine, Economics, Review
  • Afsaneh Rajizadeh, Hassan Mozaffari-Khosravi *, Javad Zavar-Reza, Seyyed Mostafa Shiryazdi Pages 762-767
    Background
    Iron is one of the nutrients that has recently received considerable attention because of its dual role in the incidence of breast cancer. The present study aimed at comparing hematological parameters, iron levels, and oxidative stress in women with and without breast cancer.

    Methods
    The participants in this case-control study were 55 women, of whom 26 were new cases of breast cancer (confirmed by biopsy) as the case, and 29 without cancer (confirmed by mammography) as the control group. All participants underwent blood testing for complete blood count (CBC (free iron, ferritin, total iron binding capacity) TIBC (2, 2-diphenyl-1-picrylhydrazyl (DPPH), and Malondialdehyde (MDA).

    Results
    The mean±SD age of the participants was 44.25±9.82 years, and there was no significant difference between groups. Also, no statistically significant difference was found between the 2 groups in variables, except the mean corpuscular volume of red cells (MCV), mean corpuscular hemoglobin concentration (MCHC), and mean cell hemoglobin (MCH). The use of iron supplements was significantly higher in the control than in the case group (p= 0. 01), with an odds ratio of 0.19% (95% CI: 0.45-0.7). The mean serum DPPH was significantly higher in the control than in the case group (p= 0. 006), but comparison of serum MDA showed no significant difference between the 2 groups.

    Conclusion
    Iron deficiency anemia was greater in patients with breast cancer than in those without it. Moreover, iron supplementation appears to have a protective effect against breast cancer incidence. In addition, serum DPPH, as a total antioxidant index, was significantly higher in the control group.
    Keywords: Iron status, Breast cancer, Oxidative stress, Premenopausal
  • Zahra Vahdatimanesh, Kazem Zendehdel, Ali Akbari Sari, Farshid Farhan, Azin Nahvijou, Alireza Delavari, Rajabali Daroudi * Pages 768-773
    Background
    Colorectal cancer is one of the most common cancers in Iran. However little is known about the economic burden associated with this cancer in Iran. The aim of this study was to estimate the economic burden of colorectal cancer in Iran in the year 2012.

    Methods
    We used the prevalence-based approach and estimated direct and indirect costs of all colorectal cancer cases in 2012. To estimate the total direct costs, we model the treatment process of colorectal cancer patients in initial and continuing phase in Iran. Then the average cost of each treatment in each phase was multiplied by the number of patients who received the treatment in the country in 2012. We used the human capital method to estimate the indirect costs. We extracted data from several sources, including national cancer registry reports, hospital records, literature review, occupational data, and interviews with experts.

    Results
    The incidence and 5-year prevalence of colorectal cancer in Iran in 2012 were 7,163 and 22,591 individuals respectively. The economic burden of colorectal cancer in Iran was US$298,148,718 in 2012. Most of the cost (58%) was attributed to the mortality cost, and the direct medical cost accounted for 32.14 percent of the estimated total cost. The majority of the direct medical cost was associated with chemotherapy costs (50%).

    Conclusion
    The economic burden of colorectal cancer in Iran is substantial and will increase in the future years.
    Keywords: Colorectal cancer, Economic burden, Cost, Iran
  • Farbod Ebadi Fardazar, Hassan Heidari, Mahnaz Solhi * Pages 774-779
    Background
    Different factors, such as personality and psychological characteristics, are effective in the self-care and control of diabetes. This study aimed at determining the effect of educational intervention based on locus of control structure of attribution theory on the self-care behavior of patients with type II diabetes.

    Methods
    This was a quasi-experimental controlled study performed on 180 patients in Babol Diabetes Association. The sampling method was simple random sampling. Data collection tool was form C of standard questionnaire in multidimensional health locus of control (MHLC) and summary of diabetes self-care activities (SDSCA). Based on the results obtained from the initial completion of the questionnaires, educational intervention was designed as three 60-minute educational sessions using short lectures, question and answer, group discussions, and consultation methods, as well as educational materials, such as films, posters, and pamphlets. Intervention was only performed for the test group. The questionnaires were filled out again 2 and 3 months after the intervention.

    Results
    Before the intervention, there was no significant difference in the mean scores of self-care, internal, chance, and external locus of control between the 2 groups. However, 2 to 3 months after the intervention, the mean scores of self-care (p
    Conclusion
    Educational intervention decreases the mean scores of chance and external locus of control and increases the mean score of internal locus of control; as a result, it improves self-care in patients with diabetes.
    Keywords: Educational intervention, Self, care, Health locus of control, Type II diabetes
  • Shoaleh Bigdeli *, David Kaufman Pages 780-785
    Background
    The application of digital educational games in health professions education is on expansion and game-based education usage is increasing.
    Methods
    Diverse databases were searched and the related papers were reviewed.
    Results
    Considering the growing popularity of educational games in medical education, we attempted to classify their benefits, flaws, and engaging factors.
    Conclusion
    Advantages, disadvantages, and engagement factors of educational digital games used for health professions education must be the focus of attention in designing games for health professions discipline.
    Keywords: Game, Advantages, Disadvantages, Game engagement factors, Health professions education
  • Fatemeh Majdinasab, Ahmadreza Khatoonabadi, Seyyedeh Maryam Khoddami *, Amirhassan Habibi Pages 786-791
    Background
    The effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the voice features in Parkinson’s disease (PD) is controversial. No study has evaluated the voice features of PD underwent STN-DBS by the acoustic, perceptual, and patient-based assessments comprehensively. Furthermore, there is no study to investigate prosodic features before and after DBS in PD. The current study aimed to assess the efficacy of STN-DBS on the voice and prosodic features by acoustic, perceptual and self-reported evaluations in PD.

    Methods and Analysis: An experimental prospective cohort pretest-posttest group has been designed to survey patients with PD candidates for STN-DBS surgery. All participants will be evaluated by a speech and language pathologist before and after surgery in four different conditions as follow: pre-surgery: Medication On/ Medication Off; post-surgery: Stimulation On/ Stimulation Off. To compare pre-surgery and post-surgery conditions paired- samples T Test or Wilcoxon signed-rank test will be used. A 95% confidence interval (p value of
    Keywords: Parkinson's disease, Sub thalamic nucleus deep brain stimulation (STN, DBS), Acoustic, Perceptual, Voice, Prosody
  • Mahnaz Solhi, Hanieh Jormand *, Mahmoudreza Gohari Pages 792-797
    Background
    Self-medication of slimming supplements has increased, and media advertising has a role in this. The present study aimed at determining the effect of media literacy educational intervention on attitudes about self-medication of slimming supplements among the female students at dormitories of Iran University of Medical Sciences.

    Methods
    In this quasi-experimental study with a control group, 98 students were selected by multistage cluster sampling method and were randomly divided into 2 equal groups of test and control. The data collecting instrument was a researcher-made questionnaire about media literacy and attitude on self-medication of slimming pills. Based on the results obtained from the early completion of the questionnaires, an appropriate educational intervention was designed and implemented. Data were analyzed 1 and 3 months after the intervention using the following statistical
    Methods
    repeated measurements, Friedman test, Chi square, independent T-test and Mann-Whitney test.

    Results
    Before the intervention, the mean scores of attitude and dimensions of media literacy were moderate in both groups, and there was no significant difference between them. However, positive correlations were observed among attitude and knowledge (r=0.99, p= 0.001), critical thinking (r= 0.61, p= 0.001), and analysis (r= 0.37, p= 0.009) in the experimental group. The mean scores of attitudes and dimensions of media literacy were found to be significant in both groups 1 and 3 months after the intervention (p
    Conclusion
    Media literacy education was effective in promoting a positive attitude about slimming supplements.
    Keywords: Media literacy, Attitude, Slimming supplements, self, medication, Female student
  • Bayan Hosseini, Saharnaz Nedjat *, Kazem Zendehdel, Reza Majdzadeh, Azam Nourmohammadi, Ali Montazeri Pages 798-803
    Background
    During the course of disease, particularly of chronic diseases, changes in internal standards cause certain changes in the estimation of quality of life (QOL). These changes indicate the phenomenon of ‘response shift’. The present study aimed at assessing response shift in different scales of QOL in Iranian cancer patients.

    Methods
    To assess response shift through the ‘then test’ approach, we asked 211 cancer patients to complete the EORTC QLQ-C30 questionnaire at pretest (at the beginning of the study), posttest (3 months later), and then test (administered immediately after the posttest). Paired t test and Cohen’s effect size were used for comparison.
    Results
    Response shift was significant in all 4 scales under study, i.e. fatigue, pain, emotional functioning, and general QOL (p
    Conclusion
    We observed a response shift in Iranian cancer patients in our study. Thus, in light of the multifactorial nature of QOL and the effect of the response shift bias on different aspects of QOL changes, it is of utmost importance to keep this bias in mind when interpreting the results and managing cancer patients’ treatment regimens.
    Keywords: Quality of life, Response shift, Conventional change, Adjusted change, Then test
  • Robab Sheikhpour *, Fatemeh Pourhosseini, Hossein Neamatzadeh, Roghayeh Karimi Pages 804-807
    Background
    Non-Hodgkin’s lymphoma (NHLs) is known as a heterogeneous group of malignant lymphoproliferative disorders. NHLs are classified into B cell and T cell types. Immunophenotypical assessment of the biopsy specimens can help diagnose NHLs.

    Methods
    In this study, 77 patients with B cell and T cell lymphoma were selected from Shahid Sadoghi hospital during 2010 to 2013. Immunohistochemical method was used to detect biomarkers like CD2, CD3, CD20, and CD45.

    Results
    In this study, 67 patients (87.01 %) had B cell lymphoma. Moreover, the most primary tissues in B cell group were lymph node and stomach, followed by bone marrow and neck. Positive co-expression of CD45 and CD20 was found in 61 patients (91.04%) with B cell lymphoma. However, 10 patients (12.98%) had T cell lymphoma, and the most primary tissue in T cell lymphoma group was the skin. Moreover, CD3 expression was seen in all patients with T cell lymphoma.

    Conclusion
    This study confirmed the main role of immunohistochemistry method in classifying and diagnosing NHLs. Moreover, the difference in CD marker expression and age in patients with B cell and T cell lymphoma, compared to other studies may be due to geographic area and genetic and ethnic differences.
    Keywords: Non, Hodgkin's Lymphomas, CD20, CD3, CD2
  • Fatemeh Kashaninasab, Kaveh Alavi, Mohammad Farhadi, Mansour Salehi, Mir Farhad Ghaleh Bandi * Pages 810-816
    Background
    Diagnosis of obstructive sleep apnea syndrome (OSAS) is valuable, but it is time-consuming and expensive. Appropriate screening instruments help clinicians select high-risk individuals for further investigations. In the present study, we compared 4 popular instruments used in screening OSAS including Berlin, STOP, STOP-BANG questionnaires, and Epworth Sleepiness Scale (ESS).

    Methods
    A total of 250 individuals, who referred to Sleep Laboratory of Shoorideh Hospital (Tehran, Iran) for polysomnography during May 2015 to November 2015, were recruited for this cross-sectional study. In addition to taking history and physical examination, 4 screening instruments including Berlin, STOP, STOP-BANG questionnaires, and ESS were completed. Diagnosis of OSAS was established using apnea-hypopnea index (AHI) in 3 categories of mild, moderate, and severe.

    Results
    Severe OSAS was diagnosed in 159 (63.6%), moderate OSAS in 43 (17.2%), and mild OSAS in 41 (16.4%) of the participants, moreover, AHI was within normal range in the other 7 (2.8%). To diagnose OSAS with any severity, Berlin questionnaire was a preferable instrument, with a sensitivity of 79.8% and specificity of 71.4%, considering the cut-point value of 3.5. In addition, in cases of severe OSAS, Berlin questionnaire showed superiority over other instruments, with a sensitivity of 80.5% and specificity of 61.5% using the cut-point value of 3.5.

    Conclusion
    None of the 4 instruments are ideal to predict OSAS. However, considering the simplicity and availability of the instruments, Berlin and STOP-BANG questionnaires had maximum diagnostic values that helped us distinguish OSAS and severe OSAS, respectively.
    Keywords: Sleep questionnaires, Obstructive sleep apnea syndrome, Shoorideh Hospital
  • Fateme Jafaraghaee, Abbas Ebadi, Reza Negarandeh, Neda Mehrdad* Pages 817-822
    Background
    As the largest and most fundamental group targeted by programs developed to improve quality of care, nurses should be the focus of attention in the management of human resources in the field of health care. A review of literature on this subject revealed the lack of scales designed for measuring professional commitment in nurses. The present study was designed to develop a scale to measure professional commitment in clinical nurses and examine its psychometric properties.

    Methods
    This study will develop a professional commitment scale for clinical nurses within one qualitative and one quantitative step. The first step of the study will entail a review of the literature on the subject and interviews with clinical nurses so as to develop the categories and the items. The second step, the quantitative step, will analyze the items extracted in the qualitative step, determining the features of the topics and factor structure of the scale. The initial scale will be completed by 300 clinical nurses. The correlation among the topics, the construct validity, and reliability of the scale will also be examined in this step.

    Results And Discussion
    This study will develop an instrument that can measure professional commitment in clinical nurses. Given the lack of instruments for measuring professional commitment in clinical nurses, the findings of this study may be of help to nursing managers, authorities, and the health system in general.
    Keywords: Protocol, Clinical nursing, Commitment
  • Azita Ganji, Abbas Esmaeilzadeh, Omid Ghanaei, Amin Saberi *, Danial Taherzadeh, Soodabe Sazgarnia, Zohre Mayabi Joghal, Mahboube Zirak, Salman Abdolah Ramazani, Leili Zarifmahmoudi Pages 823-828
    Background
    Red blood cell distribution width (RDW) is a quantitative measure of variability in the size of circulating erythrocytes. It has been recently identified as a prognostic marker in several diseases including acute pancreatitis (AP). In this systematic review the prognostic value of RDW in predicting mortality of AP patients will be assessed.
    Methods
    PubMed, Scopus, EMBASE, and ISI databases were searched until September 2016 using the following search strategy: (pancreatitis OR pancreatitides) AND (RDW OR "red cell distribution width" OR "red blood cell distribution width" OR anisocytosis). Four authors independently reviewed the retrieved articles. Studies were included if they had evaluated the association between RDW value and mortality of acute pancreatitis patients. Case reports, comments, letters to the editor, reviews, study protocols, and experimental studies were not included. Data abstraction and quality assessment for the included studies was independently performed by two authors. Quality of studies was assessed using Oxford Center for Evidence-Based Medicine checklist for prognostic studies. Data were synthesized qualitatively, and a meta-analysis was performed on the diagnostic performance of RDW to predict mortality in AP patients.

    Results
    Seven studies (976 patients) were included in the systematic review. Six studies reported a statistically significant association between RDW value and mortality. Meta-analysis was performed on four studies (487 patients) using a bivariate model and a summary receiver operating characteristic (sROC) curve was plotted with an area under the curve (AUC) of 0.757. The pooled diagnostic odds ratio (DOR), sensitivity and specificity was 19.51 (95% CI: 5.26-72.30), 67% (95% CI: 51%-80%) and 90% (95% CI: 73%-96%), respectively.

    Conclusion
    RDW is an easy to use and an inexpensive marker with a moderate prognostic value to predict death in AP patients. Clinicians should be more alert when a patient with AP has an increased RDW. Investigation of possible combinations of other prognostic markers with RDW is recommended.
    Keywords: Red blood cell distribution width, Acute pancreatitis, Prognosis, Mortality, Systematic review, Meta, analysis
  • Fatemeh Jafarlou, Farnoush Jarollahi *, Mohsen Ahadi, Vahid Sadeghi-Firoozabadi, Hamid Haghani Pages 829-837
    Background
    Dyslexia is the most common learning disorder. Visual and oculomotor deficits in dyslexic children have been reported. The purpose of this study was to measure oculomotor parameters and analyze the effect of oculomotor rehabilitation strategies on dyslexia.
    Methods
    Binocular eye movements were recorded by oculomotor subtype of videonystagmography (VNG) testing on 30 children with dyslexia and 20 typical reader children (aged 8–12) in both genders. Dyslexic children were diagnosed with DSM-V scale by experts in reading disorder centers. We studied those children with developmental dyslexia, who had deficits in eye movements recording. Dyslexic children were divided into 2 groups of case and control. Oculomotor rehabilitation (including fixation, saccade, and tracking training) was performed in case group for 1 hour, twice weekly for 8 weeks. Before the intervention, results of oculomotor tests were compared between 3 groups (healthy, case, and control). Then, to analyze the effect of the intervention, results of oculomotor tests were compared between case and control groups in pre- and post- intervention stage. Data were analyzed by independent and paired samples t tests, ANOVA, and repeated measures tests in SPSS v. 21.
    Results
    There were significant differences in oculomotor characteristics of dyslexic children in comparison with those reported in typical children. Oculomotor rehabilitation intervention had a positive effect on improvement of oculomotor responses and eye movements in dyslexic children. Moreover, there was no statistically significant difference between dyslexic children and non-dyslexic children in oculomotor skills after the training.
    Conclusion
    Our results showed the positive effects of oculomotor rehabilitation on eye movements. Primary oculomotor assessment in dyslexic children and early use of oculomotor rehabilitation combined with other treatments are highly recommended.
    Keywords: Dyslexia, Eye movements, Oculomotor deficiency, Oculomotor rehabilitation
  • Zahra Hosseinkhani *, Zhila Moradi, Farzad Khodamoradi Pages 838-842
    Background
    The rate of elder abuse has been increasing worldwide. This study aimed at identifying the group of elders susceptible to abuse and determining the influential factors of elder abuse.

    Methods
    A total of 683 elders, living in rural and urban areas of Qazvin (Iran), participated in this cross- sectional study that was conducted during September to December 2015. They were selected by stratified multistage random sampling method and filled in a standard questionnaire (H-S/EAST). Multiple logistic regression models were used for data analysis in Microsoft SPSS v.18. Type 1 error was considered equal to 0.05.

    Results
    The average age of participants was 68.5±7.6. Also, the prevalence of elder abuse in this study was 38.5 (95% CI: 3.34-42.3). After eliminating the confounders and applying multiple regression analysis, we found a significant association between elder abuse and factors such as education level (OR= 2.003, 95% CI: 1.177-3.409), residence (OR= 3.53, 95% CI: 1.969-6.324), and age (OR= 0.963, 95% CI: 0.931-0.995).

    Conclusion
    The results of this study indicated a high prevalence of elder abuse in the studied population. By identifying high-risk individuals for elder abuse and planning to improve their quality of life, we will be able to successfully overcome this issue.
    Keywords: Elder, Elder abuse, Prevalence, Iran
  • Ameneh Ebrahim Valojerdi, Kiarash Tanha, Leila Janani * Pages 843-846
    Background
    The calculation of the sample size is one of the most important steps in designing a randomized controlled trial. The purpose of this study is drawing the attention of researchers to the importance of calculating and reporting the sample size in randomized controlled trials.

    Methods
    We reviewed related literature and guidelines and discussed some important issues in sample size calculation and reporting in randomized controlled trials.

    Conclusion
    The calculation of the sample size is one of the most important steps in designing a randomized controlled trial. According to the CONSORT (Consolidated Standards of Reporting Trials) guideline and other standard guidelines for designing and reporting of RCTs, sample size calculations should be reported and justified in all published RCTs. Because sample size calculations are prone to bias and because of the high ethical and financial costs related to conducting an RCT, we recommend involving a biostatistician at the designing stage of the study and to ask for statistical advice for sample size calculations.
    Keywords: Randomized controlled trials (RCTs), Sample size, Post hoc power
  • Maryam Aalaa, Farnaz Najmi Varzaneh, Zhila Maghbooli, Neda Samandari, Ashraf Mostafavi, Sedigheh Salemi, Neda Mehrdad, Mahnaz Sanjari * Pages 847-852
    Background
    High level of perceived stress in nurses is due to a genetic predisposition and environmental stressors. The aim of NURSE (Nursing Unacquainted Related Stress Etiologies) study was to investigate the association of C677T MTHFR gene polymorphism and stress perception among nurses.

    Methods
    In this comprehensive study, 216 female nurses were recruited. Perceived stress was assessed using the Cohen Perceived Stress Scale (PSS). Genomic DNA was extracted from peripheral blood, and MTHFR genotype was detected by the polymerase chain reaction.

    Results
    MTHFR C677T genotype analysis revealed that half of the participants had normal C/C genotype, and the remaining half presented higher frequencies of C/T genotype (39.8%) compared to T/T genotype (10.2%). The mean±SD stress score in morning shift, night shift, and rotation was 15.39±4.75, 15.92±4.94, and 15.83±5.61, respectively (p= 0.7). Perceived stress score was more in highly educated group but it was not significant (p= 0.2). Distribution of different MTHFR genotypes in diverse groups revealed that in groups with more stress score, the frequency of heterozygote (C/T) and homozygote (T/T) genotypes increased. Data revealed that in low stress category, 87% of the participants had a normal genotype. However, in high stress category, 71.3% of the participants had a normal genotype.

    Conclusion
    MTHFR genotype, independent of folate availability and probable confounding parameters, might be a potential risk factor of perceived stress among nurses.
    Keywords: MTHFR Genotype, Perceived Stress, Nurses
  • Fahad Saqib Lodhi, Owais Raza, Ali Montazeri, Saharnaz Nedjat, Mehdi Yaseri, Kourosh Holakouie-Naieni * Pages 853-859
    Background
    The present study was conducted to translate and validate the World Health Organization’s Quality-of-Life Scale -BREF into local language of Pakistan.

    Methods
    A forward- backward translation procedure was followed to develop the Pakistani version of the questionnaire. Through a multi- stage clustered sampling technique, a sample of individuals aged 18 years and above completed the questionnaire in Abbottabad district, Pakistan. Psychometric properties of the instrument including reliability (internal consistency and test-retest analysis), validity (known group comparison and items’ correlation) and their domains were assessed. Satisfactory results were also shown in the correlation matrix in all domains.

    Results
    A total of 2060 participants were recruited in this study. Participants’ mean age was 35.51 (SD= 14.31) years in healthy individuals and 39.29 (SD= 14.31) years in diseased individuals. The internal consistency of the WHOQOL-BREF (Pakistani Version) was 0.86. Moreover, the physical, psychological, and environmental domains had acceptable reliability (alpha= 0.78, 0.75, and 0.73, respectively), but reliability was low (alpha= 0.56) in the social domain. Reproducibility of the WHOQOL-BREF was as follows: ICC range: 0.72–0.92 at 2-week retest interval. After performing comparison analysis, the results indicated that the questionnaire significantly segregated the study groups in all QoL domains, except for social relationship.

    Conclusion
    The study provided strong exploratory evidence for the reliability and validity of the WHOQOL-BREF for use in Pakistan. However, more exploration is needed to improve the reliability results in the social domain.
    Keywords: Reliability, Quality of life, Validity, Pakistan, WHOQOL, BREF
  • Sahar Sadat Saeedi Shahri, Ahmad Ghashghaee, Masoud Behzadifar *, Nicola Luigi Bragazzi, Meysam Behzadifar, Nasrin Mousavinejad, Mozhgan Sadat Ghaemmohamadi, Faezeh Ebadi, Hesam Seyedin Pages 860-868
    Background
    Depression is one of the most commonly diagnosed mental disorders. Nurses and other hospital service providers are a group at high risk for developing depression. Thus, knowing the prevalence of depression among nurses can help the health care decision- makers to plan ad hoc prevention programs to control depression in this group. This study was conducted to quantitatively assess the prevalence of depression in nurses by performing a systematic review and meta-analysis.

    Methods
    ISI/Web of Science (WoS), PubMed/MEDLINE via Ovid, PsychInfo, and Embase, as well as Iranian databases such as Irandoc, SID, and Magiran were searched from January 2000 to March 2017. To calculate the pooled prevalence rate, the random effects model based on the DerSimonian-Laird approach was used. I2 and the Q tests were used to examine heterogeneity among studies. To investigate the causes and sources of heterogeneity, the impact of such variables as quality, sample size, geographic region, and criteria used to diagnose depression was analyzed performing subgroup analyses. The quality of reviewed studies was assessed according to the 22-item STROBE checklist. Sensitivity analysis was performed to investigate the stability and robustness of the obtained results. All data were analyzed using the “meta” package included in the R Software Version 3.4.0.

    Results
    A total of 30 studies were retained in the current investigation. The overall prevalence of depression was 22% [95%CI 19-27] among nurses, with a high statistically significant heterogeneity (I2= 94% and Q-test= 479.87).

    Conclusion
    This rate was higher than the prevalence of depression among the general population in Iran. Presence of happy nurses with good mental state at hospitals is essential for promoting the care provided to patients.
    Keywords: Depression, Nurses, Iran, Systematic Review, Meta, analysis
  • Arman Latifi, Effat Merghati-Khoei, Davood Shojaeizadeh, Saharnaz Nedjat, Ali Mehri, Gholamreza Garmaroudi * Pages 869-876
    Background
    Various theory-based interventions (TBIs) have been done to prevent STI/HIV. The current study aimed at reviewing the TBIs for STI/HIV prevention in Iran.

    Methods
    We systematically searched 6 English and Persian electronic databases to identify TBIs conducted for STI/HIV prevention in Iran. General searches were conducted using PubMed MeSH terms. Articles were included if they were interventional and conducted using models and theories, aimed at reducing the risk of STIs, were quasi-experimental or experimental, and if their full text was available.

    Results
    Overall, 1042 studies were found. Finally, 13 original studies met our inclusion criteria. The findings indicated that HBM and TPB were the most frequently used theory/models. High school students and drug abusers were the most common target groups in the included studies.

    Conclusion
    The results revealed that the majority of the conducted TBIs contained a methodological weakness. Conducting randomized controlled trials is needed to evaluate the effectiveness of the TBIs.
    Keywords: Sexually transmitted infections, Sexual risk, reduction intervention, Theory, Model
  • Zohreh Sohrabi, Hamid Reza Koohestani *, Nayereh Baghcheghi, Somayeh Delavari, Zahra Rezaei Shahsavarloo Pages 877-881
    Background
    Virtual education refers to a variety of teaching-learning methods that are implemented and supported electronically. The present study was conducted to determine the effects of group blogging on the attitude of nursing students towards virtual education.

    Methods
    This was a quasi-experimental pretest-posttest study in which all fifth-semester nursing students (n=25) were selected and asked to design educational blogs on nursing of respiratory diseases. Attitudes of the participants towards virtual education were measured before and after the intervention.

    Results
    Pretest and posttest mean±SD were 2.98±1.03 and 3.46±0.68, respectively, showing a significant difference (p
    Conclusion
    In general, the results revealed that blogging by nursing students could improve students’ attitudes towards virtual education.
    Keywords: Blogging, Students, Nursing, Attitude, Virtual, Education
  • Maryam Tarameshlu, Amirreza Azimi, Leila Ghelichi *, Noureddinn Nakhostin Ansari Pages 882-885
    Background
    Dysphagia is frequently observed in patients with multiple sclerosis (MS). Dysphagia and its complications are common causes of morbidity and mortality in final stages of MS disease. This study aimed at determining the prevalence of dysphagia in Iranian patients with MS and identifying predictors associated with dysphagia.

    Methods
    A total of 230 MS patients were enrolled in this cross-sectional study. Dysphagia was evaluated using Mann Assessment of Swallowing Ability (MASA). Demographic characteristics (age and gender), duration of the disease, disease course, and Expanded Disability Status Scale (EDSS) were recorded for all participants.

    Results
    In total, dysphagia was found in 85 participants (37%) with mild to severe dysphagia (mild 50.6%; moderate 29.4%; and severe 20%). The logistic regression model demonstrated that disability status in EDSS (OR= 2.1; 95% CI 0.5-1.2) and disease duration (OR= 2.3; 95% CI 0.4-1.1) predicts a high risk for dysphagia in MS patients.

    Conclusion
    Dysphagia is prevalent in Iranian patients with MS. Disability level and disease duration are significant predictors of dysphagia after MS.
    Keywords: Multiple Sclerosis, Deglutition, Deglutition disorders, Prevalence, MASA
  • Naheed Aryaeian *, Sara Khorshidi Sedehi, Tahereh Arablou Pages 886-892
    Background
    Type 2 diabetes is a growing public health problem and is associated with increased morbidity and mortality. The worldwide prevalence of type 2 diabetes is rising. Polyphenols, such as flavonoids, phenolic acid, and stilbens, are a large and heterogeneous group of phytochemicals in plant-based foods. In this review, we aimed at assessing the studies on polyphenols and diabetes management.

    Methods
    A literature search in the PubMed, EMBASE, Scopus, and ISI Web of Science databases was conducted to identify relevant studies published from 1986 to Jan 2017.

    Results
    Several animal models and a limited number of human studies have revealed that polyphenols decrease hyperglycemia and improve acute insulin secretion and insulin sensitivity. The possible mechanisms include decrease in glucose absorption in the intestine, inhibition of carbohydrates digestion, stimulation of insulin secretion, modulation of glucose release from the liver, activation of insulin receptors and glucose uptake in insulin-sensitive tissues, modulation of intracellular signaling pathways, and gene expression.

    Conclusion
    Growing evidence indicates that various dietary polyphenols may influence blood glucose at different levels and may also help control and prevent diabetes complication. However, we still need more clinical trials to determine the effects of polyphenols- rich foods, their effective dose, and mechanisms of their effects in managing diabetes.
    Keywords: Polyphenol, Blood glucose, Inflammation, Phytochemical, Type 2 diabetes
  • Hadi Ghaffari *, Ahmad Tavakoli, Davod Javanmard, Hamidreza Mollaei, Helya Sadat Mortazavi, Seyed Hamidreza Monavari Pages 893-895
  • Daem Roshani *, Alina Abdolahi, Shima Rahmati Pages 896-902
    Background
    Different studies have investigated the association between p53 codon 72 Arg>Pro polymorphism and cancer risk. Because of the lack of consensus of the results in individual studies, we conducted this meta-analysis by pooling all currently available case–control studies to estimate the effect of p53 codon 72 Arg/Pro polymorphism on cancer susceptibility in Iranian population.

    Methods
    A comprehensive search was undertaken and primary data from all peer-reviewed journals indexed in PubMed, Google Scholar, Scopus, Magiran, Scientific Information Databank (SID), Iran Medex, and CAB abstract electronic were used to conduct this meta-analysis. We considered some exclusion and inclusion criteria to select the articles. Statistical heterogeneity was explored using the I-square. Publication bias was assessed graphically and statistically by Begg’s funnel plot and Egger test. All statistical analyses were performed using StatsDirect software and a two- tailed test. P-value less than 0.05 was considered statistically significant for any test.

    Results
    Our dataset, which included 35 case-control studies, consisted of 2426 cancer cases and 2928 controls. Pooled OR and 95%CI indicated that codon 72 Arg>Pro polymorphism was not associated with odds of developing cancer among Iranian population in the dominant model (Pro/Proʸ㼾 vs. Arg/Arg: OR= 0.96, 95%CI= 0.74 to 1.24 chi2= 0.06, p= 0.8). Moreover, no significant association was detected in variant allele (Pro vs Arg: OR= 1.075, 95%CI= 0.91 to 1.25), homozygous (Pro/Pro vs Arg/Arg: OR=0.911 95%CI= 0.66 to 1.25), and heterozygous (Arg/Pro vs Arg/Arg: OR= 0.84, 95%CI= 0.7 to 1).

    Conclusion
    Our study revealed that p53 codon 72 Arg>Pro polymorphism was not associated with overall cancer odds in Iranian population.
    Keywords: Meta, analysis, Cancer, p53, Iran
  • Manouchehr Ilkhani, Hassan Shojaie Baghini, Gohar Kiamarzi, Alipasha Meysamie, Parvin Ebrahimi * Pages 903-907
    Background
    Aphasia is a common outcome of Cerebrovascular Accident (CVA) in which clinical interventions have limited effectiveness. Some evidence suggests that noninvasive stimulation of the brain can have beneficial effects in the treatment of CVA induced aphasia. In patients with motor aphasia, repetitive Transcranial Magnetic Stimulation (rTMS) is used to facilitate long-term improvement in speech ability. Since identifying effective methods for treating CVA induced aphasia can be very important in subsequent decision-making and treatment interventions, the objective of this study was to evaluate the effect of low-frequency TMS in Broca’s area in the right hemisphere on the treatment of CVA induced motor aphasia.

    Methods
    This clinical trial enrolled 24 patients with a clinical diagnosis of motor aphasia caused by CVA using convenient sampling. In this study, the effect of stimulation of Broca’s area in the right hemisphere was examined by low-frequency rTMS (one Hz) on aphasia caused by CVA. To conduct verbal fluency test in patients, their correct responses to the selected images before and after rTMS during a certain time were recorded and compared by non-parametric Wilcoxon test using SPSS16 and the significance level was considered
    Results
    The study findings suggested a significant difference between Wilcoxon test results of patients before and after rTMS (z= -4.401), and it was found that using low-frequency rTMS in the right hemisphere was effective on improving dysarthria in the study population with 95 percent confidence interval (p
    Conclusion
    According to the findings, low-frequency rTMS has the potential to be considered as a treatment for patients with non-fluent aphasia caused by CVA.
    Keywords: Repetitive Transcranial Magnetic Stimulation (rTMS), Aphasia, Cerebrovascular Accident (CVA)
  • Ali Gholami, Farhad Moradpour, Maryam Khazaee-Pool, Zahra Moosavi Jahromi, Mohammadreza Vafa, Abbas Abbasi Gharemanlo, Masoudreza Sohrabi, Nader Mahdavi, Yousef Moradi, Hamid Reza Baradaran Pages 908-914
    Background
    There is mixed evidence about food insecurity and overweight/obesity coexisting, however it is unclear about association between food insecurity and weight status in people with type 2 diabetes. Therefore, the aim of this study was to evaluate the relationship between food insecurity and weight status in individuals with type 2 diabetes in rural areas in Iran.

    Methods
    1847 patients with type 2 diabetes who were residence in rural areas completed Household Food Security Scale (six-item short questionnaire). Logistic regression model was applied to assess the independent effect of food insecurity on weight status.

    Results
    Mean age of the study population was 62.6±11.8 years, and the majority of them were female (70.4%). Most of the study population (70.4%) had unhealthy weight status. Food insecurity affected more than 46% (n=852) of the households of the study population. According to weight status, more than 40% (n=565) of overweight and obese subjects and 60% (n=18) of underweight subjects lived in households with food insecurity. The results of multiple logistic regression model showed that food insecurity was not an independent significant predictor of overweight or obesity in patients with type 2 diabetes. However, low food security (LFS) was an independent significant predictor for underweight in patients with type 2 diabetes (OR=2.35, P=0.041).

    Conclusion
    It is concluded that food insecurity was frequent in all levels of weight status of patients with type 2 diabetes in rural regions. However this association observed in underweight individuals but there was no significant overall relationship between household food insecurity and in overweight and obesity in this group of patients.
    Keywords: Food insecurity, Underweight, Overweight, Obesity, Type 2 diabetes
  • Farhad Habibi Nodeh, Ibrahim Jafari Pooyan, Iraj Harirchi, Mohammad Arab * Pages 915-922
    Background
    Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran’s health system.

    Methods
    Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and English-language databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts.

    Results
    Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran’s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural).

    Conclusion
    The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.
    Keywords: Informal payment, Elimination informal payment, Bribery, Iran's health system
  • Seyedeh Zahra Masoumi, Maryam Kashanian *, Elaheh Arab, Narges Sheikhansari, Raihaneh Arab Pages 923-926
    Background
    Pregnancy is one of the most important periods of a woman’s life and is influenced by many different factors. For years, it was assumed that teenage pregnancy can cause poor pregnancy outcome.
    The purpose of this study was to compare some pregnancy complications between 2 groups of 15 to 19 and 20 to 35 year- old primigravida pregnant women

    Methods
    This was a cross- sectional study conducted on the data sheets of primigravida women who delivered their babies in a teaching hospital. A total of 3040 eligible women entered the study; of them, 280 (9.3%) were in the 15 to 19 years age group and 2756 in the 20 to 35 years age group. The 2 groups were compared for preeclampsia, PROM, preterm birth, SGA, placental abruption, and placenta previa. A logistic regression model was used for data analysis.

    Results
    The women of the 2 groups significantly differed in BMI and socioeconomic background. The rate of preeclampsia (p=0.008), PROM (p=0.002), and preterm delivery (p=0.001) were less in the 15 to 19 years age group. The rate of placental abruption, placenta previa, IUFD, and SGA was not significantly different between the 2 groups. After multivariate regression analysis, preeclampsia (adjusted odd ratio= 2.157; 95% CI= 1.38- 4.21) and preterm delivery (adjusted odd ratio= 2.443; 95% CI= 1.78- 5.13) were found to be higher in the 20 to 35 years group.

    Conclusion
    The risk of poor pregnancy outcome is not higher in teenage pregnancies compared to pregnancies in the 20 to 35 years age group if confounding factors, including socioeconomic factors, are carefully controlled.
    Keywords: Teenage pregnancy, Pregnancy outcome, Preeclampsia, Preterm delivery, PROM (premature rupture of membranes), SGA, Placental abruption, Placenta previa, IUFD