Iranian Journal of Public Health
Volume:46 Issue: 5, May 2017

This study provided the theoretical basis for program development through a new conceptualization of the concept of family physician related health care.
Critical interpretive synthesis (CIS) was used to carry out qualitative analysis and synthesis of the literature from 2006 until 2015. At the beginning of CIS, the search strategy was designed to access electronic databases such as CINAHL, Medline, Cochrane library, PsycINFO, Embase, EBMreviews, and Thomson scientific web of science database. The main review question was the clarification of the health care related to family physician in health system, which produced over related 750 articles; 60 articles related to the research objective were studied by purposive sampling. After identifying the main categories and sub-categories, synthesis of the contradictory findings in different studies was conducted. New concepts and relationships between concepts were created using CIS of documentation related to the place of family physician in health system.
To define the original position of family physician in health system, clarify its related health care and determine its boundaries from other health care providers, and its use in the design and development of family physician’s educational program, a frame of concepts related to the main concept and question was created. A more useful means of understanding family physician is offered by the synthetic constructs of this framework.
The theoretical conceptualization of family physician position and duties in the health system can be an appropriate guide for educational program and curricula in our context.

NCDs are the leading disease burdens in China and the NCDs risk factors shifts have accelerated at an unprecedented scale over the past 30 years. The aim of this study was to analysis the natural trajectories of NCDs risk factors over the life course.
The large-scale longitudinal data from the CHNS includes nine rounds of surveys between 1989 and 2011. Overall, 145913 observations (29719 individuals) at multiple exams have been followed up over a 23-year period. The mixed-effects models with random intercepts were used to the characterize shifts in the distribution of these risk factors across the whole life course.
During about 23 years observational period across all age bands, the mean AMC, UAC, TSF, BMI, WC, DBP, SD, DD, and PA trajectory all increased until a certain age. Then decreased in both gender, whereas SBP strictly increased across lifespan; and the secular trend in AMC and WC, SBP, DBP was greater in women than in men; younger generations had higher AMC, UAC, TSF, BMI, WC, WHR, WHtR, SBP, DBP levels across adulthood, whereas younger birth cohorts had lower SD, DD, and PA levels.
We observed in a large and comprehensive longitudinal dataset that provided strong evidence of population-wide secular shifts from childhood onwards, which suggests that promoting healthier lifestyles, body weight, blood pressure and enhancing the primary practitioner’s capability should be required to reduce the burden of NCDs in China.

Forensic odontology plays important role in identification of human remains in mass disasters such as air crash, tsunami, and accidents. Palatal rugae act as an ideal requisite for human identification as they are present in all victims and are resistant to changes such as aging and trauma. The study aimed to analyze differences in shape and number of palatal rugae in population from Andhra Pradesh and Telangana states.
This study was conducted in SIBAR institute of Dental Sciences, Guntur, India in 2012 on 200 subjects, gender matched and equally divided as 100 from Andhra Pradesh and 100 from Telangana states. Rugae were studied using Kapali.S classification. Association between rugae shape and gender variation between the two populations were tested by chi-square analysis and student t-test.
Average number of rugae was more (11.84±3.03) in subjects of Andhra Pradesh, compared to Telangana (9.50 ±1.65) population. Males of Andhra Pradesh showed significantly higher mean number of total rugae than in Telangana males. Distribution of total number of different rugae shapes in males and females of both the populations showed significant variation in wavy and circular rugae patterns. Wavy, curved and straight rugae were significantly higher in males and females of Andhra Pradesh compared to Telangana population. Telangana population showed significant increase in circular rugae.
Our study revealed statistically significant variation in shape and total number of rugae between observed populations of Andhra Pradesh and Telangana states.

We aimed to study the curative effects of botulinum A toxin (BTX-A) on the treatment of post-herpetic neuralgia (PNH).
We enrolled 58 PNH patients and treated them with hypodermic injection of BTX-A in Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei, China. We measured and compared the Visual Analog Score (VAS), Neuropathy Pain Scale (NPS), Quality of Life Scale (SF-36) score, PNH seizure severity degree, seizure duration, frequency of attack and the use of painkillers before and after treatment. We used SPSS13 software package for statistical analysis. Values were expressed by mean± standard deviation. P Attack frequency, attack duration and attack severity were all significantly lower after treatment (P The use of BTX-A for treating post-herpetic neuralgia produced very promising results with very few adverse reactions. BTX-A can be considered as a valid approach in the treatment of PNH, especially in patients that do not respond well to painkillers.

The mapping of the malignization mechanism is still incomplete, but oxidative stress is strongly correlated to carcinogenesis. In our research, using fuzzy logic, we aimed to estimate the oxidative stress related-cancerization risk of the oral potentially malignant disorders.
Serum from 16 patients diagnosed (clinical and histopathological) with oral potentially malignant disorders (Dept. of Cranio-Maxillofacial Surgery and Radiology, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania) was processed fluorometric for malondialdehyde and proton donors assays (Dept. of Physiology,”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania). The values were used as inputs, they were associated linguistic terms using MIN-MAX method and 25 IF-THEN inference rules were generated to estimate the output value, the cancerization risk appreciated on a scale from 1 to 10 - IF malondialdehyde is very high and donors protons are very low THEN the cancer risk is reaching the maximum value (Dept. of Industrial Engineering, Faculty of Managerial and Technological Engineering, University of Oradea, Oradea, Romania) (2012-2014).
We estimated the cancerization risk of the oral potentially malignant disorders by implementing the multi-criteria decision support system based on serum malondialdehyde and proton donor's values. The risk was estimated as a concrete numerical value on a scale from 1 to 10 depending on the input numerical/linguistic value.
The multi-criteria decision support system proposed by us, integrated into a more complex computerized decision support system, could be used as an important aid in oral cancer screening and establish future medical decision in oral potentially malignant disorders.

Mitochondria are autonomous cellular organelles that oversee a variety of functions such as metabolism, energy production, calcium buffering, and cell fate determination. Most recently, mitochondrial dysfunction caused by mitochondrial mutations played important roles in the pathogenesis of asthma. However, the frequency of mitochondrial tRNA mutations in asthma is largely unknown.
Overall, 200 patients with asthma and 100 healthy control subjects were recruited between Jan 2015 and Dec 2015 at the Guangming New District People's Hospital, Shenzhen, Guangdong Province, China. We first performed PCR amplification of the mitochondrial tRNA genes and subsequently sequenced the PCR products, and we used the pathogenicity scoring system to evaluate the potential role of these mutations.
Two patients carrying the tRNAThr G15927A mutation, three patients carrying the tRNAAla T5655C mutation and one patient carrying the tRNAGlu A14693G mutation, these mutations were absent in healthy controls. Moreover, these mutations located at positions highly conserved between different species, and may cause a failure in mitochondrial tRNA metabolism, consequently result in mitochondrial dysfunction that responsible for asthma. In addition, the pathogenicity scoring system showed that these mutations should be regarded as “pathogenic”.
Mitochondrial tRNA mutations caused the mitochondrial dysfunction may be involved in the pathogenesis of asthma. Thus, this study provided novel insight into the molecular mechanism underlying mitochondrial tRNA mutations in asthma. Moreover, screening for the mitochondrial tRNA mutations was advised for the diagnosis of patients with asthma.

Exposure to heavy metals in development of many diseases has been investigated previously, specially created by oxidative stress. The etiology of Rheumatoid arthritis (RA) is still not fully understood but oxidative stress created by heavy metals may have role in development of RA. The aim of present study was to compare serum level of heavy metals in RA and healthy control individuals.
Blood samples of 100 RA patients were collected from different hospitals in district Sargodha, Punjab, Pakistan and 100 control individuals from Dec 2013 to May 2014.The serum samples were analyzed for determination of Pb, Cd, Cr and Ni through Atomic absorption spectrophotometer (AA 6600 Shimadzu).
Statistically highly significant difference was observed between RA patients and healthy control individuals for Pb, Cd, Cr, and Ni level (P0.01). For Cr the difference between the means of both sexes was statistically not significant in RA patients and highly significant difference was observed between both sexes in healthy control group (P0.01).
Concentration of heavy metals in serum samples of RA patients and healthy control individuals differ significantly, which shows that heavy metals may contributes towards development of RA.

We aimed to evaluate an approach to induced abortions during early pregnancies that controls the suction pressure and restricts the duration of the procedure.
Three hundred patients programmed for induced early pregnancy abortions, hospitalized in the Shandong Provincial Maternity & Child care Hospital from October 2013 to October 2015, were enrolled. Patients were randomly assigned to either research or control group. In the research group, operation pressure was controlled at 400 mmHg and operation time in the uterine cavity was kept at less than 75 s. In the control group, pressure ranged from 400-500 mmHg. Clinical variables were recorded for each patient until the fourth month after surgery, correlation and multivariate analyses were carried.
Compared with control group, anesthesia and intervention durations and the suction pressure were significantly lower and the endometrial thickness of the first late follicular phase after operation was significantly larger in the research group (P Controlling the suction pressure and time for vacuum aspiration abortions during early pregnancies can reduce the incidence of intrauterine adhesions and better protect the endometrium.

Divorce, especially in women, could be assessed from socio-cultural perspective as well as psychological viewpoint. This assessment requires cultural adopted as well as valid and reliable questionnaire. This study aimed to develop and assess the psychometric properties of a questionnaire in order to address social consequences in Iranian divorced women.
This was an exploratory mixed method study conducted during 2012 to 2014. According to the grounded theory approach in the first phase, social exclusion was extracted as a core of understanding process in participants. Based on, 47 preliminary generated items reliability and validity were assessed. In the second phase, the divorced women were recruited from a safe community center in Tehran through convenience sampling.
Exploratory factor analysis conducted on the questionnaires of 150 divorced women with mean age 41.76±8.49 yr, in that, indicated five dimensions, discriminative marital status, economic dependence on marital status, exclusionary marital status, and traumatic marital status health risks and, frightening marital status that jointly accounted for the 64% of the variance observed. An expert panel approved the face and content validity of the developed tool. The Cronbach’s alpha coefficient and the Intra-class Correlation Coefficient were found to be 0.70 and 0.85, respectively.
The present study provided a valid and reliable measure as Social Exclusion Questionnaire in Iranian divorced women (SEQ-IDW) to address social post-divorce consequences, which might help to improve women’s social health.

The Jefferson Scale of Attitude toward Physician-Nurse Collaboration (JSAPNC) has been used to measure the attitude regarding collaboration between nurses and physicians. The aim of this preliminary study was to test the reliability and validity of an Arabic version of the questionnaire and adapt it for use in Palestine.
Forward-backward translation of guidelines provided in the literature was followed. Content validity was examined by nine health experts and reliability was assessed with Cronbach’s coefficient alpha; test-retest reliability. Construct validity was explored with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) by means of survey among 414 physicians and nurses worked at Shifa Medical Complex in the Gaza Strip in 2015.
Response rate was 65% and Cronbach’s coefficient alpha was 73.2 for the entire sample. Test-retest reliability was 0.79 measured by Pearson correlation. Factor analysis with Varimax rotation revealed four factors explained 60.5% of the variance in the responses labeled as physician-nurse collaboration, doctor’s authority, Shared education and Nursing role in-patient care. Goodness of fit indices from the CFA showed a satisfactory model of fit; Comparative Fit Index (CFI) = 0.89; Root Mean Square Error of Approximation (RMSEA) = 0.06; Standardized Root Mean Square Residual (SRMR) = 0.03; and Hoelter index = 206.
The Arabic version of JSAPNC is psychometrically sound tool with satisfactory measurement characteristics including validity and internal consistency reliability. Future research is required to replicate these findings with larger and representative sample. Generalization to Arab speaking countries can be considered but with caution.

Breast cancer is the most common diagnosed cancer among women in the world. Snail1 plays a role in the development of the invasive phenotypes of cancer, neural cell differentiation, cell division and apoptosis in tumor cells. Traces of snail1 in metastasis of breast cancer to bone are observed. The aim of this study was to investigate the effect of specific snail1 siRNAs on the proliferation, migration, induction of apoptosis and cell cycle arrest of MDA-MB-468 cells.
In 2015, this experimental study was performed on the MDA-MB-468 cell lines in Immunology Research Center, Tabriz University of Medical Sciences. After the design and construction of siRNA, transfection was performed with transfection reagent. The expression levels of mRNA and protein were measured by qRT-PCR and western blot analysis, respectively. The survival of cells was determined by using MTT assay cells, apoptosis using Tunel assay, Cell migration using scratch assay, Cell cycle analysis by Propidium Iodide (PI) DNA staining method using flow cytometry on the MDA-MB-468.
Transfection with siRNA significantly suppressed the expression of snail1 gene in dose-dependent manner after 48 h (P The snail1 can be considered as a potent adjuvant in breast cancer therapy.

Injuries and fatalities from road traffic Injuries are global public health concerns, and a major problem in the Iran. This study aimed to explore strategies to control road traffic Injuries (RTI) in Iran.
We conducted a qualitative study to explore possible ways to reduce the occurrence of road traffic Injuries in Iran in 2016. Interviewees were purposively sampled from various sectors due to multidisciplinary nature of RTIs. Participants were mainly representatives from the police, Ministry of Road, Municipal, emergency services and Ministry of Health. Besides, public health authorities, researchers, and university professors were interviewed. We conducted in-depth interviews using generic guides. Data was analyzed using MAXQDA 10 software. Through content analysis, we interpreted core themes relevant to the accomplishment of our study objectives.
Themes that emerged from our study include; road traffic management, governance, education, improving accident database, enforcement, driving license restrictions, and construction of pedestrian overpass.
This study revealed key informants’ views regarding available and affordable solutions to reduce RTIs in Iran. Many applicable strategies are identified in the control of RTIs in Iran. Although some solutions such as highway construction and/or expanding rail transportation have been suggested as effective measures for reducing accident, but they are costly and may not be fully applied in developing countries like Iran.

Spinal Cord Injury (SCI) is a devastating situation. Spinal Cord Injury affects functional, psychological and socioeconomic aspects of patient's lives. The ability to accomplish and explicate the one’s own and other’s feelings and emotions to spread over appropriate information for confirming thoughts and actions is defined as emotional intelligence (EI). The goal of this study was to evaluate depression and EI in SCI patients in comparison with healthy subjects.
One-hundred-ten patients with SCI and 80 healthy subjects between Aug 2014 and Aug 2015 were enrolled. The study was conducted in Imam Hospital, Tehran, Iran. All participants were asked to fill valid and reliable Persian version Emotional Quotient inventory (EQ-i) and Beck Depression Inventory (BDI). All data were analyzed using SPSS. Data were presented as Mean±SD for continuous or frequencies for categorical variables. Continuous variables compared by means of independent sample t-test. P-values less than 0.05 were considered as significant.
Mean age of patients was 28.7 and mean age of controls was 30.2 yr. Spinal cord injury in 20 (18.3%) were at cervical level, in 83 (75.4%) were thoracic and in 7 (6.3%) were lumbar. Mean values of independence, stress tolerance, self-actualization, emotional Self-Awareness, reality testing, Impulse Control, flexibility, responsibility, and assertiveness were significantly different between cases and controls. Mean values of stress tolerance, optimism, self-regard, and responsibility were significantly different between three groups with different injury level. Most scales were not significantly different between male and female cases.
Emotional intelligence should be considered in SCI cases as their physical and psychological health is affected by their illness.

Myocardial infarction (MI) occurs due to heart muscle death that costs like human life, which is higher than the treatment costs. This study aimed to present an MI prediction model using classification data mining methods, which consider the imbalance nature of the problem.
We enrolled 455 healthy and 295 myocardial infarction cases of visitors to Shahid Madani Specialized Hospital, Khorramabad, Iran, in 2015. Then, a hybrid feature selection method included Weight by Relief and Genetic algorithm applied on the dataset to select the best features. After selection of the features, the metacost classifier applied on the sampled dataset. Metacost made a cost sensitive J48 model by assigning different costs ratios for misclassified cases; include 1:10, 1:50, 1:100, 1:150 and 1:200.
After applying the model on the imbalanced dataset, the cost ratio 1:200 led to the best results in comparison to not using feature selection and cost sensitive model. The model achieved sensitivity, F-measure and accuracy of 86.67%, 80% and 82.67%, respectively.
Experiments on the real dataset showed that using the cost-sensitive method along with the hybrid feature selection method improved model performance. Therefore, the model considered a reliable Myocardial Infarction prediction model.

One of the economic evaluation techniques involves calculation of willingness to pay (WTP) for a service to find out the value of that service from the clients’ perspective. This study estimated WTP for both breast cancer and osteoporosis screening and comparatively examined the contributing factors. In fact, the comparisons served to provide an exact analysis of individual attitudes and behaviors in relation to screening programs for cancers and other diseases.
This study was first designed in six scenarios several questionnaires concerning individual breast cancer and osteoporosis screening cases, and determined the WTP median in each scenario between people in Kerman Province of Iran in 2016. Then, the demand function for breast cancer and osteoporosis screening was formulated. Moreover, the factors contributing to WTP were examined through various scenarios in Stata and econometric techniques.
The median and mean values of WTP in all the above scenarios were greater for breast cancer screening than for osteoporosis screening. Theoretically, the price assumed a minus sign whereas risk assumed a plus sign within the demand function formulated for both screening programs. Regarding the evaluated factors, age in breast cancer screening and risk of disease in osteoporosis screening were the major factors contributing to WTP.
Breast cancer screening was more valuable than osteoporosis screening program from the perspective of the subjects. The programs can be successfully designed by concentrating on patients’ age groups in breast cancer screening and high-risk patients in osteoporosis screening.

Tehran is the capital of Iran with an increasing Multiple Sclerosis (MS) incidence. A retrospective population-based study was conducted to evaluate the status of MS prevalence and MS incidence trends in Tehran Province, Iran.
A population-based study was conducted from 1991 to 2014 in Tehran Province, the capital city of Iran based on Iranian MS Society (IMSS) registry system. A structured questionnaire design to cover the important epidemiological variables, related at the individual level for MS. A Monte Carlo Permutation method was utilized to test whether the apparent change in MS trends during 1991-2014 was statistically significant.
MS incidence was significantly increased during our study period. The annual percent change (APC) was 12.8% in women during 1991 to 2004 and 12.5% in men during the same period. The point prevalence of MS was 101.39 per 100000 populations in 2014. The age-adjusted prevalence rates were 134.03 and for male patients were 42.45 per 100000.
MS prevalence and incidence in Tehran are markedly rising, it is crucial to elucidate the causes of the increasing trends and implement efficient policies lowering disease burden.