فهرست مطالب

  • Volume:32 Issue: 1, 2018
  • تاریخ انتشار: 1397/05/30
  • تعداد عناوین: 135
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  • Abdul Hameed*, Jamshed Ali, Kiran Munawar, Farah Arshad, Farhana Badar, Neelam Siddiqui Pages 1-5
    Background
    Multiple myeloma (MM) is a plasma cell disorder characterized by presence of monoclonal protein in serum or urine or both, increased bone marrow plasma cells, osteolytic lesion, hypercalcemia, and anemia. Several combination regimens are commonly recommended for treatment of multiple myeloma. The present study aimed at determining the characteristics and outcomes of patients with multiple myeloma treated at our centre.

    Methods
    During July 2012 and December 2015, all patients with proven diagnosis of MM were included in this study. Data were collected from hospital information system. The characteristics and outcomes of all patients were analyzed. Progression- free survival and overall survival of patients were also estimated. Kaplan-Meier curves and Log-rank test were applied and SPSS Version19 was used for data analysis.

    Results
    A total of 82 patients, with the median age of 51 years (Range: 23-64 yrs.) were available for final analysis. The number of patients with IgG and IgA type was 48 (58.5%) and 15(18.3%), respectively. There were 7 (8.5%) patients with non-secretory type. Most of the patients (n= 59; 71.9%) were treated with CTD regimen and 13 (15.8%) received bortezomib-based treatment. The median progression-free survival time was 30 months, and overall survival time was 48 months. The cumulative probability of survival at 36 months was 85%.

    Conclusion
    Based on our results, the onset of multiple myeloma occurs in relatively younger age groups. A small number of patients received bortezomib due to cost issues. PFS and OS in our study were comparable with published literature.
    Keywords: Multiple myeloma, Survival, Anemia, Bone disease, Plasma cells
  • Taher Akbari Saeed, Meysam Ahmadi Zeydabadi, Ahmad Fatemi, Alireza Farsinezhad * Pages 6-12
    Background
    Tissue engineering has been investigated as a potential method for healing traumatized tissues. Biomaterials are material devices or implants used to repair or replace native body tissues and organs. The present study was conducted to evaluate the effects of decontamination methods on biological/mechanical properties and degradation/adhesion test of the platelet‑-rich fibrin (PRF) membranes to compare these properties with intact membranes as a biological biomaterial.

    Methods
    The in vitro degradation tests were conducted by placing the equal sizes of (i) intact PRF membrane, (ii) PRF membrane sterilized by autoclave (iii), ultraviolet (UV), and (iiii) gamma irradiation in phosphate buffer solution on a shaker. The degradation profiles were expressed. Adhesion test was performed by counting adhered mouse fibroblast and sterilized fibrin membrane was compared to normal fibrin membrane by different sterilization methods.

    Results
    The preliminary findings of sterilized PRF membranes showed that UV exposure (p
    Conclusion
    Sterilization of fibrin membrane with different protocols does not have any adverse effects on cell adhesion; however, cell adherence is naturally very weak even in normal membranes. Also, it seems that ultraviolet ray polymerizes fibrin filaments and merges them to each other and increases the ability of fibrin membrane against degradation. Autoclaved fibrin membrane content proteins are denatured because of pressure and heat and show an increase in hardness and stability against degradation.
    Keywords: Fibrin, Tissue, Membrane, Mechanical phenomena, Biological phenomena, Decontamination
  • Hanieh Raji, Seyed Ali Javad Moosavi, Maryam Dastoorpoor, Zahra Mohamadipour, Parvin Mousavi Ghanavati * Pages 13-17
    Background
    The aim of the present study was to evaluate the utilization and diagnostic yields of CT pulmonary angiography (CTPA) using the Revised Geneva score and Wells’ criteria, in patients with suspected pulmonary embolism (PE).

    Methods
    One hundred and twelve adult patients underwent CTPA for suspected PE were participated in this study. The outcome was positive or negative CTPA for PE. Revised Geneva and Wells’ scores were calculated. The relationship between the results obtained from these two scores and the available risk factors were compared.
    Descriptive analysis such as frequency and mean as well as analytical statistics including chi-square were done. The data analysis was performed using SPSS (v. 22).

    Results
    In this study, according to the Wells’ criteria calculated for the patients, 33.9% of the patients had low clinical, 56.3% intermediate and 9.8% high clinical probability. Among the 11 high clinical patients, 9(81.8%) were CTPA positive. Based on the revised Geneva score, 65 patients (58%) had low clinical, 36 (32.1%) intermediate and 11(9.8%) high clinical probability. Among the 11 high clinical patients, 8 were CTPA positive. Positive predictive value of the low clinical patients based on Wells’ criteria and the revised Geneva score was 18.4% and 30.8%, respectively. Also, positive predictive value for high clinical probability of Wells’ criteria and the revised Geneva score was 81.8% and 72.8% respectively.

    Conclusion
    Under/overuse of CTPA in diagnosing PTE is a common problem especially in university hospitals. It is possible to avoid unnecessary CTPA requests using scholarly investigations and more accurate clinical risk assessments.
    Keywords: Pulmonary Embolism, Pulmonary CT angiography, Well's score, Revised Geneva score
  • Rasoul Zarrin, Morteza Bagheri, Alireza Mehdizadeh, Parvin Ayremlou, Amir Hossein Faghfouri * Pages 18-21
    Background
    Some genetic factors are involved in the etiology of Hashimoto thyroiditis and Graves’ disease as autoimmune thyroid diseases (AITDs). Effects of vitamin D receptor gene polymorphisms in AITDs development have already been investigated in some previous studies. However, no study has been done on the association between VDR FokI and ApaI polymorphisms and AITDs in an Iranian population. In this study, the possible effects of FokI and ApaI polymorphisms on AITDs were investigated in the population of northwest of Iran.

    Methods
    A total of 121 AITDs adult patients and 117 healthy controls matched by age and sex in the same population were included in this study. FokI and ApaI polymorphisms were genotyped by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). Chi-square test and odds ratio (OR) with 95% CI were used to analyze the data.

    Results
    FokI and ApaI genotypes frequencies were not significantly different between the 2 groups (p= 0.06, p= 0.73, respectively). However, FokI "CC" and "CT" genotypes were related to AITDs risk (p= 0.03; OR= 3.75; 95% CI, 1.16-12.17 and p= 0.04; OR= 3.41; 95% CI, 1.03-11.28, respectively).

    Conclusion
    These data suggest that FokI polymorphisms are involved in AITDs susceptibility in the population of northwest of Iran.
    Keywords: Vitamin D receptor, Genetic polymorphisms, Hashimoto disease, Grave's disease
  • Nejat Mahdieh, Sedigheh Saedi, Mahdieh Soveizi, Bahareh Rabbani, Nasim Najafi, Majid Maleki * Pages 22-26
    Background
    Arrhythmogenic ventricular cardiomyopathy (AVC) is an inherited cardiac disorder affecting 1 in 1000 individuals worldwide. The mean diagnosed age of disease is 31 years. In this article, an Iranian family reported that they were affected by ARVC due to a novel PKP2 mutation.

    Methods
    Clinical evaluations, 12-lead ECG, CMR, and signal-averaged ECG were performed. After DNA extraction, genetic testing was done, and PCR-sequencing was applied to find causal mutations. Segregation analysis was also performed for the family.

    Results
    ARVC criteria were documented in the patients. Genetic testing revealed a novel chain termination mutation (p.Tyr168Ter) in PKP2 gene; this mutation was transmitted from the mother to her 23-year-old son, but only the son was affected with ARVC.

    Conclusion
    Modifier genes were indicated using interactome analysis of Plakophilin 2 protein (PKP2); they might have led to phenotypic variability through cellular mechanisms, such as nonsense-mediated mRNA decay. At least, 9 proteins were identified that might have affected Plakophilin 2 protein function, and consequently, rationalizing this intrafamilial phenotypic variability. This study highlighted the role of modifier genes involved in ARVC as well as the major role of PKP2 mutation in developing the disease in our population.
    Keywords: ARVC-D, PKP2 gene, Phenotypic variability
  • Ali Sarabi Asiabar, Abbas Saleh Ardestani * Pages 27-32
    Background
    Effective leadership is regarded as an important factor in organizational success. This study aimed at performing a systematic review on leadership effectiveness among hospital managers.

    Methods
    A search was conducted in ScienceDirect, ProQuest, Web of Science, Ovid, and Scopus databases on the factors related to effectiveness of hospital managers’ leadership during 1990 and 2016. The initial results included 2795 papers, but after further investigation and qualitative evaluation using CASP-19, a total of 8 papers were included in the systematic review. Then, summarizing, classification, and comparison were used for data analysis and synthesis.

    Results
    From among the 8 investigated papers, 4 were conducted in different regions of the US and the other 4 studies were done in Canada, India, Turkey, and South Africa. The latest and oldest studies were conducted in 2016 and 1992, respectively. The papers included 4 reviews, 3 cross-sectional studies, and 1 qualitative study. Effective factors on the effectiveness of managers’ leadership were identified and classified into 4 categories of self-management, people management, health services provision management, and nuclear management skills.

    Conclusion
    Despite the emphasis of various studies on the existence of different effective factors on hospital managers’ leadership, all these factors can be categorized as people management skills, self-management skills, nuclear management skills, and health services provision skills.
    Keywords: Leadership effectiveness, Self-management, Organizational success, Systematic review
  • Azizallah Dehghan, Maryam Nasirian, Ali Akbar Haghdoost, Ehsan Bahramali, Hamid Sharifi * Pages 33-36
    Background
    Verbal Autopsy Questionnaire (VA) is an important tool to estimate the cause of death among those populations lacking an appropriate death registration system. In this study, the validity and reliability of verbal autopsy were assessed.

    Methods
    The Persian version of the questionnaire was prepared using the translation and back- translation method. In the first and second phases of the study, 213 and 198 families of deceased persons accepted an invitation to complete the questionnaire. A physician determined the cause of death. These causes were compared with the registered cause of death on the death certificate. Sensitivity, specificity, positive predictive value (PPV), as well as the kappa statistic (between the first verbal autopsy questioning and death registry) were calculated to determine the validity of the questionnaire. Kappa statistic was also used to determine the reliability between the first and second questioning.

    Results
    The sensitivity of the questionnaire varied from 75% among deaths due to diabetes to 100% Due to breast cancer. The specificity of the questionnaire for all causes of death was higher than 97%. PPV varied from 62.5% to 100% for all causes of death. The kappa statistic between causes of death derived from death certificate, and the first VA questioning for all causes of death was above 0.7 (p
    Conclusion
    Although the Verbal Autopsy Questionnaire does not fully identify all causes of death, it can be a useful tool for diagnosing causes of death for those deceased persons who have no death certificate.
    Keywords: Validation, Reliability, Verbal autopsy, Mortality
  • Mahshid Naghashpour, Rouhollah Rouhandeh, Marzieh Karbalaipour, Mahsa Miryan * Pages 37-46
    Background
    Food addiction has been defined as consuming palatable foods leading to addictive-like behaviors. Little studies have assayed food addiction in children and adolescents. Thus, we aimed at identifying the prevalence of food addiction and the relationship between food addiction, sociodemographic and anthropometric indicators among children and adolescents in southwestern Iran.

    Methods
    This cross-sectional study was conducted on 222 elementary school students aged 7 to 13 years in Ahvaz, Iran, using a random sampling method. Sociodemographic and anthropometric indicators were obtained. The 25-item child version of the Yale Food Addiction Scale (YFAS-C) was applied to provide food addiction diagnosis and symptoms. A nonparametric analysis was used for data analysis.

    Results
    The prevalence of food addiction was 17.3%. Also, the most common symptoms associated with food addiction were (1) inability to cut down, (2) withdrawal, and (3) tolerance. The students with food addiction diagnosis were older than the undiagnosed (p=0.04). The males and students older than 8 years showed a higher food addiction score than females and students under 8 years (p
    Conclusion
    Food addiction diagnosis was more prevalent in males and students over 8 years. Females with higher YFAS-C scores had elevated body mass index z-scores, suggesting that food addiction may be a remarkable problem in childhood and early adolescence and may also be related to a risk of overweight/obesity in Iranian students.
    Keywords: Food addiction, Body mass index, Demography, Student, Iran
  • Maryam Saboute, Ali Mazouri, Fatemeh Naimi Dehnavi, Nasrin Khalesi *, Zahra Farahani Pages 47-50
    Background
    Feeding intolerance is a common complication in preterm neonates and is responsible for prolonged hospitalization. This study aimed at assessing the effects of high-dose oral erythromycin on feeding intolerance in preterm infants.

    Methods
    A randomized, double blinded, placebo-controlled trial was performed during 2014 and 2015 (Tehran-Iran). Preterm neonates aged >14 days, who met the feeding intolerance criteria were selected for the study and their medical records were randomly assigned into 2 groups by simple randomization. Infants in group A received 10 mg/kg oral erythromycin every 6 hours for 2 days, followed by 4 mg/kg oral erythromycin every 6 hours for 5 days; and infants in group B received placebo with the same route. The number of days until reaching complete oral feeding, day of discharge from NICU, and complications related to intervention were recorded and compared between the 2 groups. Independent samples t test, Mann-Whitney, Fischer exact test, and Chi square were used to analyze the relationships between variables. P-value less than 0.05 was considered statistically significant.

    Results
    A total of 20 infants in group A received erythromycin and 20 infants in group B received placebo. Erythromycin could not alter the mean volume of feeding, duration of parental feeding, length of hospitalization, and frequency of feeding discontinuity (p>0.05); however, mean days to reach complete feeding in group A was significantly shorter than in group B (9.80 vs. 16.80 days; p=0.001).

    Conclusion
    High-dose erythromycin as a rescue measure with no potential adverse effect is beneficial in reducing the time taken to achieve full enteral feeding. However, more extensive investigations are needed to determine the best administration dosage.
    Keywords: Erythromycin, High-dose, Feeding intolerance, Preterm neonates
  • Zinat Mohammadpour, Fatemehsadat Amiri, Ali Akbar Saboor-Yaraghi, Fariba Koohdani, Marjan Norouzzadeh, Loghman Sharifi, Monireh Sadat Seyyed Salehi, Amirpasha Ebrahimi, Maryam Mahmoudi * Pages 51-56
    Background
    Resveratrol (RSV) provides several important biological functions in wide variety of cells. In this study, we investigated the molecular mechanisms underlying anti-inflammatory effect of RSV on HepG2 cells by assessing the gene expression of RelA and c-Jun- subunits of NF-κB and AP-1 transcription factors.

    Methods
    HepG2 cells were settled in a serum- free medium with high concentrations of glucose (30 mM) and insulin (1 µM) overnight and were then incubated with RSV (5, 10, and 20 µM) for 24 and 48 hours. Real time quantitative polymerase chain reaction (qRT-PCR) was used to determine RelA and c-Jun expression.

    Results
    RSV diminished hyperglycemia/hyperinsulinemia stimulated expression of c-Jun dose- dependently after 24 and 48 hours (p
    Conclusion
    The findings of the present study demonstrated that RSV may be considered as a preventative and therapeutic agent for antagonizing inflammation in Hepatocellular carcinoma (HCC).
    Keywords: AP-1, c-Jun, Hyperglycemia, Hyperinsulinemia, Inflammation, Resveratrol, NF kappa B, MAPK
  • Akram Sarabi Asiabar, Hamid Asadzade Aghdaei, Azar Sabokbar, Mohammd Reza Zali, Mohammad Mehdi Feizabadi * Pages 57-61
    Background
    Crohn's disease and Ulcerative colitis are known as inflammatory bowel disease with high morbidity which are as a result of increasing immune responses to intestinal microbiota in genetically susceptible individuals. The association of adherent invasive Escherichia coli with Crohn's disease in human has been discussed for decades. The principal aim of this study was to assess the relationship between adherent invasive Escherichia coli in Iranian patients with Crohn's disease.

    Methods
    The presence of adherent invasive Escherichia coli DNA and viable adherent invasive Escherichia coli cells were identified through PCR and conventional culture methods, respectively. All the specimens were subsequently cultured in Hi Chrome Agar medium.

    Results
    Using molecular assay, the invasive plasmid antigen H and invasion-association locus genes were detected from tissue samples confirming the presence of adherent-invasive Escherichia coli. The invasive plasmid antigen H was detected in 46.7% of CD and 13.3% of healthy peoples. The invasion-association locus gene was found in 36.7% of patients with Crohn's disease and 10% in individuals without IBD.

    Conclusion
    This study demonstrated an increased frequency of adherent invasive E. coli with invasive plasmid antigen H and invasion-association locus genes from patients with CD in comparison to control individuals. Moreover, it was shown that adherent invasive E. coli with the invasive plasmid antigen H and invasion-association locus genes can act as a predisposing factor in the development of IBD.
    Keywords: Crohn Disease, Inflammatory bowel disease, Escherichia coli, PCR
  • Ali Mouseli, Mohsen Barouni, Mohammadreza Amiresmaili, Siamak Mirab Samiee, Leila Vali * Pages 62-67
    Background
    Clinical laboratories need to manage resources properly and scientifically to survive in today's highly competitive environment. In this context, scientific-economic principles should be considered to determine the profitability or loss of laboratories. Thus, in this study, the net profit of laboratory services was measured based on scientific-economic principles.

    Methods
    This was an applied research with descriptive-retrospective approach. A laboratory was selected from 61 laboratories of Kerman, Iran, which performed the highest number of tests among the laboratories of this city. In addition, due to easy access, it was the most visited laboratory by patients. The present study had 2 main phases: (1) measuring the price of services and (2) calculating the net profit of the studied laboratory. Data analysis was performed using activity- based costing (ABC) as an econometric model and Excel software.

    Results
    The highest charges were related to direct costs (78.28%); consumable goods (47.26%) and professional and logistic human resources (46.31%) had the highest share of these costs. In the test groups, the most expensive tests belonged to the hormones (23.03%) and clinical chemistry (20.84%). Total cost, revenue, and the net profit of the studied laboratory were 641 645, 1 390 942, and 749 297 USD, respectively. After doing sensitivity analysis (50% increase in the frequency of tests), the following values were obtained: 987 071, 2 086 413, and 1 099 342, respectively.

    Conclusion
    Some test groups in the studied laboratory were not profitable, and this was due to the high cost of these tests and illogical tariffs. One way to overcome this problem is to increase the frequency of laboratory tests.
    Keywords: Cost price, Direct, indirect costs, Net profit, Clinical laboratories, Tariffs
  • Faezeh Ebadi, Ahmad Ghashghaee, Nicola Luigi Bragazzi, Mariano Martini, Razieh Sepehrian, Mozhgan Sadat Ghaemmohamadi, Sahar Sadat Saeedi Shahri, Meysam Behzadifar, Aidin Aryankhesal, Masoud Behzadifar * Pages 68-77
    Background
    Low birth weight (LBW), a crucial determinant of neonatal complications, represents a major public health concern worldwide. Epidemiological research is of crucial importance for designing and implementing ad hoc interventions for this issue, helping and guiding decision- and policy-makers in each country to prevent the increased prevalence of LBW in infants through estimating the prevalence rate, identifying and controlling major risk factors. The present investigation aimed to systematically assess LBW prevalence rate in Iran and its determinants.

    Methods
    PubMed/Medline via Ovid, Embase, Web of Science and Scopus as well as Magiran, SID and Irandoc were searched from inception until November 2016. Also, the grey literature (via Google Scholar) was mined. The DerSimonian-Laird model was exploited. The I2 and Q-test tests were used to investigate heterogeneity between the studies. Sensitivity and subgroup analyses were performed to ensure the robustness and validity of our findings. Different cumulative meta-analyses were conducted stratifying according to the year of publication and sample size. Any potential bias in publication was assessed carrying out the Egger’s test.

    Results
    LBW prevalence rate was estimated to be 8% (95%CI: 7-9) in Iran. Sensitivity analysis confirmed the stability of finding. Studies were cumulated by the year of publication, and the results did not change pre- and post-cumulative meta-analysis. No publication bias could be observed.

    Conclusion
    LBW prevalence rate in Iran is well comparable with the prevalence figures of both developed and developing countries. This could be due to the health reforms implemented in Iran throughout the years.
    Keywords: Low birth weight, Systematic review, meta-analysis, Iran
  • Javad Jamshidi, Ali Asnaashari, Reza Alipoor, Sina Mohammadi, Sara Roostaei, Mohammad Mahdi Samadian, Saiedeh Honamrmand Aliabadi, Ehsan Bahramali Pages 78-82
    Background
    ATP2B1 and STK39 have been introduced as essential hypertension candidate genes. The association of these genes’ variations have not been studied in Iranian population yet. Here we aimed to investigate the association of ATP2B1 rs2681472 and STK39 rs35929607 polymorphisms with the risk of hypertension in an Iranian population.

    Methods
    We included 400 individuals in our case-control study: 200 cases with essential hypertension and 200 healthy sex and age matched controls. All subjects were genotyped for rs2681472 and rs35929607 using a PCR-RFLP method. Genotype and allele frequencies were compared between the two groups using chi-squared test. The association was further assessed under log-additive, dominant and recessive genetic models.

    Results
    There was no association between rs2681472 and rs35929607 polymorphisms and risk of essential hypertension in our population (p>0.05). There was also no association between the studied polymorphisms and hypertension under different genetic models.

    Conclusion
    Our study indicated that rs2681472 of ATP2B1 and rs35929607 of STK39 may not have a significant effect on the risk of essential hypertension in Iranian population. More studies are still needed to validate our results.
    Keywords: Essential hypertension, ATP2B1, STK39, Polymorphism, Association study
  • Bahareh Yazdizadeh, Farideh Mohtasham * Pages 83-88
    Background
    Universal health coverage (UHC) is the desired goal of achieving universal access to health services without having to endure pain and financial difficulties. Multiple factors can help steer countries toward UHC. One of the most important factors is the production of valid quality evidence that can be achieved through research. The present study aimed at outlining the status of research systems in UHC–related organizations and identifying the barriers faced by research.

    Methods
    The key individuals and organizations that could provide rich, relevant, and diverse data in response to the research question were purposively selected for the interviews. Thematic analysis was used to analyze the interviews. Categories and subcategories were deductively extracted from the text based on research system performance as follows: resource provision, production and utilization of knowledge, existing resources, and stewardship. Then, the themes were inductively extracted from the interviews.

    Results
    Many barriers existed for performing research in UHC–related organizations. The stewardship barrier seemed to play a key role such that structural changes in organizations affected the production & utilization of evidence. Limited financial and human resources were evident in most of the organizations. Research questions were not comprehensively identified. The conducted studies either were not designed to answer the relevant questions and/or were not appropriately reported to policy makers. As a result, their implementation in decision- making did not reach the ideal status.

    Conclusion
    Research utilization aimed at achieving UHC will come to realize only when and if research is conducted to produce evidence required for decision–making and implementation. Therefore, in addition to the interventions recommended by the World Health Organization, we should design and implement interventions tailored to the local barriers and needs of UHC–related organizations.
    Keywords: Universal Health Coverage, Research Systems, Iran
  • Ahmad Ghasemi, Atabak Allafasghari, Mani Mofidi * Pages 89-93
    Background
    Computed tomography scans (CT scan) and X-rays are used to diagnose paediatric maxillary sinusitis. This study aimed at exploring the diagnostic value of the conventional and colour Doppler ultrasounds and their specific findings in cases of paediatric sinusitis.

    Methods
    A total of 60 children diagnosed with sinusitis were included in this study. The conventional and colour Doppler ultrasounds of the sinus were performed on each of them. The symptoms that suggested increased blood flow to the sinuses were interpreted as positive findings on the colour Doppler ultrasound and were named “Ghasemi signs” for the purpose of this study. Such symptoms included unilateral artery bumps on the front artery, reduction of arterial resistive index (RI) to less than 0.5, and diameter of 2 mm or above for maxillary arteries. Sensitivity, specificity, and positive and negative predictive values, and accuracy of the conventional and colour Doppler ultrasounds were also calculated.

    Results
    Compared to CT scan, the conventional ultrasound showed sensitivity and specificity of 73.4% and 100%, respectively. Sensitivity and specificity for the colour Doppler ultrasound were 89.36% and 100%, respectively. The maxillary artery diameter in normal and affected maxillary sinuses were, respectively, 2.4 mm (2.1–2.6, 95% CI) and 1.7 mm (1.6–1.9, 95% CI), with p
    Conclusion
    The findings of this study revealed that the conventional ultrasound agrees with the CT scans in the diagnosis of paediatric maxillary sinusitis. This diagnostic modality becomes even more valuable when the colour Doppler is used, particularly when considering the specific symptoms (Ghasemi signs) suggested by this study.
    Keywords: Sinusitis, Pediatric, Ultrasound, Colour Doppler, Ghasemi sign
  • Elham Esfandiari, Mohammad Ali Sanjari *, Ali Ashraf Jamshidi, Mojtaba Kamyab, Hamid Reza Yazdi Pages 94-99
    Background
    Knee osteoarthritis (KOA) is associated with a decrease in function, increase in pain and risk of falls. Lateral wedge insole (LWI) is commonly prescribed in KOA to improve pain and function. Our study aimed to 1) evaluate the clinical symptoms and risk of falls in early KOA and compare with controls; 2) evaluate the immediate and four-week effect of LWI.

    Methods
    A sample of 20 Persian dwelling individuals with early KOA and 19 matched controls were recruited. Pain with Visual Analogue Scale (VAS), Quality of life (QOL) with the knee injury and osteoarthritis outcome score, risk of falls with the Timed Up and Go (TUG) and static One-leg Balance (OLB) tests were assessed. The four-week effect of 5º LWI was considered for individuals with KOA. Independent t-test was done to report the between-group differences, and paired t-test was used to report the four-week effect of LWI.

    Results
    At baseline, statistically significant higher scores for pain, lower scores for QOL, and higher risk of falls were observed in KOA compared to controls (p
    Conclusion
    People with early KOA showed higher pain and lower level of QOL that were associated with higher risk of falls. LWI may have the potential to improve clinical symptoms and reduce the risk of falls at the early stage of KOA.
    Keywords: Osteoarthritis, Knee, Symptoms, Accidental falls, Foot orthoses
  • Farid Najd Mazhar, Hooman Shariatzadeh, Morteza Balvardi, Morteza Nakhaei Amroodi, Alireza Mirzaei * Pages 100-104
    Background
    Congenital radial club hand (RCH), as a rare congenital deformity of the upper extremity, is characterized by a wide spectrum of malformations including radial deviation. Centralization surgery is the standard treatment for severe cases that have been associated with a high rate of recurrence. This study reports the long-term results and recurrence rate of radial deviation following the centralization surgery of RCH.
    Methods
    The medical records of 13 congenital RCH patients (16 hands), who underwent centralization surgery, were reviewed retrospectively. Hand-forearm angle (HFA), hand-forearm position (HFP), and ulnar bow (UB) were used to assess forearm angles.
    Results
    The mean age of the patients was 19.4±8.9 months, and their mean follow-up was 62.1±39.9 months. The mean HFA correction was 29.4°±23.9°, the mean HFA recurrence was 13.3°±13.7°, the mean correction of HFP was 13.4±7.3 mm, and the mean recurrence of HFP was 1.4±2.8 mm. The mean UB showed 7.6°±12.5° correction immediately after surgery and a further 3.6°±7.3° at the last follow-up (overall 11.2°±17.6°). A number of 12 out of 13 parents were completely satisfied with the results.
    Conclusion
    According to our results, an acceptable long-term result is expected after the centralization surgery of RCH. However, the risk of the recurrent radial deviation is high and needs to be optimized in future investigations.
    Keywords: Radial club hand, Radial deviation, Centralization, Recurrence
  • Ehsan Zarei, Adeleh Nikkhah, Behrouz Pouragha * Pages 105-110
    Background
    Physiotherapy services constitute a principle part of health care systems, and interest in their use has increased in the recent decades. This study was conducted to investigate the utilization and OOP payment for physiotherapy services in public hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran.

    Methods
    This cross-sectional study was conducted using the data of physiotherapy department of three public hospitals. The study sample included 6528 patients who had received 7257 episodes of care. Data were extracted through hospital information systems and analyzed using multivariate regression analysis by SPSS17. ýýýýýý

    Results
    The average episode per patient was 1.11 and 12.6 session per episode.ý The average cost of each episode and treatment session was 1 784 660 IRR (USD 59) and 142 023 IRR (USD 4.7), respectively. The OOP payment share for physiotherapy was 31%. Age, OOP amount, having insurance coverage, insurance type, and service type significantly affected physiotherapy utilization. Number of treatment sessions, having insurance coverage, type of insurance coverage, and gender were related to OOP payment.

    Conclusion
    There is a large variety in utilization and OOP payment in the insurance funds, which could restrict the accessibility and utilization of services by patients, leading to inequalities in utilization. Therefore, policymakers should conduct an overall review on the tariffs and service packages of insurer organizations to provide better conditions for the elderly, unhealthy, and vulnerable population to mitigate inequality in service utilization and decrease OOP payment.
    Keywords: Utilization, Out of pocket (OOP) payment, Physiotherapy, Outpatient service, Public hospitals
  • Mostafa Setak Berenjestanaki, Masoumeh Bagheri-Nesami, Afshin Gholipour Baradari, Seyed Nouraddin Mousavinasab, Rahman Ghaffari, Manije Darbheshti Pages 111-118
    Background
    The use of positive end-expiratory pressure (PEEP) can have an important role as one of the ways to prevent and treat atelectasis, but it seems that there is still no consensus about its beneficial level. The aim of this study was to determine the effect of different levels of PEEP on the incidence of atelectasis after heart surgery.

    Methods
    This is a double-blind randomized controlled trial that was adopted from a research project recorded in the Iranian Registry of Clinical Trials. This paper is the result of a research project undertaken at Fatemeh Zahra Hospital (Mazandaran Heart Center) in 2015. 180 patients underwent open heart surgery were selected and were divided randomly into three groups: control, PEEP=8, and PEEP=10 (60 in each group). The patients in the two PEEP8 and PEEP10 intervention groups separately received 8 cm H2O and 10 cm H2O PEEP, respectively, 30 minutes after admission to the ICU for 4 hours and then received 5 cm H2O PEEP until extubation. Atelectasis was examined two hours after the extubation and on the third day after surgery.

    Results
    The incidence rates of atelectasis two hours after extubation on the first day of surgery were 22 (36.7%), 20 (33.3%) and 10 (16.7%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were statistically significant among the three groups (p=0.035). The incidence rates of atelectasis on the third day after surgery were 39 (65%), 36 (60%) and 21 (35%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were also statistically significant among the three groups (p=0.003).

    Conclusion
    The use of 10 cm H2O PEEP can lead to a reduction in the incidence of atelectasis, intubation time at the ICU and length of ICU and hospital stay. Given that this level of PEEP is effective, this method is recommended to be used in postoperative care of patients.
    Keywords: Positive End-Expiratory Pressure, Postoperative pulmonary complications, Atelectasis, Cardiac Surgery, Hemodynamic indices, Oxygenation indices
  • Mahsa Rastegar Moghadam, Azadeh Shojaei, Vahid Babaei, Farzaneh Rohani, Farideh Ghazi * Pages 119-123
    Background
    Phenylketonuria as the most common genetic metabolic disorder is the result of disruption of the phenylalanine hydroxylase gene. This study was carried out to explore the phenylalanine hydroxylase gene mutation status of Iranian phenylketonuria patients.

    Methods
    Blood samples were collected from 30 patients, and hot spot areas of the phenylalanine hydroxylase gene, including exons 6, 7, 8, 11, and 12 were studied through polymerase chain reaction and sequencing techniques.

    Results
    Eight different mutations, including 5 missense mutations, 1 splice mutation, 1 nonsense mutation, and 1 Silent/Splice mutation were detected. These mutations were R243X, R261Q, R261X, P281L, R241C, V399V, E280K, and IVS11>C. V399V and R241C were reported for the first time in Iranian population. Three polymorphisms including Q232Q, V245V and L385L and 3 novel intronic variants including IVS10-15A>C, IVS6>G, and IVS6 T>G were also detected in this study.

    Conclusion
    The results of this study prove the heterogeneous status of phenylalanine hydroxylase gene mutations in the Iranian population, which can be useful in carrier testing and genetic counseling.
    Keywords: Phenylketonuria, Phenylalanine hydroxylase gene, Sequencing, Mutation, Iran
  • Haidar Nadrian*, Towhid Babazadeh, Nadia Nadrian, Hassan Mahmoodi, Anvar Khosravi Pages 124-131
    Background
    As a primary phase of a Health Impact Assessment (HIA) on the Iranian Targeted Subsidy Plan (TSP), this study was conducted to assess the psychometric properties of a newly developed quantitative Health Policy Impact Assessment Tool (HEPIAT).

    Methods
    In 2014, multistage cluster sampling was employed to recruit 509 key informants in Sanandaj, Iran, to participate in this cross-sectional study. A comprehensive literature review was conducted to develop the initial draft of HEPIAT. Content validity was determined by a consensus panel of experts, and construct validity and factor structure of the HEPIAT were assessed using Exploratory Factor Analysis (EFA). Reliability was assessed utilizing the Cronbach’s alpha coefficient and the test– retest reliability coefficient.

    Results
    Applying EFA, the optimal solution including 35 items and 6 factors was emerged, which accounted for 64.94% of the total variance. The mean items’ relevancy, clarity, simplicity, and their total mean±SD score were 88.3±0.2, 90.1±0.5, 86.1±0.7, and 89.6±0.4, respectively. The scores of intra-class correlation coefficients (ICC) and internal consistency reliability for all the factors were ranged from 0.67 to 0.89. HEPIAT demonstrated an appropriate validity, reliability, functionality, and simplicity.

    Conclusion
    Although further works in different settings are warranted, HEPIAT may be a practical and useful quantitative instrument in socioeconomic-related HIAs aimed to inform policymakers and stakeholders on the health impacts of their decisions and plans.
    Keywords: Health impact assessment, Targeted subsidy plan, Instrumentation, Health determinants, Healthy public policy
  • Juni Handajani *, Lisdrianto Hanindriyo Pages 132-135
    Background
    Azo is a synthetic dye used in batik industries. It can be toxic to the tissue when exposed via inhalation, swallowing, or direct contact. Expression of cytokeratin will change in hyperplastic and cancer of the oral mucosa. Expression of Cytokeratin 8, 18, 19 is strong in the epithelial cells that undergo excessive hyperproliferation and oral mucosal changes in leukoplakia and squamous stratification carcinoma. The present study was conducted to analyze the expression of Cytokeratin 19 in the epithelial cells of azo-exposed buccal mucosa.

    Methods
    A total of 30 males were divided into 2 groups of azo-exposed and controls equally. Criterion for azo-exposed participants was working at batik coloring division for at least 5 years, while the controls were the ones who were not exposed to azo dyes. Exfoliative cytology using cytobrush was the method of collecting buccal mucosal epithelial cells. Expression of Cytokeratin 19 was analyzed using Cytokeratin 19 monoclonal antibody and immunohistochemical staining. Data were analyzed using independent samples t test in SPSS 13.0 software.

    Results
    There was a negative expression on the controls, while positive expression was observed in the exposed group. T test analysis showed significant differences (p
    Conclusion
    Azo dye could increase the expression of Cytokeratin 19 on buccal mucosa epithelial cells.
    Keywords: Buccal mucosa, Cytokeratin 19, Epithelial cell, Exposed-azo dye
  • Asma Pourhoseingholi, Ahmad Reza Baghestani, Erfan Ghasemi, Alireza Akbarzadeh Baghban *, Mariet Ghazarian Pages 136-141
    Background
    Use of methamphetamine (MA) and other stimulants has increased steadily over the past 10 years. Risk factor evaluation to reduce the problem in the community is one solution to protect people from addiction. This study aimed at using Bayesian zero- inflated Poisson (ZIP) model to investigate the relationship between the number of using crystal meth and some demographic factors in Tehran population.

    Methods
    A cross-sectional study was conducted to investigate crystal meth abuse in Tehran, the capital of Iran, in 2012. Stratified sampling method was used to select samples from 22 urban areas of Tehran. Trained researchers referred to the public places, such as streets, parks, squares, and libraries, to perform face-to-face interviews with the randomly selected samples. Bayesian ZIP model was used to perform the analysis, and SAS 9.3 program was used for data analysis.

    Results
    A total of 993 individuals were studied. According to Bayesian ZIP model, sex (mean= -0.27, 95%CI (-0.485, -0.061)), age (mean= 0.03, 95%CI (0.018, 0.043)), high school level education (mean= 1.276, 95%CI (0.699, 01.9)), diploma level education (mean= 10.4, 95%CI (0.511, 1.69)), and university level education (mean= 0.69, 95%CI (0.142, 1.33)) were all found to have significant associations with crystal meth usage, being the dependent variable.

    Conclusion
    Males, those with higher education levels, and older people in Tehran population are more likely to use crystal meth. This demographic information may be useful in designing preventive programs. Moreover, it is better to analyze count data with excessive zeroes using Bayesian zero- inflated model instead of the usual count models.
    Keywords: Bayesian analysis, Crystal meth, Zero-inflated Poisson, Tehran population
  • Ali Kazemi Karyani, Arash Rashidian*, Ali Akbari Sari, Sara Emamgholipour Sefiddashti Pages 142-150
    Background
    Nonmarket stated preferences valuation, especially discrete choice experiments (DCEs), is one of the commonly used techniques in the health sector. The primary purpose of this approach is to help select attributes and attributes-levels that are able to properly describe health care products or services. This study aimed at developing attributes and attributes-levels for basic health insurance system in Iran.

    Methods
    This study was conducted in 3 phases. First, narrative review was performed to identify related attributes. Also, 9 experts were interviewed to identify relevant attributes of health insurance in context. Other 36 experts rated the attributes and levels. Then, the research team decided on the inclusion of attributes and levels in the final design. The design was constructed using generic and D-efficient method with SAS 9.1. The design was divided into 3 blocks, each having 8 choice sets. Finally, the choice set was piloted with 45 participants.

    Results
    Public hospitals, and private hospitals benefits, dental insurance coverage, inpatient benefits, rehabilitation therapy, and paraclinical benefits, long-term care, medical devices benefits (Ortez, Protez, etc.), and monthly premium were identified and included in the final attribute design (D-efficiency = 98.16). The pilot study revealed that participants could easily understand and answer all the choice sets.

    Conclusion
    The results of our study indicated that health insurance service benefit packages and premium were among the most important attributes that need to be included in the final attribute design for Iranians. The policymakers and health insurance organizations should emphasize these attributes in the benefit packages to make improvements. The emphasis on these attributes can help elicit people’s preferences and willingness to pay for attributes.
    Keywords: Discrete choice experiment (DCE), Conjoint analysis, Attributes, Attribute-levels, Health insurance, Iran
  • Haleh Dadgostar *, Ghazaleh Soleimany, Shafieh Movaseghi, Elham Dadgostar, Sara Lotfian Pages 151-157
    Background
    Functional hypothalamic menstrual disorder (FHMD) has a destructive effect on the athlete’s bone mineral density and cardiovascular system. Utilizing hormone replacement therapy to treat FHMD in athletes is controversial.
    This study was conducted to examine the effect of hormone therapy on bone density and the cardiovascular system of professional female athletes with FHMD.
    Methods
    In this study, 18 female athletes with at least a 2- year history of FHMD were recruited in a 9-month single blind randomized clinical intervention (RCT) and randomly classified into 2 groups: the oral contraceptive pills (OCP) group, who received a low-dose combined oral contraceptive (OC) containing 30 µg ethinyl estradiol and 150 µg levonorgestrel (n= 10), and the control group (n = 8). Bone mineral densitometry (BMD) and certain cardiovascular risk factors were measured before and after the 9-month trial. The Chi square test was used to compare the quantitative and qualitative results.
    Results
    Bone mineral density did not change significantly in either group. Very low density lipoprotein (VLDL) (p= 0.035) and Apolipoprotein B (Apo B) (p= 0.04) reduced significantly in the OCP group. An increase was observed in the serum levels of Apolipoprotein A (Apo A) (p= 0.01) in the control group. Changes in the Apo B to Apo A ratio was significant in both groups (OCP group: p= 0.018, control group: p= 0.040). No significant changes were observed in the other measured factors.
    Conclusion
    Although the administration of estrogen did not significantly increase bone mineral density, it had positive effects on the cardiovascular system and lipid profile.
    Keywords: Functional hypothalamic menstrual disorder (FHMD), Hypoestrogenism, Bone density, Cardiovascular risk factor, Hormone therapy, OCP (oral contraceptive pills)
  • Seyed Jamaledin Tabibi, Parvin Ebrahimi *, Mozhgan Fardid, Mir Sajad Amiri Pages 158-164
    Background
    The significance and influence of organizational culture on Information Technology acceptance, especially in healthcare field, has been recognized as a source of organizational inertia. This study aimed at developing a model of Hospital Information System (HIS) acceptance for non-teaching hospitals of Iran University of Medical Sciences to encourage the authorities to promote organizational culture and successful application of HIS.

    Methods
    The proposed model was developed according to Michigan Organizational Assessment Questionnaire (MOAQ), Harrison, Hofstede models, and Comparative Values Framework (CVF). The questionnaires were designed based on the model and distributed among 400 HIS users in the hospitals under study, who were selected using stratified random sampling. The structural equation modeling method was used for data analysis in LISREL software.

    Results
    According to the final model, the influences of developmental culture on perceived usefulness, the relationship of 4 types of organizational culture with mandatoriness according to CVF, and the relationships of hierarchical and developmental culture with system use were attested. The relationships between supervision and 4 variables of HIS acceptance were confirmed. Furthermore, the influence of process/ result oriented culture on user satisfaction was demonstrated. The normed chi square index (2.60) revealed that the final model was fitted to the data. The indices were as follow: GFI= 0.95, CFI= 0.97, AGFI= 0.88, RMSEA= 0.064.

    Conclusion
    The components and structural relationships in the model of this study are applicable in the related hospitals, and using this model can promote organizational culture and acceptance of HIS by the users.
    Keywords: Hospital information system, Hospitals, Technology, Organizational culture
  • Alireza Mirzaei, Mozhdeh Zabihiyeganeh *, Seyed Adel Jahed, Elnaz Khiabani, Marzieh Nojomi, Salman Ghaffari Pages 167-172
    Background
    Numerous studies have been conducted to evaluate the frequency of hypovitaminosis D in patients with fibromyalgia syndrome (FMS) and its association with FMS symptoms. This study aimed at assessing the effect of hypovitaminosis D on the symptoms and quality of life of patients with fibromyalgia.
    Methods
    A total of 74 FMS patients with hypovitaminosis D were randomly assigned into group A (Trazodone 25 mg at bedtime vitamin D 50 000 IU weekly) and group B (Trazodone 25 mg at bedtime placebo). Serum vitamin D level, Widespread Pain Index (WPI), Fibromyalgia Impact Questionnaire (FIQ), Pittsburgh Sleep Quality Index (PSQI), and Short Form Health Survey (SF-36) were used at the beginning of the treatment and 4 and 8 weeks post treatment.
    Results
    Significant improvements were observed in WPI, FIQ, and PSQI scores in both groups. Moreover, combination of vitamin D and Trazodone resulted in significant improvement of SF-36 scores compared to Trazodone therapy. Improvement in pain-related indices including the WPI and the physical component score (PCS) fraction of SF-36 was more noticeable in vitamin D/Trazodone combination therapy.

    Conclusion
    This study suggests that vitamin D supplementation has significant therapeutic benefits in the management of FMS, especially in pain reduction of patients with fibromyalgia. According to our results, a combination of vitamin D supplements and a conventional antidepressant, when given to vitamin D-deficient fibromyalgia patients, could significantly improve both physical and psychological symptoms.
    Keywords: Fibromyalgia syndrome, Vitamin D, Pain, Quality of life
  • Maryam Dastoorpoor, Narges Khanjani, Abbas Bahrampour, Gholamreza Goudarzi, Hamidreza Aghababaeian, Esmaeil Idani * Pages 173-181
    Background
    Urban air pollutants may affect respiratory mortality. This study was conducted to investigate this effect in Ahvaz, one of the most polluted cities in the world.
    Methods
    The impact of 7 major air pollutants including O3, PM10, NO2, CO, and SO2 were evaluated on respiratory mortality in different gender and age groups using a quasi-Poisson, second degree polynomial constrained, distributed lag model, with single and cumulative lag structures adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holiday. Data were analyzed using the dlnm package in R x64 3.2.5 software. Significance level was set at less than 0.05.
    Results
    In adjusted models, for each IQR increase of O3 in the total population, the risk ratio (RR) for respiratory deaths in 0 to 14- day lags was, respectively, 1.009 (95% CI:1.001-1.016) and 1.009 (95% CI:1.002-1.017), and it was 1.021 (95% CI: 1.002-1.040) in cumulative 0 to 14- day lags. For PM10, in the total population and in adjusted models after 0 to 14- day lags and in cumulative lags of 0 to 14 for an IQR increase in the mean concentration of PM10, the RR for respiratory deaths increased significantly and was, respectively, 1.027 (95% CI:1.002-1.051), 1.029 (95% CI:1.006-1.052), and 1.065 (95% CI:1.005-1.128). NO2 showed a significant association with respiratory deaths only in the 18 to 60 year- old age group and in 9- day lags (RR= 1.318, 95% CI:1.002-1.733). Finally, the results showed that for an IQR increase in the mean concentration of CO and SO2, the adjusted RR for respiratory deaths in 9- day lags in the total population was, respectively, RR= 1.058 (95% CI:1.008-1.111) and 1.126 (95% CI:1.034-1.220).
    Conclusion
    Air pollution in Ahvaz is probably causing increased respiratory mortality.
    Keywords: Short-term effects, Air pollution, Respiratory mortality, Ahvaz
  • Mohsen Asadi-Lari, Fatemeh Homaei-Shandiz, Ali Esmaeili-Hesari * Pages 182-190
    Background
    Various treatments are used to prolong survival and improve quality of life (QOL). The purpose of this study was to assess the change in QOL scores in patients with Oesophagogastric (OG) cancer undergoing curative intent and palliative therapy.

    Methods
    This was a mix-designed cohort study with a consecutive sampling of patients with OG cancer who underwent curative or palliative treatment regimens. The QOL, as a determinant of efficacy and impact of cancer care, was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires. QOL data were collected from the eligible subjects at three points of time. The repeated measurement test was used to compare the significance of change in scores.

    Results
    Overall, 149 patients (54.4% male, 61.1% curative intent, 52.3% esophageal, 37.6 % gastric, 10.1% OG junction cancer; with mean age 62 year) with OG cancer were eligible for inclusion in the study. Compared to the palliative group, the curative group was more likely to have an esophageal tumor site, Squamous Cell Carcinoma, and stage 2 (versus stomach, Adenocarcinoma, and stage 4 in the palliative group). In comparing the patient's functional, global health status, and cancer symptom, considering time, group of treatment, and their mutual effect the result indicated significant difference between the intervention groups.

    Conclusion
    Most patients with Oesophagogastric cancer are diagnosed with an incurable form of the disease. Hence in absence of curative treatment, palliative therapy is the most effective therapy to maintain patient independency and relieve pain and symptom in order to improve their QOL. The present study has shown that palliative similar to curative intervention can improve the QOL in cancer patient especially in short term.
    Keywords: Oesophagogastric cancer, Health-related quality of life, EORTC QLQ-OG25, EORTC QLQ-C30, Repeated measurement analysis, Iran
  • Sedigheh Salavati, Arash Rashidian *, Sara Emamgholipour, Vida Varahrami Pages 191-195
    Background
    The health insurance and family physician reform in Iran were implemented in 2005. This study was conducted to assess the effect of these reforms on avoidable hospitalizations among the rural population of Eslam-shahr County, Iran.

    Methods
    We conducted a before-after study in Eslam-shahr County’s single existing hospital. This county is a part of the Tehran Province of Iran. The demographic characteristics and diagnostic codes of the rural population that were hospitalized during the 2 years leading to, and after the reforms were extracted from the hospital’s electronic information system. A list of 61 three-character and 131 four-character AHs codes were developed based on the literature review. We estimated a logistic regression model which included gender and age as independent variables to assess changes in the probability of avoidable hospitalizations following reform implementation. Analyses were carried out using STATA version 13.

    Results
    We recorded 817 rural hospitalizations before and 967 hospitalizations after reform implementation, suggesting that hospitalization growth after the reforms was almost 18.4%. The logistic regression results show that the probability of avoidable hospitalizations after the interventions had decreased compared to before the interventions were put into place (OR: 0.46; 95% CI: 0.24-0.88). Also, the probability of AHs among the 60
    Conclusion
    The reforms may have had a mixed effect on hospitalization. They may result in increased hospitalizations due to responding to the unmet needs of the population, and simultaneously they may lead to a decrease in avoidable hospitalizations and eliminate the costs imposed by them upon the health system.
    Keywords: Family physician, Health insurance, Hospitalization, Rural health
  • Maryam Saadat, Reza Salehi *, Hossein Negahban, Mohammad Jafar Shaterzadeh, Mohammad Mehravar, Masumeh Hessam Pages 196-200
    Background
    Impairment of cervical sensory input in patients with neck pain may disturb postural stability. The purpose of present study was to assess the dynamic postural stability of subjects with chronic neck pain compared to a matched control group.

    Methods
    In this case-control study, 22 chronic non-specific neck pain and 22 healthy individuals participated. Postural stability was measured with Techno-body Prokin tilting platform. Subjects performed balance tests under two conditions: eyes opened and closed. The parameters for assessment of postural stability were total stability index (TSI), anteroposterior stability index (APSI), mediolateral stability index (MLSI), and trunk deviation which demonstrated total trunk sway in medio-lateral and antero-posterior. We used a separate 2 (group) by 2 (postural difficulty) mixed-design analysis of variance (ANOVA) for analysis of postural performance.

    Results
    There were significant differences between the chronic neck pain and matched control groups in APSI, MLSI, and TSI, p
    Conclusion
    The results of this study showed that patients with chronic neck pain have poorer postural control than healthy subjects. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in patients with chronic non-specific neck pain and consider the application of intervention programs for improvement of the dynamic balance.
    Keywords: Chronic neck pain, Dynamic stability, Posture, Balance
  • Peivasteh Safarpour, Mohammad Reza Vafa, Fatemehsadat Amiri, Leila Janani, Mitra Noorbakhsh, Ensieh Rajabpour Nikoo, Homa Sadeghi Pages 201-204
    Background
    According to the recent studies, vitamin D deficiency has been correlated with progress in type 2 Diabetes and Metabolic Syndrome. The aim of this study was to assess the effect of vitamin D supplementation on glucose and lipid profiles, blood pressure, and biomarkers of liver and kidney in type 2 diabetic patients.

    Methods
    In this Double blinded randomized clinical trial, 90 patients with type 2 diabetes and serum 25-Hydroxy vitamin D levels of less than 30 ng/ml recruited from “Besat Diabetes Clinic” in Rasht, North of Iran. The subjects took 50000 IU vitamin D supplements or placebo for 8 weeks. We assessed the levels of serum 25 (OH) vitamin D, glucose and lipid profiles, oxidative and inflammatory indices, liver and kidney biomarkers, blood pressure, and sun exposure time, physical activity before and after intervention, and compared them between cases and controls.

    Results
    Vitamin D supplementation significantly increased serum vitamin D level, Superoxide Dismutase (SOD) activity, and significantly decreased serum HbA1C (Glycosylated Hemoglobin) level (p
    Conclusion
    Our results represented that weekly supplementation with 50000 IU vitamin D for 8 weeks may be effective by improving HbA1C and lipid profile in type 2 diabetes mellitus.
    Keywords: Vitamin D, Glucose, Diabetes, Lipid, Diet, Nutrition, Liver, Kidney, Type 2 diabetes, Inflammation
  • Pouran Raeesi , Touraj Harati, Khalilabad , Aziz Rezapour , Samad Azari , Javad Javan, Noughabi Pages 205-209
    Background
    In the recent decades, most studies have paid more attention to community expenditures in health sector and health outcomes. This study provides econometric evidence linking countries’ health expenditures to 3 health outcomes: (1) infant mortality, (2) under 5 mortality and (3) life expectancy within 4 different health care systems.
    Methods
    In this study, we used the econometric method to estimate the effect of health expenditure on health status. Panel data were collected and grouped for 25 countries according to the health care system over 15 years (2000-2015). The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of different factors on the 3 mentioned health outcomes.
    Results
    A significant relationship was found between health expenditures and health indicators. The effect of private health expenditures on health outcomes in countries with mixed health financing system and traditional sickness fund insurance was higher than public expenditures. Also, after comparing the results between different health care systems, we found that the effect of health expenditure on the health outcome in countries with national health system (NHS) was more than other health care systems.
    Conclusion
    To improve health status, health policymakers should focus on the factors that lie inside the health care system. Therefore, since private and public health expenditures have different effects on health outcomes in each health care system, countries should choose an optimal combination of private and public health expenditures.
    Keywords: Health expenditures, Health outcomes, Healthcare system, Panel data methodFull-Text [PDF 451 kb]
  • Soheila Aminimoghaddam*, Forough Nezhadisalami, Shabnam Anjidani, Saeedeh Barzin Tond Pages 210-213
    Background
    Gestational trophoblastic neoplasia (GTN) originates from placental trophoblast and is a highly chemosensitive and curable gynecologic malignancy. The present study was conducted to evaluate the effectiveness and safety of EMA/EP (etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin) regimen in the treatment of high-risk GTN as well as patients’ outcome.

    Methods
    Hospital charts of all patients with confirmed diagnosis of high-risk GTN who received EMA/EP regimen treatment during a 12-year period (2001-2012) at the tertiary center of comprehensive women's hospital in Tehran, Iran, were reviewed from 2012 to 2013, retrospectively.

    Results
    In this study, 25 patients with GTN who were treated with EMA/EP regimen during the study were identified. Complete remission rate in GTN patients with failure of single agent chemotherapy who were treated with EMA/EP regimen, as the first- line treatment, was 100%, while it was 81% in those with primary high-risk GTN. Overall remission rate in high-risk GTN patients treated with EMA/EP regimen was 88%. Anemia (92%) and leucopenia (72%) were the most common adverse effects of EMA/EP chemotherapy regimen. Acute myeloid leukemia (AML) and mortality, as the most severe adverse effects of EMA/EP regimen, were seen only in 1 patient.

    Conclusion
    According to the results, EMA/EP regimen could induce complete remission in 88% of patients with high-risk GTN. Application of EMA/EP is recommended as the first- line therapy in patients with failure of single agent chemotherapy. However, proper care should be considered to prevent and reduce EMA/EP hematologic toxicity.
    Keywords: EMA-EP regimen, Chemotherapy, Gestational trophoblastic neoplasia
  • Alireza Mazdaki, Aziz Rezapour, Samad Azari *, Touraj Harati Khaliabad, Masoud Behzadifar, Mahya Razi Moghadam, Behzad Raei, Mehdi Raadabadi Pages 214-219
    Background
    The fair wage to specialist physicians and nurses can enhance their job motivation, quality of work, job satisfaction level, and improve the delivery of services to patients. The present study aimed to compare the proportion of changes in earnings of specialist physicians and nurses before and after implementing the Iran’s New Tariffs Book and compare their average income with a number of selected countries.

    Methods
    This descriptive-analytical study was conducted cross-sectional in the hospitals affiliated to Iran University of Medical Sciences (IUMS) in 2016. Six months before and after the announcement and implementation of the Iran’s New Tariffs Book, the relative values of healthcare services were compared. Study population included all specialist physicians and nurses working in the hospitals affiliated to IUMS. Sample size was determined by sampling formula.

    Results
    The proportion of changes in the income of medical specialists and nurses after establishing the book varied between 8% and 184%. Based on our findings, the highest increases were observed in internal medicine (184%), surgery (160%), gastroenterology (153%), and pediatrics (120%), whereas, the lowest ones belonged to ophthalmology (8%), emergency medicine (11%), neurology (24%) and anesthesia (32%). Nurses’ income was surged by 43%.

    Conclusion
    Pursuant to the findings, the income belonged to all examined medical specialists and nursing groups has increased after implementing the Iran’s New Tariffs Book. The result suggested that income differences among groups have been broadened after the implementation of the Book. There was a wide and significant difference in specialist physicians’ income vis-à-vis nursing groups’ income before and after establishing the New Book.
    Keywords: Medical tariffs, Specialists, Nurses, Earnings, Iran
  • Ahmad Tavakoli, Seyed Hamidreza Monavari *, Hamidreza Mollaei, Farah Bokharaei-Salim, Maryam Esghaei, Hossein Keyvani, Hadi Ghaffari Pages 220-223
    Background
    Human parvovirus B19 was known as one of the possible cause of mild respiratory tract diseases in previous studies. However, there are some reports of acute obstructive respiratory disease and severe pneumonia. The purpose of current study was to assess the prevalence and clinical features of parvovirus B19 in respiratory infection.

    Methods
    This study was conducted on 156 patients diagnosed with respiratory infection at the Iran University of Medical Sciences-affiliated hospitals. After extraction of viral DNA from swab samples, detection of parvovirus B19 was performed by real-time PCR assay.

    Results
    In 156 patient’s samples, parvovirus B19 was found in 8 (5.1 %) cases including 5 males (5.9%) and 3 females (4.1%). The most common clinical symptoms were wheezing (100%), tachypnea (100%), fever (75%) and rhinorrhea/pharyngitis (75%).

    Conclusion
    This is the first attempt to assess the prevalence of parvovirus B19 infection in Iranian patients with respiratory infection. The low frequency of parvovirus B19 detected in our study does not support the role of this virus in the development of respiratory infection. However, further studies are needed to better evaluate the etiological role of parvovirus B19 in respiratory infection.
    Keywords: Parvovirus B19, Real-time PCR, Respiratory infection, Iran
  • Alireza Olyaeemanesh, Masoud Behzadifar *, Nasrin Mousavinejhad, Meysam Behzadifar, Sanaz Heydarvand, Samad Azari, Mariano Martini, Ahad Bakhtiari, Nicola Luigi Bragazzi Pages 224-230
    Background
    Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani’s government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the “Health System Transformation Plan” (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran.

    Methods
    Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts – policy- and decision-makers, professors and academicians, health department workers, health activists, journalists.

    Results
    Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran’s HSTP was revised, finalized and then performed.

    Conclusion
    HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved.
    Keywords: Strengths, Weaknesses, Opportunities, Threats, SWOT, Health system transformation plan, Iran
  • Marzieh Hasanpour, Maryam Bagheri, Fatemeh Ghaedi Heidari * Pages 231-234
    Background
    Critical thinking skills are one of the most important competencies in successful clinical performance of nursing students. Emotional intelligence is also one of the concepts related to critical thinking and can play an important role in the ability to think. Thus, this study was conducted to investigate the relationship between emotional intelligence and critical thinking in nursing students.
    Methods
    This was a quantitative, descriptive–correlative Study. Participants were nursing students in different levels. To collect data, California Critical Thinking Test (form B) and Bar-On Emotional Intelligence Questionnaire were used. Then, data were analyzed with descriptive and inferential statistics using SPSS 16 software.
    Results
    Pearson correlation test showed no significant correlation between the total score of critical thinking skills and each of its components with the total score of emotional intelligence and its component, except for empathy (p=0.001), in nursing students.
    Conclusion
    The findings revealed a significant relationship between empathy and critical thinking skills in nursing students. Using these elements as teaching techniques for nursing education courses can be very helpful in developing good nurse-patient relationships and improving patient care.
    Keywords: Critical Thinking, Emotional Intelligence, Nursing Students, Iran
  • Maryam Esghaei, Mohsen Moghoofei, Mohsen Keshavarz, Hossein Keyvani *, Farah Bokharaei-Salim, Mohammad Farahmand, Seyed Hamidreza Monavari Pages 235-238
    Background
    Respiratory infections, especially viral infections, are the most prevalent infection affecting Hajj pilgrims. Commonly 3 major human influenza viruses (A/H1N1, A/H3N2, and B) are responsible for these morbidities. The present study was conducted to develop a statistical report on human influenza in Hajj pilgrims.

    Methods
    Nasal and throat samples were collected from 232 returning Iranian pilgrims in hospitals of IUMS. All samples were kept in the refrigerator at 4 °C and stored at −70 °C until RNA extraction. RNA extraction was performed by QIAamp viral RNAmini kits (QIAGEN, Hilden, Germany) and influenza viruses were detected by TaqMan RT-PCR.

    Results
    Participants included 115 (49.5%) male and 117 (50.5%) female patients, with the age range of 10 to 93 years (mean: 53 years). The pandemic and seasonal influenza A (H1N1) virus were detected in 2 (0.8%) and 20 (8.6%) pilgrims, respectively, and also influenza B was identified in 1 person (0.4%).

    Conclusions
    Since the probability of an influenza pandemic has been anticipated for the coming years, it seems necessary to plan a continuous monitoring of large gatherings like Hajj and conduct statistical studies in the region. Moreover, material surveillance in humans needs to be boosted. Therefore, results of influenza research can be important for developing WHO reports.
    Keywords: Influenza, Hajj, Pilgrim, Iran
  • Reza Safdari, Hamideh Ehtesham*, Leila Bahadori Pages 239-245
    Background
    Educational role is one of the most important roles of librarians, which has taken on wider dimensions. A review of the literature on the training programs provided by librarians revealed an evolution of the ideas and trends in this area. This systematic review aimed at providing a clear image of the available educational programs, their target groups, and the way they are performed.

    Methods
    This systematic review was done to identify different aspects of the educational role of medical librarians. It was conducted on the studies published in PubMed database during 2005 and 2015. All the studies that described the educational activities of medical librarians were considered for inclusion. All the studies were evaluated by 2 researchers using a checklist, which was developed as an assessment tool. Variables that were considered were as follow: skills taught by librarians, target group, providing training on information resource, teaching method, and session location. After data extraction process and appraisal, the mentioned variables were classified into main categories.

    Results
    A total of 24 studies met the inclusion criteria. The training skills taught by librarians were classified into 3 main groups: information literacy, evidence-based practice, and health literacy. The target groups were library users, patients, and health professionals. Group training was provided, and if necessary, personal training was also offered. Recently, synchronous online training has also been added to the training methods. Most of the training programs are held in classrooms.

    Conclusion
    By categorizing different aspects of training programs, this study aimed at providing a basis for designing a framework to identify the tasks of educational librarians in health sciences.
    Keywords: Librarians, Education, Information literacy, Evidence-based practice, Health literacy
  • Nader Roshan, Seyed Farshad Allameh *, Omid Eslami Pages 246-248
    Ampullary neoplasms are one of the causes of obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) is useful procedure for diagnosing and tissue sampling of ampullary neoplasms. Ampullectomy by resecting entire ampulla provides whole lesion for pathologic evaluation and also is appropriate for real pathologic staging for further management decision but ampullectomy considered as a heroic endoscopic procedure. We share our experience in this field and explain our results.
    Keywords: Ampullary neoplasm, Endoscopic retrograde cholangiopancreatography
  • Khodamorad Jamshidi, Mehrdad Bahrabadi *, Abolfazl Bagherifard, Mehdi Mohamadpour Pages 249-253
    Background
    Giant cell tumor (GCT) of the bone is a benign neoplasm with local aggressive behavior. Distal ulna is a very rare place for GCT. Published studies have mainly focused on case reports, and thus there is no consistent treatment strategy for this tumor at this location. This retrospective study was conducted to evaluate the oncological and functional results of 2 different surgical treatment methods for GCT in distal ulna.

    Methods
    In this study, 9 patients with GCT of distal ulna were followed after surgical treatment of GCT of distal ulna. Of the patients, 2 had local recurrence after surgery in other hospitals and 7 had primarily been admitted to our hospital. Four patients, all with grade 2 Enneking and Campanacci’s classification, were treated by extended curettage and bone grafting, while 5 patients with grade 3 were managed by distal ulnar resection. Minimum follow-up time was 24 months.

    Results
    Patients with grade 3 GCT of distal ulna, who had extended curettage, had a local recurrence up to one year after surgery. Local recurrence was never seen in those with grade 3 disease with resection or in those with grade 2 disease with extended curettage as the treatment of GCT in this location.

    Conclusion
    Based on our study, which is the largest cohort of GCT of distal ulna, extended curettage, and en bloc resection can be suggested as valuable methods of treatment for grades 2 and 3 tumors, respectively.
    Keywords: Giant cell tumor, Ulna, Extended curettage, En bloc resection, Benign aggressive
  • Masoumeh Erfani Khanghahi, Farbod Ebadi Fard Azar Pages 254-261
    Background
    Evaluation is one of the most important aspects of medical education. Thus, new methods of effective evaluation are required in this area, and direct observation of procedural skills (DOPS) is one of these methods. This study was conducted to systematically review the evidence involved in this type of assessment to allow the effective use of this method.

    Methods
    Data were collected searching such keywords as evaluation, assessment, medical education, and direct observation of procedural skills (DOPS) on Google Scholar, PubMed, Science Direct, SID, Medlib and Google and by searching unpublished sources (Gray literature) and selected references (reference of reference).

    Results
    Of 236 papers, 28 were studied. Satisfaction with DOPS method was found to be moderate. The major strengths of this evaluation method are as follow: providing feedback to the participants and promoting independence and practical skills during assessment. However, stressful evaluation, time limitation for participants, and bias between assessors are the main drawbacks of this method. Positive impact of DOPS method on improving student performance has been noted in most studies. The results showed that the validity and reliability of DOPS are relatively acceptable. Performance of participants using DOPS was relatively satisfactory. However, not providing necessary trainings on how to take DOPS test, not providing essential feedback to participants, and insufficient time for the test are the major drawbacks of the DOPS tests.

    Conclusion
    According to the results of this study, DOPS tests can be applied as a valuable and effective evaluation method in medical education. However, more attention should be paid to the quality of these tests.
    Keywords: Evaluation, Medical education, Directly observed procedural skills
  • Hassan Hashemi, Ali Akbar Haghdoost, Mohammad Haji-Aghajani, Ghasem Janbabaee, Ali Maher, Somayeh Noori Hekmat, Amir M. Javadi, Rohaneh Rahimisadegh, Samira Emadi, Mahamad Reza Rajabalipour, Hajar Haghighi, Reza Dehnavieh, Masoud Ferdosi, Gholamreza Khademi Pages 262-267
    Introduction
    Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking.

    Methods
    Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described.

    Results
    The followings were done to accomplish the goals of each step: collecting experts’ viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation).

    Conclusion
    In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran’s health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.
    Keywords: Policy making, National Roadmap, Health system, Iran
  • Hossein Ayatollahi, Mohammadhadi Sadeghian, Mohammadmahdi Kooshyar, Abass Shirdel, Hossein Rahimi, Amirhossein Jafarian, Saeide Ghazaei, Narges Soltani, Fatemeh Shams, Neda Motamedi Rad, Sepideh Shakeri * Pages 268-272
    Background
    Adult T cell leukemia lymphoma (ATLL) is a rare disease, significantly linked to the infection by the human T-cell lymphotropic virus 1(HTLV-1). ATLL is typically preceded by decades of clinical latency during which infected cells accumulate selectable traits leading to a malignant transformation. Amongst all the HTLV-1 infected carriers only about 3-5% will develop ATLL. Despite the intensive attempt to improve the overall survival, ATLL remains one of worse prognosis among the hematologic malignancies. FMS like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutations are mutations which are frequent among leukemic patients. We aimed to investigate the frequency of FLT3 mutation status in patients with acute type of ATLL which has not been studied yet.

    Methods
    In this case control study 38 patients with acute type of ATLL were retrospectively analyzed between February 2015 and February 2017. Forty HTLV-1 positive patients were also used as control cases. Genomic DNA was extracted according to phenol-chloroform protocol and two restriction fragment length polymorphism (RFLP) PCR reactions were set up to detect FLT3/ ITD and FLT3/TKD mutations. Differences between variables were evaluated by the chi-square test and t test for categorical and continuous variables, respectively. SPSS software v. 15 was used for statistical analysis. All P values were two sided and values less than 0.05 were considered to be significant.

    Results
    No FLT3 mutations were detected in acute type of ATLL patients. So far, not many studies have shown the frequency of FLT3 mutation in ATLL patients

    Conclusion
    Therefore, we conclude that although FLT3 mutations are rather unusual in the acute type of ATLL patients, but other alternative mechanisms associated with ATLL remain to be further investigated. This study was a novel project regarding the analysis of FLT3 mutation in the field of ATLL research.
    Keywords: Adult T cell leukemia, Human T-cell lymphotropic virus 1, Iran
  • Ahmad Ghashghaee, Masoud Behzadifar *, Samad Azari, Zeynab Farhadi, Nicola Luigi Bragazzi, Meysam Behzadifar, Sahar Sadat Saeedi Shahri, Mozhgan Sadat Ghaemmohamadi, Faezeh Ebadi, Roghayeh Mohammadibakhsh, Hesam Seyedin, Mahya Razi Moghadam Pages 273-282
    Background
    Nosocomial infections represent a serious public health concern worldwide, and, especially, in developing countries where, due to financial constraints, it is difficult to control infections. This study aimed to review and assess the prevalence of nosocomial infections in Iran.

    Methods
    Different databases were searched between January 2000 and December 2017. To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95% confidence interval. To examine the heterogeneity among studies, the I2 test were conducted. The reporting of observational studies in epidemiology (STROBE) checklist was used to assess the methodological quality of observational studies. To further investigate the source of heterogeneity, meta-regression analyses stratified by publication year, sample size and duration of hospitalization in the hospital were carried out.

    Results
    52 studies were included. Based on the random-effects model, the overall prevalence of nosocomial infection in Iran was 4.5% [95% CI: 3.5 to 5.7] with a high, statistically significant heterogeneity (I2=99.82%). A sensitivity analysis was performed to ensure the stability results. After removing each study, results did not change. A cumulative meta-analysis of the included studies was performed based on year of publication and the results did not change. In the present study, a high rate of infections caused by Klebsiella pneumoniae (urinary tract, respiratory tract, and bloodstream infections) was found.

    Conclusion
    Preventing and reducing hospital infections can significantly impact on reducing mortality and health-related costs. Implementing ad hoc programs, such as training healthcare staff on admission to the hospital, may play an important role in reducing infections spreading.
    Keywords: Nosocomial infections, Prevalence, Iran, Systematic review, Meta-analysis, Hospital
  • Azar Moezy *, Azadeh Erfani, Ali Mazaherinezhad, Seyed Ali Javad Mousavi Pages 283-290
    Background
    Chronic Obstructive Pulmonary Disease (COPD), in addition to its respiratory problems, is accompanied by several musculoskeletal consequences. The aim of this study is to investigate the effectiveness of eccentric exercise in the form of downhill walking (DW) on respiratory capacity, physical function and quality of life (QOL) in patients with COPD.

    Methods
    The randomized controlled trial was carried out during 2014 - 2015 in Hazrat-e-Rasool Hospital in Tehran, Iran. The study design was as an assessor blind RCT on 32 patients with COPD that randomly assigned to the eccentric training (ET) and control (CON) groups. Patients in ET group received a 12-week DW exercise on the treadmill while the patients in the control group were only treated by COPD conventional medications and walked on paved surfaces. Functional tests, FEV1, FEV1 to FVC and St. George’s Respiratory Questionnaire (SGRQ) were used to assess the subject’s physical status and QOL pre and post-intervention.

    Results
    The FEV1 (p=0.008), FEV1/FVC (p=0.002), six-minute walk test (p=0.029), timed up & go test (p=0.023), SGRQ symptom (p=0.022), SGRQ activity (p=0.007), SGRQ impact (p=0.033) and total score of SGRQ (p=0.013) improved significantly in the ET group compare to the CON group.

    Conclusion
    DW could have positive influence on physical status and QOL of patients with COPD.
    Keywords: Chronic obstructive pulmonary disease (COPD), Eccentric training, Downhill walking, Quality of life (QOL), Physical function, RCT
  • Rasoul Shavaleh, Seyed Abbas Motevalian*, Nader Mahdavi, Mashyaneh Haddadi, Mahmoud Reza Mohaghegh, Zahra Hamedi Pages 291-295
    Background
    In Iran, Road Traffic Injuries (RTIs) is the second-leading cause of deaths, and the first leading cause of disability-adjusted life year, and has one of the highest rates of death (32.1 per 100 000 population) all over the world. This study’s aim was to investigate the epidemiological pattern and underlying components of hospitalized RTIs in 31 provinces of Iran in 2011.

    Methods
    This study conducted on all hospitalized RTIs during one-year period (March 21, 2011 to March 21, 2012). Data extracted from a hospital-based traffic injury registration system. According to a national law passed in 2005, all hospital expenses of traffic injuries should be covered by ministry of health based on governmental tariffs. The medical costs of eligible patients will be paid to the hospitals only if the patient data are sent to the above mentioned database. Statistical analysis was performed using SPSS v.16 (SPSS Inc., Chicago, USA), and spatial maps are provided using GIS 10.2. Descriptive statistics and t-test were used to compare means. World (WHO 2000-2025) standard population used to calculate age-adjusted incidence rate. All statistical tests were performed at the 5% level of statistical significance.

    Results
    There were 322,064 injured cases recorded in the registration system during the study period. The national age-adjusted incidence rate of RTIs was 405 per 100,000 population. The highest incidence rates were in the age group of 15-29 years (643 per 100,000 population), followed by 30-44 year age groups (401 per 100,000 population). The incidence rate in men was 3.36 times more than women. Motorcyclist were the most frequent type of road users (39.2%) who involved in RTIs, followed by passengers (28.9%) and pedestrians (20.0%). Head injuries were among the most affected part of the body which occurred in 27.2% of the patients. The proportion of urban crashes was 60.7%.

    Conclusion
    The results of this study indicated that the majority of RTI occurred on motorcyclists and head injuries was the most commonly affected body part. Therefore, in order to reduce motorcycle accidents and avoiding head injury among them, stricter law enforcement is urgently needed for helmet use and promotion of safety behaviors among motorcycle riders.
    Keywords: Road traffic injuries, Road user, Head injury
  • Fariba Fathollahi-Dehkordi, Ziba Farajzadegan * Pages 296-303
    Background
    Studies have shown that participation of Iranian women with family history of breast cancer in screening service is low. This investigation has evaluated the effectiveness of health models according to peer group in improving clinical breast exam (CBE) among Iranian women with a family history of breast cancer.

    Methods
    This was a randomized control trial conducted during June and August 2015 in Isfahan. A total of 54 women were assigned into intervention and 53 to control group. Women 20 years or older with an affected relative were included. CBE screening, stage of change screening, knowledge, and belief were considered as outcomes after educational program. Data were analyzed by ANOVA and descriptive statistics by SPSS. Significance level was set at 0.025.

    Results
    Investigation was completed by 98 women; and we considered 22% as effect size. Three months after the intervention, screening practice was 52% in interventional versus 18% in control group (p
    Conclusion
    Peer group interventions, which can be organized by health models, have positive effects on CBE in women with positive history of breast cancer.
    Keywords: Breast cancer, Peer group, Health belief model, Transtheoretical model, Family history, Screening
  • Jalal Arabloo, Sogand Tourani, Hamid Ravaghi * Pages 304-311
    Background
    Tobacco consumption is still considered as the first preventable cause of death in the world. In order to influence tobacco policy process, researchers and policymakers must use frameworks of policy-making to understand the process to provide them insights for influence the process. This systematic review aims to review the application of policy analysis frameworks in the field of tobacco control.

    Methods
    A systematic search for articles was performed using four databases (Ovid Medline, Scopus, Cochrane Library, and PubMed) up to December 19, 2016. The articles were selected based on inclusion and exclusion criteria. All research studies focusing on tobacco policy and on one or more specified frameworks of policy analysis included in this study. Finally, thematic analysis was used to synthesize the findings.

    Results
    17 studies based on eligibility criteria were included in this study. The findings of this study showed that most of the studies were in North America, published in the Health journals, conducted to analyze the national and state policies, focused on analyzing agenda-setting phase. Multiple streams model was the most widely used framework within the literature. Few studies had used advocacy coalition framework. From the three agenda setting frameworks and theories (MSF, PEF, ACF), the ACF framework is the most detailed framework in terms of elements and factors affecting the dynamics of political sub-system the reasons for models selection and suitability for the study was noted only in a small number of studies. The results of this study showed underuse and the incomplete or improper use of policy analysis models and frameworks in the field of tobacco research.

    Conclusion
    The study showed that a number of theories and frameworks have been used but their use was limited and have significant methodological weaknesses.
    Keywords: Tobacco, Systematic review, Policy analysis
  • Maryam Honardoost *, Azam Rajabpour, Ladan Vakil Pages 312-316
    Molecular epidemiology is a subdivision of medical science and epidemiology that emphases on the involvement of potential environmental and genetic risk factors, recognized at the molecular level, to the etiology and avoidance of sickness through populations. This arena has developed from the combination of molecular biology and traditional epidemiological research. Molecular epidemiology can improve our knowledge about the precise pathogenesis of disease through recognizing particular pathways that affect the risk of developing the disease. Furthermore, it tries to find how the collaborations between genetic characteristics and environmental exposures works in disease occurrence.
    Keywords: molecular biology, epidemiology
  • Hamideh Sabet Rohani *, Alireza Ahmadvand, Gholamreza Garmaroudi Pages 317-320
    Background
    Reviewing the reproductive health indicators (RHIs) provides the possibility of periodic health system performance evaluation to achieve balanced development. This study aimed to determine the trend of ten reproductive health indicators changes during 2002-2011, and examining their relationship with the Human Development Index (HDI).
    Methods
    In this ecological study the trend of ten reproductive health indicators from five selected provinces of Iran were mapped. Then the relationship of these ten indicators with HDI was investigated using non parametric Spearman's rank correlation coefficient in SPSS v. 20.
    Results
    There was a statistically significant direct and strong correlation between the percentage of childbirth by a trained person and HDI (r= 0.9, p=0.037).
    Conclusion
    In our study, it can be expected that the provinces with similar reproductive health indicators, likely have similar HDI.
    Keywords: Reproductive health indices, Human development index, Ecological study
  • Hojjat Rahmani, Ali Sarabi Asiabar, Somayeh Niakan, Seyed Yaser Hashemi, Ahmad Faramarzi *, Sahar Manuchehri, Ghasem Rajabi Vasokolaei Pages 321-326
    Background
    Iran is located in Asian esophageal cancer belt, with age-standardized incidence rate (ASR) of approximately 7 per 100,000 for both men and women. To provide potential solution recommendations for achieving accurate estimations regarding the burden of the disease in Iran, we designed a study to assess the burden of esophageal cancer in Iran during 1995-2015 by collecting data from the Global Burden of Disease studies.

    Methods
    Data were extracted from the Global Burden of Disease (GBD) during 1995-2015, which were published by the Institute for Health Metrics and Evaluation. For this purpose, disability adjusted life years (DALYs), incidence, and prevalence rate were applied to report burden of esophageal cancer based on gender and age group in Iran during 1995-2015. The Cochran-Armitage and t test were used to assess statistical significance. Stata Version 13 and Excel 2016 were used for data analysis.

    Results
    During 1995-2015, in total, 304 102 DALYs (179 562 for males vs. 124 540 for females) were attributed to esophageal cancer in Iran. In both genders and all ages, the number of DALYs increased significantly from 45 018 in 1995 to 74 399 in 2015.

    Conclusion
    Esophageal cancer is still a public health issue in Iran. Most of DALYs were due to years of life lost (YLL), suggesting the need for prevention, early detection, and screening programs. P-value was statistically significant just between male and female groups (p
    Keywords: Esophageal cancer, Disability adjusted life years, Iran, Global burden of disease
  • Zahra Kavosi, Hamed Rahimi, Saeideh Khanian *, Payam Farhadi, Erfan Kharazmi Pages 327-333
    Background
    Outsourcing is considered as one of the tools for organizational development and promotion of productivity by managers. In recent years, outsourcing of healthcare services has become significant. The aim of this study was to identify the most important factors influencing the decision making of outsourcing healthcare services.

    Methods
    This study is a combined study. First, the literature was examined to identify the factors influencing decision making for outsourcing. Then, with the aim of consensus on the most important factors affecting the decision making of outsourcing in health services, the panel of experts and Delphi technique were used. Sampling was purposeful.

    Results
    In the selected articles, a total of 180 factors were extracted. The members of the panel of experts from these 180 factors selected 29 sub-factors in the form of six main factors: strategy, quality, management, technology, performance feature, and economy, as the most important factors affecting the outsourcing of services. Finally, the results of Delphi showed that 22 sub-factors were more important in outsourcing decision making at healthcare services.

    Conclusion
    The study showed that the decision making to outsource health services is a complex and multi-criteria decision. Therefore, when deciding to outsource healthcare services, attention should be paid to various factors, such as strategy, quality, management, technology, and economics.
    Keywords: Outsourcing, Health services, Management, Decision making, Quality, Delphi
  • Shervan Shoaee, Pegah Khazaei, Fatemeh Mashhadiabbas, Masoud Varshosaz, Farshad Sharifi, Hossein Hessari * Pages 334-337
    Background
    Impacted tooth is common in dental practice. Dentists usually remove them if they are associated with any pathologic sign or symptom. The challenge is whether to extract the asymptomatic tooth or not. This study was conducted to determine the association between developmental odontogenic cysts and tumors and impacted and unerupted teeth, if left untreated.

    Methods
    In this matched case-control study, 262 participants were recruited in case and control groups to evaluate the association between the presence of odontogenic cyst and tumors and unerupted and impacted teeth in patient records in the School of Dentistry, Shahid Beheshti University of Medical Sciences during 2000-2002. The controls referred to a dental radiology center for routine OPG. We also recorded the data on age, gender, the involved jaw, and type of lesion. All patients’ records were reviewed by the research director and an oral pathologist separately. The variables that were matched as confounders were age, gender, and the site of the involved jaw.

    Results
    Results of conditional logistic regression analysis showed that the presence of odontogenic lesions was associated with impacted teeth (OR = 6.9), and not associated with the involved jaw and unerupted teeth.

    Conclusion
    Impacted teeth could be considered as a potential risk factor for the presence of odontogenic lesions.
    Keywords: Impacted tooth, Unerupted tooth, Odontogenic lesions
  • Sanaz Heidarvand, Masoud Behzadifar*, Hasan Abolghasem Gorji, Meysam Behzadifar, Maryam Darvishnia, Nicola Luigi Bragazzi Pages 338-343
    Background
    Visit length is an indicator that can be used to assess patients’ satisfaction of the health care services. In recent years, some studies have focused on the mean visit time in Iran. This study aimed at determining the average visit time in Iran by performing a systematic review and meta-analysis.

    Methods
    In this study, Embase, PubMed/MEDLINE, Scopus, ISI/Web of Science databases, and Google Scholar search engine, as well as Iranian national databases/thesauri, such as MagIran, SID, and Irandoc were used. These databases were searched from their inception until September 2017. The quality of retained studies was assessed using the STROBE checklist. Average visit length was reported using stochastic model with 95% confidence interval (CI). I2 and Q tests were used to assess the heterogeneity of the studies. A sensitivity analysis was conducted to ensure the stability of the results.

    Results
    After searching the scholarly databases and reviewing the articles based on inclusion and exclusion criteria, 6 studies were finally selected. Based on the random model, the mean visit time was 4.89 minutes in Iran, ranging from 4.66 to 5.12 minutes (p=0.82). The most time visit in specialists belonged to psychiatrists with 9.12 (7.28 to 10.96) minutes (p=0.19) and the lowest belonged to internists with 3.59 (2.24 to 4.95) minutes (p=0.00), respectively.

    Conclusion
    The average visit time in Iran was estimated to be 4.89 minutes. To increase patients’ satisfaction and provide a better disease treatment and management in Iran, the following suggestions could be helpful: properly distributing physicians across the country, reducing waiting lists, and implementing the use of guidelines to standardize the visit time.
    Keywords: Visit length, Physicians, Specialists, Iran, Systematic review, Meta-analysis
  • Satar Rezaei, Mohammad Hajizadeh, Hamed Zandian, Afshin Fathi, Bijan Nouri * Pages 344-351
    Background
    This study aimed to explore service quality in Iranian hospitals by a systematic review and meta-analysis of the existing literature.

    Methods
    The literature search in the international (PubMed, Scopus, and the ISI) and Iranian (SID, Iranmedex, and Magiran) scientific databases was conducted to identify studies (published in English and Persian) used the service quality gap (SERVQUAL) model to examine service quality in Iranian hospitals between 2000 and 2016. The databases were searched using a combination of the following keywords: “hospital service quality”, or “healthcare service quality”, and “SERVQUAL model”, or “gap model”, and “Iran”. A random-effects meta-analysis model was used to investigate the quality of hospital care in Iran.

    Results
    A total of 13 articles with 4,217 patients were included in the study. Results indicate that there are negative gap values between patient's expectations and perceptions in six SERVQUAL dimensions namely. tangibility, reliability, responsiveness, assurance, empathy, and access. The overall mean score of patients’ expectations and perceptions of quality of hospital care in Iran were estimated 4.59 and 3.69, respectively (i.e., quality score gap= -0.9). The highest and lowest quality score gap values were related to the reliability and responsiveness dimensions, correspondingly.

    Conclusion
    The study found that expectations of patients from hospital care have not been met in Iran. Thus, improving service quality in Iranian hospitals warrants further attention by health professionals, health policy-makers, and hospital managers.
    Keywords: Service quality, Iranian hospitals, SERVQUAL model, Systematic review, Meta-analysis
  • Joseph E. Dib*, Clive E. Adams, Francois Kazour, Fouad Tahan, Georges Haddad, Chadia Haddad, Souheil Hallit Pages 352-360
    Background
    Violent patients constitute 10% of all psychiatric admissions. Treatment options and clinical practice interventions vary across the globe and no survey of practice in a Middle Eastern setting exists. Surveying treatments in Lebanon will show treatment interventions used in this part of the world and, most importantly, provide the treatment options that could potentially be used for clinical trials pertaining to emergency psychiatry.

    Methods
    A survey of clinicians’ opinions and practice was conducted between July and August 2017 at the largest psychiatric hospital in Lebanon.

    Results
    Five of seven experienced psychiatrists provided opinions when interviewed of their preferred intervention when dealing with an emergency psychiatric episode. Whilst this varied in detail, there was a consistent view that there should first be verbal control, then use of medications, and finally physical restrain of the patient. A total of 39 emergency episodes (28 people) occurred in the one month (64% men in their 30s). Bipolar disorder was the most frequent single diagnosis behind the aggression (n=16, 41%; 12 people 43%) but the combined schizophrenia-like illnesses underlay 18 of the 39 episodes (46%; 13/28 people 46%). In clinical life, we found evidence of high family involvement, but little attempts made at initial verbal control in the hospital. All 39 episodes involved administration of pharmacological interventions. Medications were used in 29 of cases (74%) and non-medication interventions used in the remaining 10/39 (26%).

    Conclusion
    This survey provides some evidence that clinicians’ preferences may not fully reflect clinical practice but also that experienced clinicians are using several clearly effective techniques to manage these very difficult situations. However, as for other parts of the world, treatment in Lebanon has limited or no underpinning by evidence from well-designed, conducted and reported evaluative studies.
    Keywords: Aggression, Agitation, Survey, Psychiatric Hospital, Lebanon, Pharmacotherapy
  • Leila Amini , Mehri Kalhor , Anoushe Haghighi , Naiemeh Seyedfatemi , Fatemah Hosseini Pages 361-364
    Background
    Rheumatoid arthritis is one of the most common autoimmune diseases. Because immunological changes can be induced by steroid hormones, it seems that oral contraceptive pills can affect the severity of the disease. In this study, we examined the effect of oral contraceptive pills on rheumatoid arthritis activity in women.
    Methods
    This blinded randomized clinical control trial was performed in the selected rheumatology centers in Tehran, Iran, in 2011. A total of 100 women with rheumatoid arthritis were included (50 in the intervention and 50 in the control groups), and those in the intervention group took oral contraceptive pills intermittently for 8 weeks. Disease activity was measured at 1 and 9 weeks based on DAS-28, which includes the number of tender joints, number of swollen joints, ESR, and GH. Data were analyzed using SPSS-16, and significance level was set at p≤0.05. This study was registered in IRCT (number: 138904224364N1) and all interventions were done after receiving confirmation from the Ethical Committee of Tehran University of Medical Sciences (Code: 250/ 6441).
    Results
    After administering oral contraceptive pills to the intervention group, we found significant differences between the 2 groups in disease activity and severity scores (p=0.04). Intervention group showed lower swollen joints score (p=0.02), lower joint tenderness score (p=0.02), and lower general health score (p=0.001) than the control group.
    Conclusion
    According to the results of this study, oral contraceptive pills can improve rheumatoid arthritis activity and severity. As these pills are used for contraception, women with rheumatoid arthritis can benefit from both effects of these pills
    Keywords: Oral contraceptive pill, Disease activity, Rheumatoid arthritis, Autoimmune diseases, Contraception
  • Mohammad Rezapour , Mohammad Mehdi Sepehri , Morteza Khavanin Zadeh , Mahmood Alborzi Pages 365-370
    Background
    The kidneys of patients with chronic kidney disease (CKD) do not function well enough and those in end-stage renal disease (ESRD) of CKD need hemodialysis (HD) as a common renal replacement therapy (RRT) procedure. HD requires a vascular access (VA), and arteriovenous fistula (AVF) is the common VA choice in the world due to its very few complications. Despite the widespread use of AVFs, some risk factors maximize AVF failure, which is accompanied by complications of the patient such as repeating VA surgeries and hospitalization. Therefore, finding effective factors in the success of surgery is highly important and, thus, this study aimed at measuring the effect of anastomosis angle on the success of AVF surgery.
    Methods
    This study evaluated the effect of conducted angle in an AVF anastomosis on AVF maturation. The images of 48 created AVFs for CKD patients was provided over a one-year period (from May 2016 to April 2017). Cross-tab analysis was used, and significance level was considered meaningful at p-value≤0.001. A centralized database was designed to integrate data. A method for image processing was developed and geometrical characteristics of the vessels (such as anastomosis angle) and also the diameter of artery and vein were measured via AutoCAD 2017 software and exported to the database along with other data.
    Results
    The rate of the AVF failure in the studied patients was 8.96%. The anastomosis angle ≤ 30° is preferable from the AVF status point of view because most AVF maturation (or least AVF failure) rates are detected at this range.
    Conclusion
    This study was performed based on a new approach without the need to measure hemodynamic parameters. Moreover, it signified the important role of anastomosis angle in the function of AVF, showing that the anastomosis angle ≤ 30° is a preferable intraoperative recommendation for AVF surgery
    Keywords: Vascular access surgery, Hemodialysis, Anastomosis angle, AVF failure, AVF maturation, Surgical process improvement
  • Kambiz Abachizadeh , Soheila Omidnia , Ahmad Hajebi , Reza Shekarriz, Foumani , Maryam Mohseni Pages 371-376
    Background
    Positive health as a “health asset” goes beyond risk factors for diseases and produces longer and healthier life, as well as, better prognosis when illness strikes, against traditional medicine focusing on treating people in negative health to a state that is neutral or free from disease. The aim of present study was to conduct a national survey estimating positive health indicators of Iranians
    Methods
    This survey was performed on September 2014 in all provinces of Iran with 10500 samples. The psychometrics of employed scale was examined in separate study. To estimate positive health indicators, each question included a series of declarative statements and each respondents answer to questions based on a five-point Likert type scale.
    Results
    From a total of 10500 respondents, 10244 fulfilled questionnaire (Response rate= 97.5%). About 49% of participants were male. In a scale from 1 to 5, mean of score of life satisfaction, happiness, quality of life, and self-perceived health were 3.45, 3.28, 3.56 and 3.66, respectively. The highest level of positive health indicators was achieved in provinces of Guilan and West Azerbaijan.
    Conclusion
    The result of the study shows majority of Iranian people assess their perception of health, quality of life, life satisfaction and happiness as ‘moderate’ or ‘good’ (between 66 to 82% of respondents. It would seem that measured positive health indicators in comparison with the rates of past national studies, have been decreased between 3.5 to 4% that should be noticed in social health policy making
    Keywords: Positive health, Iran, Indicator, Survey, Nationa
  • Behzad Damari , Kamel Shadpour , Narges Rostamigooran Pages 377-380
    Residency areas are primary social factors that directly and indirectly affect health and in synergy with other factors, changes health equity indices.
    Qazvin as one of the provinces in the Islamic Republic of Iran has been a pioneer in the provision of an integrated health program with intersectoral collaboration approach and the participation of residents.
    In this study required data was gathered in a qualitative method by reviewing documents, group discussions with stakeholders and residents and interviews with key informed individuals. In the beginning, stakeholder’s analysis revealed highly effective organizations and their method of cooperation.
    Insufficient access to housing, weak security, insufficient swage system and deficiency of entertainment and park environment are four top urgent issues which are related to housing. Strategic goals for each issue has been designed in a four-year time frame and projects for reaching the goals that are considered in three categories: promotional, facilitator and mandatory.
    Cooperation of multiple stakeholders including managers and residents are features of preparing this program. A change of stakeholders’ perspective to health-oriented performance in housing is the added value of this public act
    Keywords: Housing, Intersectoral collaboration, Social determinant of health
  • The clinical application of ICF model for occupational therapy in a patient with stroke: A case report
    bolghasem Fallahzadeh Abarghuei, Afsoon Hassani Mehraban*, Laleh Lajevardi, Mahin Yousefi Pages 381-385

    The ICF (the international classification of functioning, disability, and health) is a globally agreed framework and classification to define the spectrum of problems in the functioning of patients. ICF tools were developed based on ICF Core Set (ICF-CS) for the clinical application of ICF and patient management in the rehabilitation process. The current case report aimed at using ICF-based documentation tools in the occupational therapy process in a patient with chronic stroke. The case was a male who had a stroke 6 months prior to the study. The occupational therapy provided to this patient included 5 patient management components (examination, evaluation, prognosis, diagnosis, and intervention) using the ICF-based documentation tool. After one month, improvement in balance and mobility, going up and down the stairs without help, independent upper and lower body dressing achieved. The ICF was clinically applied to the occupational therapy practice in this case report. Because of the close relationship of ICF tools with the concept of occupational therapy, particularly client-centered approach and holistic evaluation of patients, occupational therapists can use ICF in clinical practice to have a more comprehensive view toward patients’ recovery.

    Keywords: ICF, ICF tools, Occupational therapy, stroke
  • Morteza Khavnin Zadeh , Amirhossein Dehghani Esfahani , Alireza Azadeh Pages 386-387
    For doing systemic chemotherapy, central venous ports are used to access central veins and internal jugular vein. Installing these devices though can be with complications on the side which cause them function limits. In this text a case is presented in which after installing a complete and intact port, some malfunction was detected in the chemotherapy procedure after several months which leads us to port Malposition which is probably caused by the huge soft tissue of patient’s breast. This can be prevented simply by installing the port primarily in the zone with less soft tissue.
    Keywords: Central Venous Catheter Chemotherapy Port, Coiling of the Distal Tip
  • Farzad Soleymani , Hossein Safari palangi , Ali Sarabi Asiabar , Abbasali Keshtkar , Mohsen Mohammadi , Ali Akbari Sari , Ali Saber Pages 388-393
    Background
    Hospital infections have affected millions of people around the world and are considered as one of the most important issues related to patient safety. Therefore, this study was conducted to estimate the extra costs caused by hospital-acquired infections in hospitals.
    Methods
    This retrospective cohort study was conducted in Tehran province, Iran, in 2017. Medical records of 235 patients hospitalized in one of Tehran hospitals were reviewed for the study. They were divided into case (90 patients) and control (145 patients) groups. Data were analyzed using SPSS and STATA software.
    Results
    Results revealed no significant relationship between age and gender with the incidence of nosocomial infection (p>0.05). However, the chance of nosocomial infection is most affected by length of hospital stay and costs paid by patients. Moreover, nosocomial infection increases the length of hospital stay up to 25 days. Our results revealed that the mean±SD hospital stay of infected and non-infected patients were 15.8±17.2 and 40.8±19.1 days, respectively. Furthermore, the total cost of patients without any hospital infection was 2451±3098 USD (83 674 480±105 765 500 Rials). On the other hand, the cost for infected patients was 3264±6078 USD (207 497 500±111 430 700 Rials).
    Conclusion
    Hospital-acquired infections can impose great costs on both patients and the health system. The results of this study indicated the importance of taking specific measures for infection control in hospitals
    Keywords: Hospital-acquired infection, Hospital costs, Medical records, Iran
  • Novin Nikbakhsh , Sussan Moudi , Sara Alvarzandi , Maede Niazifar , Nazila Farnoush , Ali Bijani , Marjan Moudi Pages 394-399
    Background
    Depression is a common psychiatric disorder in breast cancer patients. This study was designed to evaluate the clinical efficacy of group psychotherapy on breast cancer patients with depressive disorder who took citalopram.
    Methods
    This clinical trial was conducted on 40 breast cancer patients with depressive disorder. The control group received citalopram 20-40 mg/ day for 12 weeks and the intervention group participated in 8 sessions of group psychotherapy in addition to the same dose of citalopram. At the baseline and 3, 6, and 12 weeks after treatment, patients were followed- up. Treatment outcomes and quality of life were compared between the 2 groups.
    Results
    Overall, the depression score of Hospital Anxiety and Depression Scale (HADS) at baseline with the mean of 11.6±1.6 was signed in the range of clinical depression and after intervention it declined to 8.8±3.6 (in the 3rd week), 7.1±3.9 (6th week), and 5.9±4.5 (12th week). Furthermore, HADS anxiety score at baseline with the mean of 12.6±2.6 was signed in the range of clinical anxiety and after intervention it declined to 9.1±3.0, 7.3±4.1, and 6.0±4.0, respectively. This improvement was significantly more in the combined therapy intervention group (p<0.001). The mean score of quality of life based on WHO QOL-BREF questionnaire increased by 1.85 fold in the case group, improved from 44.09 to 81.70, while the slight change was observed in the control group (p<0.001). During the treatment, no significant adverse drug event was observed in the 2 groups (p>0.05).
    Conclusion
    Group psychotherapy has a significant effect on improving depression, anxiety, and quality of life in breast cancer patients
    Keywords: Breast cancer, Depression, Anxiety, Citalopram, Group psychotherapy
  • Ali Gholami , Msoudreza Sohrabi , Abbas Abbasi, Ghahramanloo , Farhad Moradpour , Saeid Safiri , Mansooreh Maadi , Maryam Khazaee, Pool , Farhad Zamani Pages 400-405
    Background
    An unhealthy diet is one of the most important risk factors for chronic diseases. The goal of this study was to use the latent class analysis (LCA) modeling to define unhealthy diet habits among an Iranian population.
    Methods
    This cross-sectional study was conducted within the framework of Amol (North of Iran) cohort health study (Phase 1). The participants aged 10 to 90 years. All participants provided written informed consent. Latent class analysis was used to classify the participants of the study. All analyses were conducted by PROC LCA in SAS 9.2 software. Significance level was set at 0.05.
    Results
    The mean age of the participants was 42.58±17.23 years. Four classes of individuals with different diet habits were identified using LCA modeling: class 1: individuals with healthy diet patterns (92.6%); class 2: individuals with slightly unhealthy diet habits (6.3%); class 3: individuals with relatively unhealthy diet habits (0.8%); and class 4: individuals with unhealthy diet habits (0.2%). Being female and alcohol consumption increased the odds of membership in latent classes 2,3, and 4 compared to class 1. Physical activity decreased the odds of membership in classes 3 and 4 compared to class 1.
    Conclusion
    Overall, almost more than 7.4% of all participants had some degree of unhealthy dietary habits, and some variables acted as risk factors for membership in risky classes. Therefore, focusing on these variables may help design and execute effective preventive interventions in groups with unhealthy dietary habits
    Keywords: Unhealthy diets, Latent class analysis, Diet pattern
  • Vahid Alipour , Abolghasem Pourreza , Majid Koosheshi , Hassan Heydari , Sara Emamgholipour Sefiddashti , Abbas Rahimi Foroushani Pages 406-410
    Background
    Considering the health economics aspect, the effect of population aging on the growth of medical expenditures is of great importance. Thus, the aim of this study was to investigate the growth rate of inpatient hospital expenditures (IHE) of older age groups compared to younger age groups or testing of steepening hypothesis.
    Methods
    In this descriptive-analytic study, monthly IHE data of insured patients from April 2011 to March 2014 was collected from Iran Health Insurance Organization database. The sample consisted of 297,145 patients who were selected using stratified random sampling among the patients insured by different health insurance funds. Using the Age-cut method, patients were classified into two main age groups: older than 60 and under 60 years old. The average IHE of the two groups and the growth rate of their expenditures were estimated. At the 95% significance level, the difference in average growth rate of IHE was tested between the two age groups using t-statistic in Stata (version 13.0) software.
    Results
    The findings of this study revealed that per capita IHE for the older and younger groups was $469 and $399, respectively. The monthly average growth rate of IHE for the older (60-90 yrs.) and younger groups (30-59 yrs.) was 2.43% and 2.38%, respectively. The difference between the monthly average growth rate of the older and younger groups was not statistically significant (t = - 0.0332; P value = 0.9736).
    Conclusion
    Our study results rejected the steepening hypothesis. The monthly average growth rates of IHE in both older and younger age groups have risen to a similar extent over the period of 36 months. Further research should focus on the inpatient hospital expenditures of younger age groups to explain the causes of their increased expenditures.
    Keywords: Ageing, Inpatient hospital expenditures, Steepening hypothesis
  • Dindar Qurtas Pages 411-413
    Background
    Cutaneous leishmaniasis (CL) is an infectious disease of zoonotic characteristic; its etiological agent is a protozoan of Leishmania species. This infectious agent is transmitted to humans through a secondary vector, which is infected sand-fly. According to WHO report, Iraq is a country where cutaneous leishmaniasis is an emerging disease, especially, its rural areas are labeled to be the source of the infection and endemicity. Course of the disease and treatment is highly defined by the subtype of cutaneous leishmaniasis and its species.
    Methods
    Data were collected from cutaneous leishmaniasis registry database of Erbil Dermatology Teaching Center in city of Erbil from August 2016 to August 2017. The collected data were descriptively analyzed for the clinical manifestations and the course of disease in the outbreak of this disease in Erbil governorate.
    Results
    A total of 124 patients were enrolled in this study. Among them, 93 (75%) were male and 31 (25%) were female. Their age ranged from 2 years to 73 years, with the mean age of 30.7±11.3. The majority of the patients were members of army forces. The total number of the lesions was 325. The number of lesions being ulcerated at the time of presentation was 179 (55%) and non-ulcerated lesions 146 (45%). Time needed for improvement ranged from 1.5 to 4.8 months. Recovery time of cutaneous leishmaniasis lesions from time of onset to the remission ranged from 1.3 to 14.3 months.
    Conclusion
    The complete recovery time of the CL lesions was longer than what has been mentioned previously in Iraq. Ulceration of the lesions depends on the diameter of the lesions, as increased diameter increases the possibility of the ulceration. The possibility of lesion ulceration increases with an increase in the diameter of the lesions. Considering the observations in different clinical patterns and course of this disease, further studies should be conducted to identify CL species.
    Keywords: Cutaneous leishmaniasis, Clinical manifestation, Ulceration
  • Ramazan Fallah , Anoshirvan Kazemnejad , Alireza Shoghli , Nasim Vahabi Pages 414-419
    Background
    Child growth is an important health indicator in human’s lifespan. Evaluating growth variations in infants and children is highly important. This study was conducted to evaluate the risk factors of child growth retardation and determine childhood growth velocity in Zanjan province, Iran.
    Methods
    This longitudinal study was conducted on 7892 children aged 0 to 2 years in Zanjan province in 2013. The sampling method was multi-stage cluster sampling. To determine the growth velocity, 2- pointed model was used. We applied the marginal models of generalized equation estimators (GEE). The related curves were obtained using LOWESS method, and data were analyzed using R Version 2.14.1.
    Results
    In this study, 3879 (49%) of the participants were female, and the mean age of mothers was 27.1±5.4 years. Growth velocity had a significant association with gender, mother’s residency, multiple pregnancies, gestational age, and exclusive breastfeeding (p<0.001). A significant association was observed between gender and weight growth velocity (p<0.001). Moreover, exclusive breastfeeding had a significant association with weight growth velocity (p<0.001).
    Conclusion
    Growth velocity in girls was slightly higher than in boys, however, no considerable difference was found between height growth velocity of girls and boys. The findings of this study also indicated that each month increase in exclusive breastfeeding leads to less growth velocity in children. So, exclusive breastfeeding is strongly recommended to prevent childhood obesity
    Keywords: Growth, Marginal model, Growth velocity, Weight
  • Yousef Rahmani , Sareh Mohammadi , Hossein Karim , Mahin Rezazadeh , Mehran Babanejad , Afshar Shahmohammadi , Alireza Rai Pages 420-428
    Background
    Several studies in the recent decade have supported a relationship between different types of infections and CHD (Coronary Heart Disease); however, such a relationship is not definitely proven. Helicobacter pylori is one of the most common infections in human. The role of inflammation in the pathogens of CAD (Coronary Artery Disease) has been widely discussed; although, the mechanism is not clearly known yet.
    Methods
    In this systematic review and meta-analysis all case-control articles on the relationship between Helicobacter pylori and CHD published from 31st June 2000 to 31st June 2016 indexed in Scopus, PubMed, Google Scholar, Science Direct, and Iranian databases Magiran, Iran Medex, Irandoc, and SID were included. The articles were searched using the following keywords in Farsi and English. The extracted data was imported into Microsoft Excel and analyzed in Stata 12.
    Results
    Thirty case-control studies conducted in different regions of Iran (15 provinces) have been published from 2001 to 2015 included in this study. A general estimate of OR (Odds Ratio) for the association of Helicobacter pylori and heart diseases in Iran was 2.351 (95 CI: (1.715, 3.221)).
    Conclusion
    According to the observed association between Helicobacter pylori and heart diseases in the resent study, most of the hosts of the bacterium are afflicted with the infection in their childhood. Therefore, personal hygiene promotion and preventive programs for Iranian children may have a considerable role in reducing the risk of the infection and cardiovascular diseases, consequently
    Keywords: Coronary heart disease, Helicobacter pylori, Iran, Meta-analysis
  • Abolghasem Fallahzadeh Abarghuei , Mahsa Fadavi, Ghaffari , Safoura Tousi , Malek Amini , Ali Reza Salehi Pages 429-433
    Background
    One of the vulnerable populations of any community are the elderly, who are exposed to poor balance, falls, injuries, reduced quality of life (QoL) and independency, and early death. Considering the importance of balance in independently performing activities of daily living (ADL) and its impact on QoL, in this study, we aimed at investigating the effect of Cawthorne and Cooksey exercises (CCE) on QoL and balance of 60 to 80 year-old individuals in Shiraz, Iran.
    Methods
    This clinical trial study was conducted on forty 80 to 60-year-old individuals of Jahandideghan retirement center in Shiraz (20 in the intervention and 20 in the control groups) in 2014. The intervention group did CCE in three 60- minute sessions a week for 2 months. The balance status of the participants was assessed with Berg balance test, and their QoL was also examined using SF36 Quality of Life Questionnaire before the intervention and at 2 months post intervention. Data were analyzed by independent t test in SPSS software Version 19.
    Results
    The results of the study revealed that the difference was significant in the balance change scores between the 2 groups (p<0.001, effect size = 0.78). Change differences in the QoL scores were significant between the 2 groups as well (p<0.001, effect size = 0.39).
    Conclusion
    CCT improved QoL and balance of 60 to 80 year- old Shirazians, so considering the low cost, easy implementation, and considerable impact of the exercises, CCT could be used to prevent and treat balance disorders of the elderly
    Keywords: Balance, Cawthorne, Cooksey exercises, Quality of life, The elderly
  • Somayeh Delavari , Mitra Amini , Zohreh Sohrabi , Hamidreza Koohestani , Sajad Delavari , Rita Rezaee , Elaheh Mohammadi , Anne Demeester , Bernard Charlin , Masoomeh Kheirkhah Pages 434-439
    Background
    Clinical reasoning plays an important role in the accurate diagnosis and treatment of diseases. Script Concordance test (SCT) is one of the tools that assess clinical reasoning skill. This study was conducted to determine the reliability and concurrent and predictive validity of SCT in assessing final lessons and gynecology exams of undergraduate midwifery students.
    Methods
    At first, 20 clinical scenarios followed by 3 questions were designed by 2 experienced midwives. Then, after examining the content validity, 15 scenarios were selected. The test was used for 55 midwifery students. The correlation of SCT results with grade point average (GPA) was measured. To evaluate the concurrent validity of SCT, the correlation between SCT scores and the final exam of the gynecology course was measured. To measure predictive validity, the correlation of SCT scores with comprehensive exams of midwifery was calculated. Data were analyzed using SPSS software. Descriptive statistics, Pearson correlation, and coefficient Cronbach's alpha were used for analysis. The test’s item difficulty level (IDL) and item discriminative index (IDI) were determined using Whitney and Sabers’ method.
    Results
    The internal reliability of the test (calculated using Cronbach’s alpha coefficient) was 0.74. All questions were positively correlated with the total score. The highest correlation coefficient was related to GPA and comprehensive test with the score of 0.91. The correlation coefficient between SCT and the final test (concurrent validity) was 0.654, and the correlation coefficient between SCT and comprehensive test (predictive validity) was 0.721. The range of item discriminative index and item difficulty level in this exam was 0.39-0.59 and 0.32-0.66, respectively.
    Conclusion
    SCT shows a relatively high internal validity and can predict the success rate of students in the comprehensive exams of midwifery. Also, it showed a high concurrent validity in the final test of gynecology course. This test could be a good alternative for formative and summative tests of clinical courses.
    Keywords: Clinical decision-making, Problem-solving, Assessment, Educational, Clinical competence, Clinical skill, Midwifery, Psychometrics
  • Majid Kermani , Mohsen Dowlati , Ahmad Jonidi Jafari , Roshanak Rezaei Kalantary Pages 440-445
    Background
    Air pollution is one of the main reasons for disease and emergency hospitalizations. Therefore, air pollution control and hospital preparedness are of paramount importance. This study was conducted to determine the association of air pollutant levels with the rate of hospital emergency admissions due to respiratory and cardiovascular diseases and acute myocardial infarction in Tehran during the last decade.
    Methods
    This was a cross sectional study. At first, information on hourly concentration of air pollutants was gathered from Tehran Environmental Protection Agency and Air Quality Control Company. Raw data and meteorological parameters were used in Excel format to prepare an input file. The number of emergency hospital admissions due to pollutant exposure was assessed using the AirQ2.2.3 model.
    Results
    Results of this study revealed that there were 54 352 cases of emergency hospitalizations due to respiratory diseases in a relative risk of 1.0048 [1.0008-1.0112] and 20 990 cases of emergency hospitalizations due to cardiovascular diseases in a relative risk of 1.009[1.006-1.013] during 2005-2014. In addition, 3478 patients were admitted to the emergency department because of acute myocardial infarction with RR of 1.0026 [1.0026-1.0101].
    Conclusion
    This study demonstrated that a high percentage of hospital emergency admissions was because of respiratory and cardiovascular diseases. Moreover, it was found that acute myocardial infarction could be due to the high level of air pollution and could increase admissions to the emergency department. Therefore, appropriate measures are needed to reduce air pollution and increase hospital preparedness
    Keywords: Air pollution, Emergency, Respiratory diseases, Cardiovascular diseases
  • Aslan Nazari , Iravan Masoudi Asl , Masoud Abolhallaje , Amir Ashkan Nasiripour , Mohammad Javad Kabir Pages 446-452
    Background
    Social health insurances provide protection to access affordable coverage of services and stewardships of health system need to intervene to fulfill these objectives. This study conducted to assess interaction between stewardship and social health insurances.
    Methods
    This qualitative study conducted in two phases as comparative study and document analysis in 2018. Comparative study employed to identify the dimensions and requirements of interaction between stewardship of health systems and social health insurances in countries around the world. In document analysis, all evidence about Iran health financing reviewed. Data extraction forms were used to gather data.
    Results
    There were less interaction between stewardship and social health insurances in revenue collection and risk pooling. Advisory role of stewardship and proposals to coverage of uninsured people and performing risk analysis were some examples of such interaction. In Iran’s health system, where stewardship plays a magnificent role in service provision, the basis of interactions are contracts, payment systems and timeline of payments.
    Conclusion
    Mechanisms of interaction in Iran is not clear or does not work properly. Thus, nonstructural merging of social health insurances needs to redefine these mechanisms
    Keywords: Stewardship, Health system, Social health insurances, Interaction, Iran
  • Hooman Angoorani , Zeinab Karimi , Farokh Naderi , Ali Mazaherinezhad * Pages 453-458
    Background
    Central fat deposition seems to be a risk factor for developing metabolic and cardiovascular diseases in overweight and obese individuals. Ultrasound is an accurate and non-invasive tool for measuring abdominal fat thickness and can precisely separate subcutaneous from visceral fat. This study was conducted to apply ultrasonography as a simple and reliable method to measure subcutaneous and visceral abdominal fat thickness and evaluate the relationship between this measured abdominal fat thickness and metabolic risk factors.
    Methods
    A total of 80 overweight and obese women were included in this study. Anthropometric indices and abdominal fat thickness were measured using ultrasound. The association between abdominal fat thickness and metabolic risk factors with anthropometric indices was assessed using correlation coefficient.
    Results
    The mean (± SD) of subcutaneous and visceral fat thickness was 2.71±0.92 and 5.46±1.88, respectively. There was a relationship between waist circumference and visceral and subcutaneous fat thickness. Also, there was a relationship between ultrasound–measured visceral fat thickness and fasting blood glucose and triglyceride.
    Conclusion
    Ultrasonography is a simple and reliable method to measure abdominal fat thickness as an important predictor of metabolic diseases.
    Keywords: Ultrasonography, Obesity, Visceral fat, Metabolic disease
  • Somayeh Mohamadi , Ismail Ebrahimi *, Mehdi Dadgoo , Mahyar Salavati , Ahmad Saeedi , Bijan Valiollahi Pages 459-463
    Background
    Ankle Instability Instrument (AII) is a questionnaire for determination of ankle stability status. The aim of this study is to cross-culturally translate and investigate the reliability and validity of AII in a sample of Persian-speaking Iranians, suffering from ankle sprain.
    Methods
    One hundred twenty persons with a history of ankle sprain were recruited in the study. All participants completed the Persian version of Ankle Instability Instrument, Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) at the baseline. Out of them, 60 randomly selected subjects completed the questionnaires once more, one week later. Face validity, Test–retest reliability, internal consistency, standard error of measurement, minimal metric detectable change, spearman’s correlation coefficient and confirmatory factor analysis of AII measured. We used Lisrel v 8.80 software with significant level of p<0.05.
    Results
    Persian version of AII is clear and unambiguous and its qualitative face validity was confirmed in the pilot study on the 20 subjects with a lateral ankle sprain. The interclass correlation coefficient, Cronbach’s alpha, standard error of measurement and minimal metric detectable change were 0.93, 0.87, 0.81 and 2.25 (95% confidence interval, 0.85-0.96). The Spearman correlations coefficients between AII, and CAIT, FAAM and FAOS measures were 0.91, 0.71 and 0.69 respectively. The original three factor structure of AII was replicated based on the confirmatory factor analysis. Which showed an adequate fit of the model to the data and goodness-of-various fit indices.
    Conclusion
    The Ankle Instability Instrument Persian Version (AII-PV) is a reliable and valid measure for assessing the ankle stability status.
    Keywords: Ankle sprain, Instability, Psychometric, Questionnaire, Persian, Confirmatory factor analysis
  • Esmaeil Allahmoradi , Saeid Taghiloo , Versa Omrani, Nava , Saeideh Sadat Shobeiri , Mohsen Tehrani , Mohammad Ali Ebrahimzadeh , Hossein Asgarian, Omran * Pages 464-469
    Background
    Portulaca oleracea, known as Purslane, is an annual growing herb with wide distribution around the world and traditionally used to manage several diseases. Different therapeutic properties as an anti-fever agent as well as anti-inflammatory and analgesic effects have been attributed to P. oleracea. The aim of this study was to investigate the effects of P. oleracea aerial extract on production of pro- and anti-inflammatory cytokines by human peripheral blood mononuclear cells (PBMCs).
    Methods
    Aerial parts of P. oleracea (stems and leaves) were collected and extracted by percolation using methanol. The optimal and non-cytotoxic dose of hydro-alcoholic extract for cell culture analysis was determined by MTT assay. To assess the anti-inflammatory effects of P. oleracea, PBMCs obtained from 12 normal volunteers were cultured in RPMI complete medium and co-treated with E. coli lipopolysaccharide (LPS) and P. oleracea hydro-alcoholic extract. Following 18-hour incubation, culture supernatants were harvested for measurement of secreted TNF-α, IL-6 and IL-10 by ELISA. Statistical analyses were performed using the SPSS v.20, and data analyzed by Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis and post Hoc tests. P-values<0.05 were considered significant.
    Results
    The optimal non-cytotoxic concentration of P. oleracea aerial extract was defined as 100 μg/ml based on MTT viability assay. P. oleracea hydro-alcoholic extract significantly decreased the concentration of both pro-inflammatory cytokines TNF-α and IL-6 in LPS-stimulated PBMCs (p<0.001 and p<0.001, respectively). However, the concentration of IL-10 as an anti-inflammatory cytokine, did not show any statistically significant change (p=0.390).
    Conclusion
    Our findings highlighted the potential anti-inflammatory properties of P. oleracea in herbal medicine. Future analysis on different constituents of total extract may confirm its therapeutic effects as a promising anti-inflammatory compound.
    Keywords: Portulaca oleracea, Anti-inflammatory agent, Tumor necrosis factor-alpha, Interleukin-6, Interleukin-10
  • Fatemeh Fazli , Behshid Farahmand*, Fatemeh Azadinia , Ali Amiri Pages 470-474
    Background
    Cervical pillows are considered to be part of the therapeutic strategy in cervical spondylosis, but there is little or no convincing scientific evidence on the effectiveness of these pillows in relieving pain and disability in these patients. Hence, this study investigated the effects of ergonomic latex pillow in conjunction with routine physiotherapy versus routine physiotherapy alone on disability and pain intensity in patients with cervical spondylosis.
    Methods
    22 patients with cervical spondylosis in a single-blinded pilot study with a pre/post-test design were randomly assigned to experimental and control groups. Both groups received 12 sessions of physiotherapy for four weeks. In the experimental group, participants were given an ergonomic latex pillow to sleep it for four weeks. Participants in the control group slept on their own usual pillow. All the participants filled out the Neck Disability Index questionnaire, and scored their neck pain intensity on the Numerical Pain Rating Scale before and after the intervention. Changes of variables (pain and disability) within and between groups were compared by Paired T-test and the Independent Sample T-test, respectively via SPSS v.20 (p<0.05).
    Results
    Numerical Pain Rating Scale and Neck Disability Index scores were decreased statistically significant within groups. In the experimental group, neck disability scores were significantly lower than those in the control group (p=0.038). However, pain intensity scores were not significantly different between groups.
    Conclusion
    Ergonomic latex pillows can significantly decrease disability related to neck pain in patients with cervical spondylosis after four weeks.
    Keywords: Cervical spondylosis, Pillow, Neck pain, Disability
  • Ghobad Moradi , Mohammad Mehdi Gouya , Babak Eshrati , Minoo Mohraz , Leila Molaei , Bakhtiar Piroozi* Pages 475-479
    Background
    Antimicrobial resistance (AMR) is one of the most important threats to health worldwide. Therefore, the World Health Organization (WHO) have invited countries around the world to work together to inhibit AMR, and all the member states are expected to prepare a national plan for tackling AMR by 2017. This project was aimed to prepare the National Action Plan of the Islamic Republic of Iran for combating antimicrobial resistance (NAP-IRIAMR) during 2016 to 2021.
    Methods
    In this article, the literature and available documents were reviewed to identify key stakeholders. Moreover, interviews, brain storming sessions, and meetings with key stakeholders were held to determine NAP-IRIAMR objectives, strategies, policies, and indicators for monitoring and evaluation. To reach consensus and make a conclusion, participants’ views and comments were analyzed using Delphi method and expert panel.
    Results
    In this national action plan for combating AMR, 13 key stakeholders were identified and 5 objectives were set: (1) raising public awareness and increasing trainings on AMR, (2) continuous monitoring of AMR, (3) preventing the spread of microorganisms resistant to antimicrobials, (4) promoting the rational use of antimicrobials, (5) promoting research and development in the field of AMR.
    Conclusion
    The NAP-IRIAMR was prepared for the years 2016- 2021. Intersectoral cooperation is needed to combat AMR. It is expected that implementing the NAP-IRIAMR and reaching the determined goals will help overcome the problems related to AMR.
    Keywords: Antimicrobial resistance, Antimicrobial, Infectious disease, National Action Plan, Iran
  • Maryam Jazayeri , Yousef Moradi , Arezoo Rasti , Manouchehr Nakhjavani , Mahboobeh Kamali , Hamid Reza Baradaran* Pages 480-485
    Background
    Vitamin D deficiency is related to rickets in children, and it can increase the risk of osteoporosis in adulthood. The aim of our study was to estimate the prevalence of vitamin D deficiency among healthy Iranian children and adolescents. Vitamin D levels less than 20ng/ml and between 20 and 30ng/ml was considered as vitamin D deficiency and insufficiency, respectively.
    Methods
    Relevant observational studies evaluating the prevalence of vitamin D deficiency through 1 January 1990 to 28 Dec 2016, were searched in several electronic databases including Iran-Medex, Scientific Information Database (SID), Irandoc, PubMed and NLM Gateway (for MEDLINE), Web of Science, and Scopus with no restriction on language. Only full-text articles were used for data extraction and synthesis after considering the inclusion/exclusion criteria.
    Results
    11 studies included; the data of four studies of Iranian newborns were withdrawn because of their high heterogeneity. The prevalence of vitamin D deficiency in Iranian boys and girls were 35% (CI 95% 34–37) and 61% (CI 95% 60–63), respectively. The prevalence of vitamin D insufficiency in Iranian children and adolescents was 31% (CI 95% 30–31).
    Conclusion
    It seems that the prevalence of vitamin D deficiency is very high among Iranian children and adolescents. The present findings could provide practical information for healthcare decision makers.
    Keywords: Vitamin D deficiency, Insufficiency, Prevalence, Children, Iran
  • Zahra Emami , Nadjla Hariri *, Mohammad Ebrahim Khamseh , Fatemeh Nooshinfard Pages 486-494
    Background
    Scientometric studies are highly important, as they provide information about scientific products worldwide and empower scientists to compare research activities in different regions. The present study was conducted to map scientific research in diabetes mellitus using scientometric analysis in Middle Eastern countries during 2003- 2007.
    Methods
    This was an analytical study with a scientometric approach. The study population was formed by the indexed scientific results of diabetes mellitus in the Web of Science database during 2007-2013. Data were analyzed using Excel, and HistCite to map the scientific texts.
    Results
    A total of 6532 records were retrieved from 3926 institutions. These records belonged to 19 323 authors and were published in 1420 journals.
    The Journal of Diabetes Care, with 3928 citations, had the most global citation score (GCS). The Journal of Diabetes Research and Clinical Practice, with 185 citations, achieved the first degree of local citation score (LCS). Most of the scientific documents produced in the Middle East belonged to Turkey (31.91%) and Iran (21.7%). Seven scientific clusters based on LCS, and 5 based on GCS existed in the scientific mapping. Topical clusters based on global and local indices showed that the prevalence of diabetes, hyperglycemia, and pregnancy outcomes, diabetic risk factors, diabetic complications and their new treatments, and glucose monitoring in Type 1 diabetes were the fields being addressed in the main articles of the clusters.
    Conclusion
    Scientific production and local and global citations in diabetes research in Iran (21.7% of diabetes research in the Middle East) have elevated the country to a prominent position. Top ranking countries in diabetic research were Turkey, Iran, and Israel, respectively. Moreover, this paper quantified the studies that were done on different aspects of diabetes. The results of this study can be used by health care providers to employ the best multidisciplinary approach for managing diabetes and its complications. Also, the results can help the policy-makers and governments to determine the priorities for budget allocation based on the burden of diseases. Establishing a regional diabetes network in the Middle East can be beneficial and lead to scientific collaboration and an increase in scientific production in this field.
    Keywords: Scientific research, Diabetes mellitus, Middle East, Scientometric
  • Mostafa Langarizadeh , Azam Orooji * Pages 495-501
    Background
    In recent years, liver disorders have been continuously increased. Proper performance of data mining techniques in decision-making and forecasting caused to use them commonly in designing of automatic medical diagnostic systems. The main aim of this paper is to introduce a classifier for diagnosis of liver disease that not only has high precision but also is understandable and has been created without expert knowledge.
    Methods
    In regards to this purpose, fuzzy association rules have been extracted from dataset according to fuzzy membership functions which determined by fuzzy C-means clustering method; while each time, extracting fuzzy association rules, one of the five quality measures including confidence, coverage, reliability, comprehensibility and interestingness is used and five fuzzy rule-bases extracted based on them. Then, five fuzzy inference systems are designed on the basis of obtained rule-bases and evaluated in order to choose the best model in terms of diagnostic accuracy.
    Results
    The proposed diagnostic method was examined using data set of Indian liver patients available at UCI repository. Results showed that among considered quality measures, interestingness, reliability and truth outperformed respectively, and yielded precision, sensitivity, specificity and accuracy of more than 90%.
    Conclusion
    In this paper, a classification method was developed to predict liver disease which in addition to high classification accuracy, it has been created without expert knowledge and provided an understandable explanation of data. This method is convenient, user friendly, efficient and requires no expertise.
    Keywords: Fuzzy association rule mining, Membership function extraction, Liver disease, Fuzzy diagnostic system, Rule quality measures
  • Amir Mehrgou , Mansoureh Akouchekian* , Simin Hemati Pages 502-506
    Background
    Breast cancer is one of the most common cancers among Iranian women whose relationship with mutation status in BRCA1 is previously approved. Therefore, screening of the most mutated exons in BRCA1 in hereditary breast cancer patients provides beneficial information about the main disease-causing reason.
    Methods
    A total of 14 Iranian hereditary breast cancer patients participated in this case series study. DNA was extracted from patients’ blood samples for PCR assay. The quality of PCR products was determined using horizontal electrophoresis. Then, sequencing and analysis of the sequencing results were performed to investigate variation status in the sequences.
    Results
    Five variants in 4 patients were found, including 1 pathogenic variant in exon 16 (H1686Q, NM_007294.3:c.5058T>A) and 4 novel intronic variants of uncertain significance (NC_000017.11:41228314G>T, NC_000017.11:41228309C>T, NC_000017.11:41228317G>T, and NC_000017.11:41203042G>A) in BRCA1. This study was the first to report 1 rare pathogenic variant in BRCA1 (H1686Q, NM_007294.3: c.5058T>A) in an Iranian family as the main disease-causing reason. Another interesting finding was non-existence of variations in almost all globally-reported and mutated exons in BRCA1.
    Conclusion
    Investigation of these exons in BRCA1 showed the uniqueness of mutation pattern in Iranian breast cancer patients compared to other world regions. Due to the existence of other BRCA1 exons and also other predisposing genes in breast cancer, the main cause of cancer development in other participants might have been put in those exons and genes. We concluded that the most mutated exons in BRCA1 in Iranian population may not be the same as those found in other parts of the world.
    Keywords: Hereditary breast cancer, BRCA1 gene, Variation
  • Unaib Rabbani *, Zafar Fatmi Pages 507-513
    Background
    Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country.
    Methods
    A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic regression was performed to calculate the adjusted odds ratio (OR) with 95% confidence interval, to identify the putative risk factors for occupational injuries.
    Results
    Incidence of occupational injuries was 35.0 per 100 per year (95% CI: 28.9 - 42.7). Cuts (70%) and hand tools (71%) were the most common type and agent for injury, respectively. Majority of injuries occurred during harvesting (55%). Increasing age [AOR 1.03 (95% CI: 1.01 - 1.05)], income <6000PKR/month [AOR 2.27 (95% CI: 1.08 - 4.76)] and driving tractor [AOR 2.58 (95% CI: 1.25 -5.33)] increase the risk for injuries.
    Conclusion
    There was a high burden of injuries among the agricultural workers in Pakistan. Large-scale studies are required to further characterize the risk of injuries and develop preventive strategies to protect agricultural workers.
    Keywords: Agriculture, Developing country, Incidence, Occupational injuries, Pakistan
  • Zahra Maddah , Mahdieh Ghalenoee* , Jamileh Mohtashami , Mohammad Amin Pour Hoseingholi , Roghayeh Esmaieli , Vahid Naseri, Salahshour Pages 514-519
    Background
    Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children that creates problems in parents-children relationships. Improving familial and social interactions of these children needs mental and social interventions, and parents’ management training (PMT) program is one of these interventions. The present study aimed at determining the effectiveness of PMT program on parent-child relationship of parents with ADHD children.
    Methods
    Through an experimental research, 40 parents with ADHD children were selected based on purposeful sampling. A total of 20 parents were randomly placed in intervention group and received 8 sessions of intervention course (60 minutes per session) and the other 20 parents were grouped in the control group and received no training intervention. Research tools included a researcher-designed demographics questionnaire and Parker’s Bonding Instrument (PBI). Data were collected at pretest, posttest, and follow- up stages and analyzed using descriptive and covariance analysis.
    Results
    The results revealed that PMT program was significantly effective in reducing excessive support and increasing parent care index in parents with ADHD children (p<0.05).
    Conclusion
    The results of the present study supported the effectiveness of PMT program on parent-child relationship of the parents with ADHD children.
    Keywords: Parents management training program, Parents, Parent-child relationship, Mental health, Psychology, ADHD
  • Soheila Aminimoghaddam , Rozhin Pahlevani *, Maryam Kazemi Pages 520-525
    Background
    Electrosurgery is widely used in reproductive related surgeries and technological advancements to improve efficacy and reduce potential complications. However, some reports have indicated lack of sufficient knowledge and training about basic principles and technical aspects of electrosurgery among obstetricians and gynecologists.
    Methods
    In this paper we present a summary on basic concepts and principles of electrosurgery and review the recent evidence on the use of electrosurgical devices in gynecologic procedures including endometrial ablation, gynecologic malignancies, loop electrode excision procedure (LEEP), and infertility.
    Result
    Considering the extensive use of these technologies in reproductive related surgeries, procedures including laparoscopy, hysteroscopy, and loop procedures further highlights the importance of more detailed training in this field. Gynecologists must learn the basics in more detail and update their knowledge on the growing body of evidence regarding the advancements of these technologies to reduce potential complications and select the most cost-effective treatment options for each patient.
    Conclusion
    Try to understanding the underlying biophysical principles and more in-depth familiarity with various electrosurgical devices could lead to less complications and optimize evidence-based gynecological practice.
    Keywords: Electrosurgery, Gynecologic procedures
  • Nahid Mohammadzadea , Mohammad Reza Shalbafan , Vahid Shariat , Babak Zamani , Behnam Shariati , Fateme Omrani , Mohammad Rohani * Pages 526-529
    Background
    Dysregulation of serotonin system is hypothesized to play the main role in the etiology of obsessive-compulsive disorder (OCD). Transcranial sonography (TCS) is a helpful noninvasive and low-cost tool for the assessment of subcortical brain architectures, mainly basal nuclei, cerebellar central structures, and midbrain. In this study, an ultrasound assessment was performed for a sample of the patients with OCD and healthy control group to evaluate echogenicity of midbrain raphe nuclei (RN).
    Methods
    A total of 35 patients with OCD and 35 healthy controls of similar age and sex entered the study. Semi-structured clinical interview was performed according to the DSM IV-TR criteria to verify OCD. Echogenicity of the midbrain RN was assessed by an experienced neurologist applying TCS. The echogenicity of the 2 groups was compared using chi- square test. SPSS software (version 18, PASW) was used for statistical analysis and p-value of less than 0.05 was considered significant.
    Results
    In this study, 15 OCD patients (42.9%) and 11 (31.4%) controls showed decreased echogenicity of midbrain RN. Also, the results of the chi-square test showed that the midbrain RN echogenicity was not significantly lower in patients with OCD compared to the control group (p= 0.322).
    Conclusion
    Although decreased midbrain RN echogenicity is a characteristic of patients with major depression, it was not shown in OCD patients in this study, which can be explained by the involvement of RN projections rather that RN serotoninergic neurons.
    Keywords: Transcranial sonography, Obsessive-compulsive disorder, Raphe nuclei, Echogenicity
  • Behzad Damari , Hossein Almadani , Mahin Ahmadi Pishkuhi * Pages 532-539
    Background
    Addiction is a serious concern in workplaces, as it can lead to accidents, absenteeism, and loss of productivity, neglect, delay, arguing, unhappiness, production cuts, and irregular working pattern. This national survey was conducted to assess the prevalence and pattern of drug use among employees of industrial environments in Iran.
    Methods
    In this cross sectional study, the sample size was determined to be 13489 using multistage cluster sampling method during November 2013 and November 2014. Data were collected by trained interviewers using a structured questionnaire developed by the research team. Urine drug test was done for participants using laboratory rapid kits. A total of 13 286 questionnaires were completed with remarkable responsiveness such that only 1.2% of them were excluded due to defects in urine drug tests, and the rest were analyzed after the review.
    Results
    The response rate to the questionnaires was 98.4% and 13 128 individuals took the urinary drug test. Many participants who had positive urine test did not express drug use and positive tests were more than self-reported cases. Compared to information about the pattern of drug use, data on the estimated prevalence of drug use was more reliable.
    Conclusion
    This study presents the protocol of a well-designed national survey, including sampling procedure, appropriate instrument and test, field work, and discussion on the strengths and limitations of the study, and thus its results can be used effectively by policymakers.
    Keywords: Drug use, Survey, Workplace, Addiction
  • Hossein Aazami , Farhad Seif , Babak Ghalehbaghi , Alireza Mohebbi , Aslan Ahmadi , Pegah Babaheidarian , Kobra Zinat Entezami , Majid Khoshmirsafa , Sahand Ghalehbaghi , Reza Falak * Pages 540-543
    Background
    Different inflammatory mechanisms take part in the immunopathogenesis of chronic rhinosinusitis (CRS). Immunoglobulin (Ig) A is the first-line defense in the airway tracts and other mucosal sites, but little is reported regarding its serum level in CRS patients. The purpose of current study is to determine the serum levels of total IgA, and its subclasses (IgA1, and IgA2) in CRS with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and control groups.
    Methods
    In this case-control study the serum levels of total IgA and IgA subclasses were determined by Nephelometry and ELISA methods, respectively. The difference of the median concentrations was analyzed with the Kruskal-Wallis test. Collected data were analyzed using SPSS and presented by GraphPad Prism software.
    Results
    A total of 10 CRSwNP patient, 10 CRSsNP patients and 10 healthy controls participated in our study. The mean age of the groups were 38.2±12.6, 25.6±10.54, and 30.1±9.5, respectively. The concentrations of total IgA were 156(120-165), 165 (149-173), and 172 (152.8-184.3) mg/dl, respectively. The concentrations of IgA1 were 107 (77.9-169.9), 156.1(112.8-175.6), and 130.4 (118.8-175.2) mg/dl, respectively. The concentrations of IgA2 were 26.11 (18.41-38.11), 26.96 (15.48-38.39), and 23.2 (18.42-31.78) mg/dl, respectively. There was no significant difference in total IgA (p=0.120), IgA1 (p=0.397) and IgA2 (p=0.925) serum levels among three groups.
    Conclusion
    Our study showed there is no difference in total IgA and IgA subclasses in the serum of CRS patients in comparison to healthy controls.
    Keywords: Chronic Rhinosinusitis, Nasal polyps, CRSsNP, CRSwNP, Serum IgA, Isotype switching
  • Somaye Yosaee , Kurosh Djafarian , Alireza Esteghamati , Abbas Motevalian , Farzad Shidfar , Shima Jazayeri *, Mehdi TehraniDoost Pages 544-547
    Background
    Although a growing body of evidence suggests an association between obesity and depressive disorder, the association remains inconclusive. Metabolically healthy obese (MHO) phenotype, defined by favorable lipid profile, and normal insulin sensitivity, blood pressure, may be considered as a possible explanation for these inconsistencies. Accordingly, this study aimed to compare depression score among metabolic unhealthy obese (MUO) and age- and sex-matched healthy controls.
    Methods
    In this comparative study including 157 Iranian adults, we assigned participants into three groups (non-obese metabolic healthy group, MHO and MUO) according to the BMI cutoff and MetS criteria. Depressive symptoms were assessed by Beck Depression Inventory. Analysis was done using SPSS version 14.0. All variables are expressed as means ± SD. One-way ANOVA and Multiple linear regression were used for data analysis.
    Results
    After adjustment for sex, marital status and educational level, MUO participants had significantly higher Beck depression score (P= 0.036) compared to MHO and non-obese metabolic healthy groups. After adjustment for demographic variables, there was a significant association between waist circumference (β = 0.142, p=0.023), BMI (β= 0.347, p= 0.037), FBS (β= 0.096, p< 0.001), and the number of MetS components (β= 1.71, p= 0.002) with depression score.
    Conclusion
    MHO was a benign phenotype in relation to depression.
    Keywords: Depressive symptom, MetS, Obesity
  • Hossein Aazami *, Farhad Seif , Babak Ghalehbaghi , Alireza Mohebbi , Aslan Ahmadi , Pegah Babaheidarian , Kobra Zinat Entezami , Majid Khoshmirsafa , Sahand Ghalehbaghi , Reza Falak Pages 545-548
    Background
    Different inflammatory mechanisms take part in the immunopathogenesis of chronic rhinosinusitis (CRS). Immunoglobulin (Ig) A is the first-line defense in the airway tracts and other mucosal sites, but little is reported regarding its serum level in CRS patients. The purpose of current study is to determine the serum levels of total IgA, and its subclasses (IgA1, and IgA2) in CRS with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and control groups.
    Methods
    In this case-control study the serum levels of total IgA and IgA subclasses were determined by Nephelometry and ELISA methods, respectively. The difference of the median concentrations was analyzed with the Kruskal-Wallis test. Collected data were analyzed using SPSS and presented by GraphPad Prism software.
    Results
    A total of 10 CRSwNP patient, 10 CRSsNP patients and 10 healthy controls participated in our study. The mean age of the groups were 38.2±12.6, 25.6±10.54, and 30.1±9.5, respectively. The concentrations of total IgA were 156(120-165), 165 (149-173), and 172 (152.8-184.3) mg/dl, respectively. The concentrations of IgA1 were 107 (77.9-169.9), 156.1(112.8-175.6), and 130.4 (118.8-175.2) mg/dl, respectively. The concentrations of IgA2 were 26.11 (18.41-38.11), 26.96 (15.48-38.39), and 23.2 (18.42-31.78) mg/dl, respectively. There was no significant difference in total IgA (p=0.120), IgA1 (p=0.397) and IgA2 (p=0.925) serum levels among three groups.
    Conclusion
    Our study showed there is no difference in total IgA and IgA subclasses in the serum of CRS patients in comparison to healthy controls.
    Keywords: Chronic Rhinosinusitis, Nasal polyps, CRSsNP, CRSwNP, Serum IgA, Isotype switching
  • Somaye Yosaee , Kurosh Djafarian , Alireza Esteghamati , Abbas Motevalian , Farzad Shidfar , Mehdi Tehrani, Doost , Shima Jazayeri * Pages 549-552
    Background
    Although a growing body of evidence suggests an association between obesity and depressive disorder, the association remains inconclusive. Metabolically healthy obese (MHO) phenotype, defined by favorable lipid profile, and normal insulin sensitivity, blood pressure, may be considered as a possible explanation for these inconsistencies. Accordingly, this study aimed to compare depression score among metabolic unhealthy obese (MUO) and age- and sex-matched healthy controls.
    Methods
    In this comparative study including 157 Iranian adults, we assigned participants into three groups (non-obese metabolic healthy group, MHO and MUO) according to the BMI cutoff and MetS criteria. Depressive symptoms were assessed by Beck Depression Inventory. Analysis was done using SPSS version 14.0. All variables are expressed as means ± SD. One-way ANOVA and Multiple linear regression were used for data analysis.
    Results
    After adjustment for sex, marital status and educational level, MUO participants had significantly higher Beck depression score (P= 0.036) compared to MHO and non-obese metabolic healthy groups. After adjustment for demographic variables, there was a significant association between waist circumference (β = 0.142, p=0.023), BMI (β= 0.347, p= 0.037), FBS (β= 0.096, p< 0.001), and the number of MetS components (β= 1.71, p= 0.002) with depression score.
    Conclusion
    MHO was a benign phenotype in relation to depression.
    Keywords: Depressive symptom, MetS, Obesity
  • Fakhrossadat Mirhosseini , Neda Mehrdad , Shoaleh Bigdeli*, Hamid Peyravi , Homeira Khoddam Pages 553-560
    Background
    Researchers have contributed to the definition of SoTL; however, the literature is not conclusive on its definitions and attributes. Therefore, this study was an attempt to precisely define SoTL by its attributes, antecedents and consequences.
    Methods
    The Walker and Avant (2011) concept analysis method was used.
    Results
    The 9 emerged attributes are: Committed engagement in action, Critique-based, Disciplinary, Context-oriented, Critical enquiry process, Continuous deep reflection, Dynamic process, Shared publicly, and Learning focused.
    Conclusion
    This study helps promote understanding and application of SoTL.
    Keywords: Concept analysis, Scholarship of teaching, learning, SoTL, Walker, avant methodology
  • Raheleh Roudi *, Hosein Nemati , Mahsa Moghadam Rastegar , Mehdi Sotoudeh , Behzad Narouie , Azadeh Shojaei Pages 561-565
    Background
    Prostate cancer is a complex condition in which both genetic and environmental factors concomitantly contribute to the tumor initiation and progression. Recently, HOXB13 has been proposed as a susceptibility gene for prostate cancer.
    Objective
    The present study was conducted to determine the existence of potential variations in HOXB13 gene in Iranian men with prostate cancer (PCa) compared to benign prostatic hyperplasia (BPH) cases.
    Methods
    HOXB13 genetic status was screened in 51 samples, including 21 blood and tissue of PCa cases, and compared to 30 cases affected by BPH using PCR/sequencing. Then, the existence of potential association was investigated between genomic DNA alterations in blood and tissue PCa specimens.
    Results
    Analysis of BPH tissues showed single nucleotide variations c.366C > T (rs) or c.513T > C (rs9900627) in exon 1, but not in exon 2. Evaluation of PCa tissues revealed 2 cases with both synonymous c.366C > T and c.513T > C variants and 2 cases with the synonymous c.366C > T variant in exon 1. The variants c.366C > T and c.513T > C, simultaneously or separately, were found in blood samples of PCa patients. The novel variant c.127A > G in exon 2 was detected in 1 PCa blood sample. Our analysis indicated a significant reciprocal correlation between HOXB13 mutation in the tissue and blood samples of PCa cases (p= 0.02).
    Conclusion
    The variants in exon 2 of HOXB13 may influence the risk of prostate cancer. Also, evaluation of HOXB13 mutation may be considered as a novel marker for screening PCa. Further investigations are warranted to evaluate the clinical significance of HOXB13 in Iranian population.
    Keywords: Prostate cancer, HOXB13, Benign prostatic hyperplasia, Variant, Iran
  • Samaneh Khorrami *, Saeed Daneshmandi , Ghasem Mosayebi Pages 566-573
    Background
    Herbal medicine is becoming progressively accepted treatment for management of different diseases worldwide. Recognition of the active ingredients and mechanisms of herbal medicine against the immune system and related anomalies is highly favorable. This experimental study aimed to investigate the effects of Sesame (Sesamum indicum L.) essential oil and sesamol as effective components on mouse splenocytes subsets, macrophages and dendritic cells (DCs).
    Methods
    Effective components of sesame were extracted and used to treat splenocytes, PHA (5μg/ml) and LPS (10 μg/ml) stimulated splenocytes, macrophages and DCs in different concentration (0.01–100 μg/ml). The cell proliferation/viability was measured using the MTT assay and nitrite levels were measured by the diazotization method. Moreover, TNF-α and IL-1β cytokines concentration were assayed by ELISA. Treated DCs also analysed for maturation marker levels and cytokine production.
    Results
    Analysis of the results indicated that sesame components suppress PHA-stimulated splenocytes with no effect on LPS-stimulated subsets. Furthermore, the sesame ingredients reduced the release of IFN-γ and increased secretion of IL-4 from lymphocytes. Macrophages viability was not affected and production of NO, TNF-α, and IL-1β were inhibited using sesame essential oil and sesamol. DCs phenotype skewed to immature and release of TNF-α and IL-1β were abrogated form DCs.
    Conclusion
    These results indicate that sesame essential oil and its effective component as sesamol may capable of suppressing the response of cellular immunity with the domination of Th2 responses and also could modulate macrophages and the dendritic cells pro-inflammatory functions.
    Keywords: Sesame, Sesamol, Splenocyte, Macrophage, Nitric oxide, Dendritic cells
  • Seyed Mehdi Moosavizadeh , Hamidreza Alizadeh Otaghvar *, Mohammad Baghae , Arefeh Zavari , Hamid Mohyeddin , Hamidreza Fattahiyan , Behnood Farazmand , Seyed Mohammad Ali Moosavizadeh Pages 574-577
    Background
    Peripheral nerve injuries may affect all age groups and exert devastating impacts on the professional and personal life of the patients. The investigation of nerve regeneration and use of biomaterials and synthetic materials have resulted in advancements in the treatment of peripheral nerve injuries and lesions. Nerve conduits can be used to adjoin the digital sensory nerve spaces of less than 3 cm, especially when the direct tension-free repair of peripheral nerve lesions is not possible. The present study was conducted to evaluate the use of nerve conduits by functional and nonfunctional parameters (i.e. histological study).
    Methods
    This experimental study was conducted on 30 male rabbits. After cutting or crushing the right femoral nerve of the rabbits, they were divided into 3 groups: group 1, with right femoral nerve cut; group 2, with right femoral nerve crushed; and group 3, with right femoral nerve cut using a conduit. The 3 groups were evaluated after 1, 8, and 16 weeks for functional parameters (i.e. walking track analysis). In addition, they were subjected to nonfunctional examination (i.e. histological study) after 16 weeks, then, the results were compared.
    Results
    The 3 groups showed no statistically significant differences in motor recovery in the eighth and 16th weeks (p>0.05). Based on the histological study, group 3 with an end-to-end nerve cutting using a conduit, showed a significantly higher axon count compared to groups 2 and 3 (p<0.05).
    Conclusion
    End-to-end anastomosis using conduit led to axon growth; moreover, comparable functional recovery was observed with end-to-end neurorrhaphy in a rabbit model. Given that the diameter of the nerves and muscles, which might be neurotized in humans, and is much bigger and not comparable to that of the rabbits, it is highly recommended to conduct studies on animals with the larger size, such as primates, to facilitate the generalization of the results to humans.
    Keywords: Conduit, Femoral nerve, Nerve anastomosis, Motor recovery, Histologic study
  • Elham Ehsani, Chimeh*, Haniye Sadat Sajadi , Reza Majdzadeh Pages 578-582
    Summary
    Given the key role of adequate, skilled, well-trained, and motivated Human Resources for Health (HRH) in achieving Universal Health Coverage (UHC), this manuscript investigates the current situation of Iran HRH after the implementation of the recent Health Transformation Plan (HTP) in accordance with UHC analytical framework and by using four domains of availability, accessibility, acceptability and quality. We conclude that, Conflicts of interest and multiple interventions from different sectors have controversial and sometimes negative effects on the health workforce. In order to achieve the objectives of UHC from the perspective of human resources, Iran needs unified governance and comprehensive planning in this criterion. Also the effects of health system interventions on health workforce before implementation should be assessing.
    Keywords: Universal health coverage, Human resources for health, Health transition plan, Health workforce
  • Ali Gholami *, Shabnam Nadjafi , Farhad Moradpour , Zahra Moosavi Jhromi , Ali Montazeri , Mohammad, Reza Vaez, Mahdavi , Ali Asghar Haeri Mehrizi , Abbas Abbasi, Ghahramanloo , Sare Hatamian , Masoudreza Sohrabi , Mohsen Asadi, Lari Pages 583-590
    Background
    Quality of life (QoL) is now considered as a key indicator in health studies. Therefore, this study was conducted to evaluate QoL in the general population of Tehran (capital of Iran) using SF-12v2 questionnaire and determine some factors associated with it.
    Methods
    This was part of a large population-based cross sectional study conducted in Tehran, Iran, in 2011. Participants were selected from all districts of Tehran using multistage cluster random sampling method. Data were collected using the Iranian version of the SF-12v2 questionnaire. Linear regression model was used to assess the independent effect of surveyed variables of the study population on their QoL. P< 0.05 was considered statistically significant.
    Results
    Overall, 30 809 individuals over the age of 20 from 22 urban districts were included in this study and evaluated by SF-12v2 questionnaire. The mean age of the study population was 44.5±15.9, and most of them were female (19 967 (64.8%)). The total mean score of SF-12v2 was 60.4 and the lowest and highest mean scores were observed in GH (46.9±26.5) and MH subscales (64.1±24.7), respectively. It was also observed that District 3 of Tehran had the highest mean score (65.2±18.7) in the total QoL and District 12 had the lowest mean score (56.6±18.7), respectively. The results of multiple linear regression model showed that sex, age, education, household size, presence of chronic disease in family, having insurance, smoking, and marital status were significantly related to most subscales and two summary components of QoL.
    Conclusion
    The results of this study showed that the surveyed population of Tehran had a relatively moderate QoL, but it changed from district to district. It was also observed that age and education of the study population were important variables in relation to QoL.
    Keywords: Quality of life, QoL, Short form instrument, SF-12v2, Iran
  • Keivan Rahmany , Maryam Barati , Masoud Ferdosi , Amir Rakhshan , Ali Nemati * Pages 591-597
    Background
    Iranian health system underwent a series of reforms entitled Health Transformation Plan (HTP) in 2014. The plan started with packages that have imposed financial burden and increased expenditure in the health system. This study aimed to identify strategies and solutions to reduce expenditures in HTP in Iran.
    Methods
    To conduct this qualitative study, the researchers held 15 semi-structured interviews with prominent experts in the research arena in 2018. Content analysis was used to analyze the data using MAXQDA 10 software.
    Results
    Data collection yielded 9 main topics, including purchase and provision medicine, prescription, purchase and use of equipment, diagnostic medical services, referral system, human resources, physical space, payment system, and modifying and increasing base salaries.
    Conclusion
    In Iran’s health system, some aspects of HTP wasted resources, eg, the waste of resources in the service delivery system; thus, policymakers should consider proper strategies to control the costs based on the nature of their implementation.
    Keywords: Cost control, Health transformation plan, Qualitative study, Iran
  • Kamyar Mansori , Fatemeh Khosravi Shadmani , Hossein Mirzaei , Roya Vesal Azad , Sorour Khateri , Shiva Mansouri Hanis , Yousef Moradi * Pages 598-604
    Background
    Children in all countries, especially in developing countries, constitute a vulnerable group. Therefore, attention to their health issues is very important. The aim of this study was to determine the prevalence of stunting in Iranian children under-five years.
    Methods
    All original studies were searched by complex search syntax from international databases including Medline (PubMed), Web of sciences, Google scholar, Scopus, CINHAL and the Iranian databases consist of SID (Scientific Information Database, www.sid.ir), Irandoc (Iranian Research Institute for Information Science and Technology, Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and Magiran (www.magiran.com) from January 1989 to August 2017. Two independent reviewers identified relevant studies in several steps. We employed a random effect model to generate a pooled prevalence. The reported prevalence is presented as percent and 95% confidence interval (CI). Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression.
    Results
    Finally, 16 studies from different settings remained for meta-analysis in order to have a pooled prevalence estimate, which prevalence of total stunting was 12% (95%CI: 10–14). Subgroup analysis for gender showed that the prevalence of stunting in both boys and girls children were equal to 10% (95%CI: 8–11) and 9% (CI 95% 8–10), respectively. Also pooled prevalence of stunting in southern provinces are higher than other provinces.
    Conclusion
    The prevalence of stunting in some regions of Iran is higher than others. Although, in recent years much effort has been made to address deprivation such as economical, nutritional and social supporting, improvement of the quality of life, there are still nutritional problems in these areas of Iran.
    Keywords: Prevalence, Stunting, Children under 5 years, Iran
  • Leila Moftakhar , Masoud Solaymani, Dodaran* , Bahman Cheraghian Pages 605-609
    Background
    Gestational hypertension is a serious problem among pregnant women in Shadegan. This study was conducted to estimate the prevalence and risk factors of gestational hypertension in these women.
    Methods
    In this study, the prevalence of gestational hypertension was estimated. Then, a case-control study was performed on 310 pregnant women with gestational hypertension and 930 healthy pregnant women in 2014. Multiple logistic regression was used to explore the possible risk factors. The analysis was repeated in a subgroup of primigravidae women to identify the risk factors that led to gestational hypertension.
    Results
    The prevalence of gestational hypertension among pregnant women in Shadegan was 9.6%. Moreover, multiple logistic regression of all pregnant women showed that obese pregnant women were 1.79 times (OR = 1.79; 95%CI = 1.19-2.71; p<0.005) more likely to have gestational hypertension. Overweight and obese primigravidae women were 2.13 (OR = 2.1; 95%CI = 1.031-4.34; p<0.041) and 4.8 (OR = 2.4; 95%CI = 1.13-5.16; p<0.022) times more likely to have gestational hypertension than women with normal BMI, respectively. Age, education, history of gestational hypertension, and type of residential area of the primigravidae women were also significant factors.
    Conclusion
    BMI is the most important risk factor for gestational hypertension. More focus needs to be laid on this issue to raise awareness on the preservation of proper BMI before pregnancy, which can help decrease gestational hypertension.
    Keywords: Gestational hypertension, Pregnancy, Risk factor, Shadegan, Iran
  • Farshad Sharifi , Mojde Mirarefin , Mahtab Alizadeh, Khoei *, Neda Nazari , Baharak Najafi , Hossien Fakhrzadeh , Seyed Masoud Arzaghi , Ulrika S?derhamn , Fahimeh Taati , Neda Mehrdad Pages 610-617
    Background
    The Nutritional Form for the Elderly (NUFFE) is a newly developed tool. This study aimed to carry out a psychometric evaluation of the Persian version of NUFFE (NUFFE-P) among nursing home residents.
    Methods
    Nursing home participant’s aged ≥ 60 years (n=97) were enrolled. The inclusion criteria were residency for at least 6 months in the nursing home, and ability to communicate. Exclusion criteria included cognitive impairment, having depressed mood, severe hearing loss, problems in upper and lower extremities also, history of hospital admission during 6 months before enrollment. Anthropometric measures, laboratory tests, three-day food intake, NUFFE-P version, Mini Nutritional Assessment (MNA), Barthel Index (BI) and Geriatric Depression Scale (GDS-15) were assessed. The relationship between the NUFFE-P and MNA scores was considered as concurrent validity.
    Results
    The Cronbach’s alpha coefficient of NUFFE-P tool was 0.76. The intraclass correlation coefficient for the total score between two raters obtained 0.98 (CI 0.97-0.99). The correlation coefficient between the NUFFE-P and the MNA scores was -0.75 (p<0.01). Four factors were extracted for the NUFFE-P in an exploratory factor analyses. Sensitivity 69.8% and 100% and specificity 75.7% and 85.6% were achieved to detect elderly at medium risk (cutoff=6), and at high risk of under-nutrition (cutoff=11) respectively.
    Conclusion
    The NUFFE-P has sufficient psychometric properties in nutritional status screening among the Iranian elderly nursing homes residents.
    Keywords: Elderly, Nutrition assessment, Sensitivity, Specificity
  • Kamran Bagheri Lankarani , Sulmaz Ghahramani * Pages 618-622
    This debate article highlights the major issues that should be considered in social studies in health, which could guide the policymakers to target the root causes of diseases and to better evaluate the impact of previous health interventions at community level. This is a prerequisite for a prosperous health system, and there is an urgent need for reliable and timely evidence for intervention on all social issues that could affect health.
    Keywords: Social studies, Social determinants of health, Health, Policymaking
  • Atusa Rabiee , Behnoosh Vasaghi, Gharamaleki *, Sayyed Ali Samadi , Younes Amiri, Shavaki , Javad Alaghband, rad , Saba Seyedind , Soode Hosseini Pages 623-629
    Background
    Past studies have documented working memory impairment in participants with high-functioning Autism Spectrum Disorders (IQ>70), but inconsistent findings have been reported. One possibility is the existence of verbal responses in the evaluation of working memory performance. The aim of the current study is to examine the working memory performance and its correlation with a prominent deficit in participants with high-functioning Autism Spectrum Disorders by non-verbal working memory tasks compared with typically developing samples.
    Methods
    The current study is a cross-sectional, comparative study. The working memory performance of the 30 participants with high-functioning Autism Spectrum Disorders (7-16 years) and 30 typically developing was compared by working memory subtests of the Leiter International Performance Scale-Revised in Tehran, Iran. Two groups were matched for age and gender. ANOVA, ANCOVA, repeated measures ANOVA and Pearson’s correlation coefficient were used to analyze the data statistically. The significance value was set at p<0.05.
    Results
    The results showed that if the effect of FSIQ (full-scale intelligence quotient) were controlled individuals with high-functioning Autism Spectrum Disorders exhibited significant impairment in the Reverse Memory subtest (p=0.001). Also, unpredictably Forward Memory (r=0.38, p=0.03) and Reverse Memory tasks (r=0.38, p=0.03) displayed a significant positive correlation with the Social interaction subscale of the Gilliam Autism Rating Scale (Second Edition).
    Conclusion
    It seems that nonverbal working memory is impaired in persons with high-functioning Autism Spectrum Disorders. Results of the current study revealed that factors like complexity and cognitive load of tasks may influence working memory performance in individuals with high-functioning Autism Spectrum Disorders.
    Keywords: Autism spectrum disorder, Executive function, Working memory
  • Taraneh Yazdanparast , Kamran Yazdani , Philippe Humbert , Alireza Khatami , Saman Ahmad Nasrollahi , Hournaz Hassanzadeh , Amir Houshang Ehsani , Leila Izadi Firouzabadi , Alireza Firooz * Pages 630-634
    Background
    Skin biometrology is a useful method for evaluation of inflammatory skin disorders such as dermatitis, psoriasis, and lichen planus. The current study tries to compare the biophysical features of skin in dermatitis, psoriasis, and lichen planus.
    Methods
    By a convenient sampling method, 22 mild to moderate chronic dermatitis, 26 psoriasis, and 21 lichen planus patients were recruited in the study. Stratum corneum (S.C.) hydration, Transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, elasticity parameters (R0, R2, and R5), skin temperature, skin thickness, and echo-density of epidermis and dermis were measured on the lesional (selected active lesion), uninvolved perilesional, and uninvolved symmetrical skin. The average of perilesional and symmetrical uninvolved parameters was used as control, while the percentage change of each parameter [(lesion – control / control) ×100] was calculated, and compared among three diseases by ANOVA test using SPSS software version 18. The significance level was set at α=0.05.
    Results
    Comparison of percentage changes showed that the changes in TEWL, friction index, sebum content, R2 (gross elasticity), R5 (net elasticity), skin temperature, dermal thickness, and epidermal density are not significantly different among three skin diseases. But there were significant differences in three diseases considering the decrease in S.C. hydration (p<0.001), R0 (opposed to firmness) (p<0.001), and dermal density (p<0.001) compared to control skin. Moreover, the increase in skin pH (p<0.001), melanin content (p=0.048), erythema (p=0.023), and epidermal thickness (p <0.001) significantly differed among these diseases.
    Conclusion
    Dermatitis, psoriasis and lichen planus lesions had specific biophysical changes. It may be helpful in their differential diagnosis.
    Keywords: Biophysical properties, Dermatitis, Lichen planus, Psoriasis, Ultrasonographic properties
  • Ali Gholami , Farhad Zamani , Elham Zandian , Masoudreza Sohrabi , Farhad Moradpour , Mansooreh Maadi , Maryam Khazaee, Pool , Abbas Abbasi, Ghahramanloo * Pages 635-640
    Background
    Due to the rise of non-communicable diseases (NCDs) and lifestyle changes, this study aimed at determining the subclasses of Iranian adults based on body mass index, some NCDs, and status of physical component of quality of life.
    Methods
    A total of 5207 participants of Amol cohort study were studied in this study. Latent class analysis (LCA) was used to determine the best model with the minimum AIC or BIC.
    Results
    We decided that the 6 latent classes model was the best model. The first class described 35.1% of the participants and was characterized by individuals with no disease status. The sixth class described 0.7% of the individuals and was characterized by individuals exhibiting high probability of body mass index (BMI) equal or more than 25, kidney inadequacy, hypertension, and moderate physical component of quality of life status.
    Conclusion
    This study showed the pattern of body mass index, chronic diseases, and physical component of quality of life. Our findings demonstrated that some risk factors and non-communicable diseases tend to accumulate in some classes, especially classes 5 and 6, and thus the risk of developing these diseases rises along with increase in their clustering abilities. These results point out the critical importance of designing specific preventive interventional programs for these stratums of individuals.
    Keywords: Non-communicable diseases, Body mass index, Quality of life, Latent class analysis, Amol
  • Mani Yousefvand , Alireza Olyaeemanesh *, Mohammad Arab , Ebrahim Jafaripooyan Pages 641-647
    Background
    Since approximately 45% of basic health insurance (BHI) resources are spent and distributed based on the Relative Value of Health Services (RVHS) book, therefore, any revision in this book will most probably affect the behavior of health insurance organizations. The present study was prospected to determine the effect of revising RVHS on behavior of BHI funds as the main providers of treatment resources.
    Methods
    This is a qualitative study in which data were analyzed using content analysis method. Semi-structured interviews were used to gather the required data. 27 interviewees were chosen using purposive sampling method. Finally, MAXQDA software was used to analyze and code the data.
    Results
    According to the results, revision of RVHS influenced the behavior of health insurance organizations. The most important changes in the behavior of health insurance funds involved the following: formation of a committee for cost management and handling the insurance documents, creating a uniform coding system for health services, redesigning the handling process of documents, increased share of insurance funds from health expenditures, with 300 new services added to basic package and revising the package according to the new version of the book. Furthermore, the rest of the changes included in the global payment method based on the new book, delay in paying claims, increased deductions based on the payment of expensive services on treatment protocols, holding periodic training courses, and teaching the new book as well as the procedures for handling the documents.
    Conclusion
    With regard to the revision of RVHS and considering the incremental approach in revision of relative values, the increased claims of health services delivery centers and delay in payment of these claims were the most important changes in the behavior of health insurance funds. Health policy makers can overcome such issues and provide proper financial conditions through reduction of conversion factor and mobilization of resources. Such policies will open the space for best management of the behaviors affected by revision of relative values.
    Keywords: Relative value unit, Payment system, Physician fees, Behavior, Basic health insurance
  • Parvin Cheraghi , Zahra Cheraghi *, Shiva Bozorgmehr Pages 648-652
    Background
    Osteoporosis is the most common metabolic bone disease and is a public health issue, particularly among the elderly, across the world. Given the significance of the disease in causing disability and, in particular, its dangers in old age, we aimed to examine osteoporosis and its determinant factors among the elderly.
    Methods
    We conducted a cross sectional study in the province of Hamadan from September 2015 to March 2016 on all the elderly men and women covered by ‘Integrated and Comprehensive Elderly Care Program’. The data required for this study was collected through an aging health care checklist. To estimate the adjusted association of potential risk factors and other confounding variables of osteoporosis, multiple logistic regression was used at a significance level of 5%.
    Results
    In this cross sectional study, 1779 elderly men and women aged 6o years and over were studied. The prevalence of osteoporosis was 7.99% (95%CI:7.79-8.18), which was higher among women than in men (8.08% vs. 7.83%). The factors that raised the probability of osteoporosis were as follow: aging (OR= 1.05, 95% CI: 1.02-1.07, p<0.001), low education (OR=1.96, 95% CI:1.02-3.84, p=0.04), living in urban areas (OR=2.82, 95% CI:1.93-4.11, p<0.001), smoking (OR=2.39, 95% CI:1.42-4.04, p<0.001), and family history of osteoporosis (OR=1.95, 95% CI:1.07-3.54, p=0.03).
    Conclusion
    Based on our results, aging, low education level, living in urban areas, being a cigarette smoker, and having a family history of osteoporosis were all predicting factors for osteoporosis among the elderly.
    Keywords: Osteoporosis, Elderly, Prevalence, Iran, Hamadan
  • Poupak Rahimzadeh , Seyed Hamid Reza Faiz , Mostafa Hoseini , Seyed Hamzeh Mousavie , Farnad Imani , Ali Reza Negahi * Pages 653-658
    Background
    Given the importance of patients’ pain after laparoscopic surgeries, this study was conducted to compare the effectiveness of intraperitoneal bupivacaine, acetazolamide, and placebo on pain relief after laparoscopic cholecystectomy surgery.
    Methods
    Patients admitted to Rasool Akram hospital with physical status I or II, based on the American Society of Anesthesiologists (ASA) system, who were candidates for laparoscopic cholecystectomy surgery due to gallstones, were included in this study. Patients were divided into 3 groups (each group containing 20 patients) using block randomization with foursome blocks. Group 1 received bupivacaine, group 2 acetazolamide, and group 3 intravenous saline as placebo. After surgery, pain score was assessed by visual analogue scale, and shoulder pain and analgesic doses were also measured. The mentioned parameters were assessed at 1, 4, 8, 12, and 24 hours after surgery.
    Results
    In this study, 60 patients were included in 3 groups. The mean pain recorded (VAS) at 1, 4, and 8 hours after surgery was not significantly different between acetazolamide and bupivacaine groups, but their score was significantly lower than the placebo group (p<0.05). However, the score recorded at 12 and 24 hours after surgery was not significantly different between the 3 groups (p>0.05). Mean of pain reliever (acetaminophen) injected to the patients when needed was not significantly different among the 3 intervention groups (p<0.05). The highest prevalence of shoulder pain (70%) belonged to the placebo group and the lowest (25%) to acetazolamide (p<0.05). Mean heart rate, systolic blood pressure, diastolic blood pressure, and the respiratory rate were not significantly different among intervention groups in 1, 4, 8, 12, and 24 hours after surgery (p>0.05).
    Conclusion
    According to the results, acetazolamide and bupivacaine injection reduced pain in early hours after laparoscopy. However, pain intensity was not different between intervention groups and the control group after 12 hours, so re-prescription seems to be appropriate at this time. Acetazolamide injection significantly reduces shoulder pains after surgery.
    Keywords: Laparoscopy, Cholecystectomy, Pain, Acetazolamide, Bupivacaine
  • Seyed Jalal Kiani , Davod Javanmard , Hadi Ghaffari , Ahmad Tavakoli , Helya Sadat Mortazavi , Farah Bokharaei, Salim , Zahra Bangaleh , Seyed Hamidreza Monavari * Pages 659-662
    Background
    Different outcomes of parvovirus B19 (B19V) infection in immunocompromised patients, including HIV1-infected persons, may be life-threatening. Considering the hematologic disorders associated with B19V infection, this study aimed to investigate the prevalence of B19V infection among HIV1-infected individuals in Iran.
    Methods
    Serum samples from 100 HIV1-infected patients were analyzed for B19 viral DNA using real-time PCR assay. COBAS TaqMan HIV-1 test was performed for quantitative measurements of HIV-1 RNA in the patients’ sera.
    Results
    Real-time PCR analysis revealed that 10 out of 100 cases (10%) were positive for B19V infection. Across various age groups, the B19V infection was more prevalent among patients within the age range of 21-40 years. Higher prevalence of B19V infection was observed among HIV1-infected patients with a viral load of higher than 400 copies/mL.
    Conclusion
    Despite limitations, this study may set the stage for further evaluations with larger sample sizes to elucidate the potential role of B19V in hematologic disorders, which may result in exacerbation of the disease in HIV1-infected patients. Moreover, as it has been shown that B19V infection can be treated using intravenous immunoglobulin (IVIG) therapy, available treatments may help improve the quality of life in HIV-infected persons.
    Keywords: Parvovirus B19, HIV-1, Anemia, AIDS
  • Marzieh Pashmdarfard , Narges Shafaroodi * Pages 663-670
    Background
    Clinical education is one of the main parts in medical education, and rehabilitation sciences are not exception. Through clinical education programs, students gain required qualifications to enter professional life. Several factors impact on students' clinical education, and identifying these factors could help in the improvement of clinical education and could improve knowledge transferring to clinical practice especially in rehabilitation sciences in Iran. The purpose of present review study is identifying the factors potentially affecting the clinical education of rehabilitation students in Iran.
    Methods
    A systematic review study conducted based on the evidence-based method on published articles from 2000 to 2017. The search process was carried out on MEDLINE, CINAHL, PsycINFO, and EMBASE databases.
    Results
    A total of 167 papers were selected. Given identical findings and considering eligibility criteria, 12 articles in the fields of clinical education, clinical competence, professional ethics education, and clinical reasoning were ultimately chosen.
    Conclusion
    The results indicate that many factors might influence the clinical education of rehabilitation science students. Environmental factors (including ministry policies, educational curriculums, clinical education environments, and educational facilities/equipment) and individual factors (the knowledge and skills of students and characteristics of clinical trainers) were identified as the most influential factors in clinical education.
    Keywords: Education, Rehabilitation, Clinical competence, Professional practice, Students
  • Sima Nedjat , Robab Sahaf *, Hamid Reza Khankeh , Reza Fadayevatan , Reza Majdzadeh , Masoud Karimlou Pages 671-677
    Background
    The elderly population’s health has become a priority as their numbers are on the rise and they are increasingly becoming vulnerable to physical and mental diseases. Studies show that an elderly person’s health depends on his/her utilization of health knowledge in daily life. Hence, here we investigated the contributing factors of knowledge utilization in the elderly population.
    Methods
    A qualitative study was conducted through conventional content analysis. Semi-structured in-depth interviews were held with 29 elderly individuals from Tehran. A focus group discussion was conducted (eight elderly individuals), and an expert panel was held with nine experts to complement the results.
    Results
    Upon data analysis, four categories and seven subcategories were extracted. The main categories included provision of basic needs, maintaining dignity, life satisfaction, and negative feelings toward self and others. The concept of ‘life satisfaction’ held a pivotal role in relation to the other categories.
    Conclusion
    Life satisfaction was the main category in the utilization of health knowledge among the elderly. Aging should be foreseen and forethought to increase life satisfaction. The followings can be effective in increasing life satisfaction in the elderly: Promoting positive-thinking, placing greater emphasis on spiritualism in life, employment of the elderly, and promoting the culture and tradition of respecting the elderly.
    Keywords: Knowledge utilization, Life satisfaction, Old people, Elderly, Iran
  • Ensiyeh Jamshidi , Sima Nedjat *, Saharnaz Nedjat , Sima Nikooee , Narges Rostamigooran , Reza Majdzadeh Pages 678-685
    Background
    Studies show that 90% of an organization’s knowledge is embedded and synthesized in its employees’ minds. Thus, when employees leave the organization or their positions change, their valuable knowledge, skills, and experiences are lost, however, if used properly, tacit knowledge can be a source of innovation and competitive advantage in an organization. This study aimed at exploring the methods for sharing and utilizing tacit knowledge in health organizations.
    Methods
    In this study, qualitative approach was adopted to explore ways of utilizing tacit knowledge in health organizations. Tacit knowledge experts, who had published at least one relevant article, conducted 17 individual and 2 group interviews. Purposeful sampling was used to select the participants. Methods for sharing and utilizing tacit knowledge were explored by holding in-depth semi-structured interviews. Data were analyzed using thematic analysis.
    Results
    The results were summarized into 5 categories and 18 themes. The categories included ‘identification of different dimensions of organizational knowledge’, ‘prerequisites of tacit knowledge utilization’, ‘defining the process of tacit knowledge utilization’, ‘converting tacit to explicit knowledge’, and ‘converting tacit to tacit knowledge’. Participants believed that the process of converting tacit to explicit knowledge was a cyclical process that included the understanding the existing situation and detecting knowledge entry points, identifying knowledge items and harvesting them, assessment, codification, and standardization, entry into knowledge repository, and updating.
    Conclusion
    Our results revealed that health organizations need the prerequisites of tacit knowledge sharing to acquire the capacity to utilize this kind of knowledge. Because the themes extracted in this study are rarely used in health organizations, the results will be helpful in guiding the development of knowledge utilization strategies and planning in these organizations.
    Keywords: Knowledge utilization, Tacit knowledge, Health organizations
  • Bahman Mohammadi , Parviz Mohajeri , Samaneh Rouhi , Rashid Ramazanzadeh * Pages 686-689
    Background
    Mutations in embB gene have been reported in ethambutol (EMB) resistance Mycobacterium tuberculosis (M. tuberculosis) isolates. The aim of this study was survey on embB 306 and 406 EMB resistant M. tuberculosis isolated from patients in West of Iran (2014-2015).
    Methods
    Fifty strains of M. tuberculosis from patients with pulmonary tuberculosis (TB) were considered. Drug susceptibility using proportional method was performed. Polymerase chain reaction (PCR) -DNA sequencing was applied for mutation in embB 306 and 406 codon detection. Data were analyzed in SPSS 16 software using descriptive statistics and Fisher's exact test (p<0.05).
    Results
    In this study 7 (14%) M. tuberculosis isolates were resistant to EMB. 6 (85.71%) and 1 (14.28%) resistant isolates had embB 306 and 304 codon mutations, respectively. Between embB306 mutations and resistance to EMB and MDR isolates had a significant relationship (p<0.001).
    Conclusion
    The data indicated that embB 306 mutations have effect on EMB resistant. Detection of EMB resistant and these mutations prominent for antibiotic prescription.
    Keywords: embB gene, Mutations, Ethambutol Resistance, Mycobacterium tuberculosis
  • Bahareh Laribi , Mehdi Shekarabi *, Amir Hassan Zarnani , Majid Ghaffarpour , Mohsen Marzban Pages 690-696
    Background
    Epidemiological evidence suggests a role of Epstein-Barr virus (EBV) in triggering the pathogenesis of Multiple Sclerosis (MS). The aim of this study was to assess the EBV-specific antibodies in MS patients with various clinical patterns and their association with the production of IFN-γ, IL-12, and IL-4 cytokines compared with healthy individuals.
    Methods
    We measured EBNA-1 IgG, VCA IgG, and production of IFN-γ, IL-12 and IL-4 cytokines in patients with different clinical patterns and healthy controls using ELISA method.
    Results
    There was a higher titer of anti-EBV antibodies in MS patients compared to healthy controls. SPMS patients generated higher EBNA-1 levels than those with RRMS and PPMS patients whereas; the level of VCA IgG was higher in the RRMS patients than PPMS. In PPMS patients, a significant increase was found in IFN-γ and IL-12 cytokines compared to other subtypes, whereas IL-4 cytokine had a decreased level compared to RRMS patients. Higher anti-EBV antibodies are associated with increased IL-12 cytokine in RRMS patients. However, no significant correlation was found between these antibodies and other secreted cytokines.
    Conclusion
    EBV infection is one of the strong risk factors for MS. Acting on these factors could be useful to decrease the incidence and disease exacerbation of MS. Study of the antibody levels to EBV virus could be useful for evaluating MS risk score in each clinical subtypes.
    Keywords: Multiple sclerosis, Epstein-Barr virus, Anti-EBNA-1, Anti-VCA, Cytokines
  • Fatemehsadat Amiri , Mohammadreza Vafa* , Linda Gonder, Frederick , Karen Vajda , Mohammadebrahim Khamseh , Alireza Abadi , Amin Salehpour Pages 697-703
    Background
    This study was designed to determine the level of fear of hypoglycemia (FoH), pediatric parenting stress and self-efficacy in parents of children with type 1 diabetes (T1D).
    Methods
    In this cross-sectional study, 61 families of children with T1D who had been diagnosed for at least 6 months recruited from "Gabric Diabetes Education Association" in Tehran. Sixty mothers and 41 fathers of 61 children (26 girls, age: 6.0-12.7 years) were assessed using the Hypoglycemia Fear Survey-Parent (HFS-P), Pediatric Inventory for Parents (PIP) and Self-Efficacy for Diabetes Scale-Parent (SED-P) questionnaires. Pearson correlation analysis was used to compute the correlation between HFS-P, PIP and SED-P scores separately for mother and fathers.
    Results
    Only 8.3% of children had controlled diabetes. Internal reliability of the Persian version of all questionnaires was good. FoH were higher for mothers. Mothers whose children had diabetes for less than two years had significantly lower mean HFS-Behavior subscale (HFS-B) scores than mothers whose children had diabetes for more than two years. There was a positive correlation between fathers’ mean HFS-B score and children’s total insulin dose per day. Parents' FoH score was positively correlated with increased pediatric parenting stress. Findings also showed considerable emotional distress in 51% of mothers and 29.7% of fathers. Frequency of self-monitoring blood glucose tests (SMBG) correlated negatively with HbA1c.
    Conclusion
    We concluded that parents with high levels of FoH and stress may benefit from diabetes education. Important implications for education are considering psychological adjustment, recognizing diabetes-related fear and stress in parents, encouraging fathers to become actively involved in the child’s diabetes management and emphasizing the importance of SMBG.
    Keywords: Hypoglycemia, Fear, Parenting stress, Self-efficacy, Type 1 diabetes
  • Akbar Nikpajouh , Mohammad Amin Shahrbaf , Mahdyie Doayie , Maryam Mohseny , Ali Ebadi , Mahasti Alizadeh , Ali Hossein Zeinalzadeh , Nastaran Laal , Tolou Hasandokht , Termeh Tarjoman , Mina Ahmadi , Leila Sabzmakan , Zahra Yekta , Zahra Sanaei , Mohammad Ali Seif, Rabiei * Pages 704-711
    Background
    According to the World Health Organization, hospitals should assess their internal wards to improve health promotion services using self-assessment tools. To achieve this goal, standards of health promoting hospitals have been developed by the World Health Organization, and measurable elements and indicators have been defined to facilitate the practical application of these standards in planning, implementation, and evaluation of health promotion in hospitals. Moreover, a form has been developed for this self-assessment. Considering linguistic and cultural differences in various countries, standards must be written in equivalent texts and, then, their content and face validity should be examined.
    Performing this process in a systemic and scientific way can guarantee that the same tools have been used, and thus the results obtained from different hospitals are comparable.
    Methods
    After the preparation phase (considering research aim, obtaining permission from the original designers, and determining the time), the following activities were done: translating the form from its original language to the target language, combining and compiling initial translations to a single translation, reversing the final version of the translation from the target language to the original language, obtaining cognitive information, revising and concluding, and determining the content and face validity of the translated form and final report.
    After filling in the form, face validity was calculated using impact score formula. Content validity was measured using content validity ratio (CVR) and content validity index (CVI).
    Results
    After calculating the impact score, all 40 items showed a high impact score greater than 1.5, representing the fact that all items are important. The minimum value of CVR for each of the 40 items was estimated to be 0.64; CVI of all items was greater than 0.79.
    Conclusion
    Given the input of the standards of health promoting hospitals affiliated to the World Health Organization in National Accreditation of Iranian hospitals, the form was translated and found to be valid according to content and face validity and is available in Persian to be used in Iranian hospitals (Appendix 1).
    Keywords: Health promotion, Hospital, Self-assessment
  • Bakhtiar Piroozi , Amirhossein Takian , Ghobad Moradi *, Mohammad Amerzadeh , Hossein Safari , Obeid Faraji Pages 712-716
    Background
    Health Transformation Plan (HTP) has been one of the biggest reforms in Iran's health system over the past 3 decades. The plan has been implemented since May 2014 and includes several packages that can affect the utilization of health care services. We aimed to assess the effect of implementation of HTP on utilization of specialist outpatient visit rate in clinics affiliated to university hospitals.
    Methods
    We chose Kurdistan province to collect monthly specialist outpatient visit data for 50 months because this province was not a patient referral hub. An interrupted time series (ITS) analysis and segmented regression analysis were used to evaluate the effects of HTP on specialist outpatient visit rates. Statistical analyses were conducted using STATA version 13.
    Results
    A significant increase was observed in the specialist outpatient visit rate (12.1 outpatient visit per 1000 population) in the first month after the implementation of HTP (p= 0.000, 95% CI= 6.36-17.83). Also, after the implementation of HTP, a significant increase was observed in the monthly trend of specialist outpatient visit rate equivalent to about 0.53 every month per 1000 population compared to the monthly trend in specialist outpatient visit rate before the intervention (p= 0.033, 95% CI= 0.04-1.01).
    Conclusion
    HTP has significantly increased the specialist outpatient visit rate in clinics affiliated to university hospitals in Kurdistan province. Thus, it is necessary to perform some comprehensive studies on all public, private, and semi-private sectors in different parts of the country to provide a better and more comprehensive picture of the effects of HTP on utilization of specialist outpatient visit services.
    Keywords: Utilization, Health system reform, Outpatient, Outpatient health service, Clinic visit
  • Ameneh Ebrahim Valojerdi , Leila Janani * Pages 717-720
    In the statistical analysis of observational data, propensity score is a technique that attempts to estimate the effect of a treatment (exposure) by accounting for the covariates that predict receiving the treatment (exposure). The aim of this paper is to provide a brief guide for clinicians and researchers who are applying propensity score analysis as a tool for analyzing observational data. We reviewed literature about how, when and why propensity score is used and then we discussed some important practical issues in using propensity score in observational studies. Appling propensity score as a method for analyzing observational studies is very useful but, we should know when and how we can use this method. Moreover, new methods of propensity score analysis such as Bayesian and doubly robust approaches were established in recent years, and these methods could be more useful for researchers in estimating causal effect from observational studies.
    Keywords: Propensity score, Observational study, Causal inference
  • Nahal Ahmadzadeh , Farbod Ebadi Fard Azar *, Hamid Reza Baradaran , Reza Salman Roghani , Marzieh Shirazikhah , Mohammad Taghi Joghataei , Saiedeh Bahrampouri Pages 721-726
    Background
    Disability can involve many by diseases, injuries, or aging, and thus access to rehabilitation services has a key role in improving these patients’ social life. Since 2008, Iran has improved the access to rehabilitation facilities along with the global convention. Yet, nationwide studies are required to evaluate the fair distribution of centres in each province. Thus, the present study aimed to evaluate the distribution of outpatient rehabilitation services in 32 provinces of Iran to help policymakers make more appropriate decisions.
    Methods
    In this cross sectional study, which was conducted between April and October 2017, a master facilities list (MFL) of rehabilitation services that was developed in Iran was used to identify health facilities. Data were collected from the statistics of the Deputy for Rehabilitation of Social Welfare Organization offices and Red Crescent Organization in 32 provinces of Iran. Descriptive data were analysed by SPSS version 22 and reported by percentage and number in 1 000 000 population; distribution was drawn on Iran’s map by the GIS software.
    Results
    According to the MFL, outpatient rehabilitation services include physical medicine & rehabilitation, physiotherapy, occupational therapy, speech therapy, audiometry, and orthotics & prosthetics (90%); other rehabilitation centres include general rehabilitation centres, day care centres, and vocational centres (10%). The largest number of occupational therapy, physiotherapy, and audiology offices were found in Tehran, where general rehabilitation centres, day care centres, and vocational centres were less than 3 per 1 000 000 population. There were no rehabilitation centers in 14 provinces, and there were very few physical medicine and rehabilitation centres in most of the provinces.
    Conclusion
    There was significant difference in the distribution of outpatient rehabilitation facilities in different provinces of Iran and some provinces required urgent attention of policymakers, as they had the least number or no rehabilitation facilities.
    Keywords: Iran, Availability, Rehabilitation center, Outpatient facilities
  • Katayuon Jahangiri , Saeide Aghamohamadi *, Ardeshir Khosravi , Elaheh Kazemi Pages 727-731
    Background
    Authoritative information and description of the causes of mortality trends is one of the most basic principles of evaluation of the health sector in all countries. Therefore, this study aims to predict the trend in main groups of causes of death in the Islamic Republic of Iran.
    Methods
    The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education during the years 2006 to 2015. The information was collected via death certificate, burial permit, and information forms. In order to forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1.
    Results
    Based on the results, the crude death rate in the total population has reduced from 435.86 in 2006 to 405.01 per 100000 population in 2035. It is anticipated that endocrine, nutritional and metabolic diseases with the rate of 197.71 per 100000 population will be responsible for the highest causes of death in the year 2035 and from 2021 onwards, the mental and behavioral disorders will be responsible for the lowest rate of mortality.
    Conclusion
    Non-communicable diseases have a major role in the deaths of Iranian population; therefore, to reduce the impact of non-communicable diseases on individuals and society, a holistic approach is needed which requires all sectors to cooperate.
    Keywords: Prediction, Causes of death, Iran, Lee Carter
  • Soodabeh Hoveidamanesh , Farnoush Davoudi *, Jalil Koohpayehzadeh , Marzieh Nojomi Pages 732-735
    Background
    Screening and behavior consultation are considered to be limited, dispersed and expensive services across the country. To deliver efficient and equitable services current disordered practices need to be consolidated.
    Methods
    An analysis of current situation, learned lessons and future scopes of country’s preventive care delivery, along with a review of international experience and generous participation of various stakeholders, led to proposing a model for screening and behavior consultation practices in IR. Iran.
    Results
    Upon the results of the previous steps, the desired model was based on the network system and family physician. Comprehensive health centers and other centers affiliated to the network are the most appropriate service positions. However, private and academic preventive centers are playing their rules.
    Conclusion
    The proposed model matches the overall pattern of service delivery in the health system (network system with the private sector and the educational sector).
    Keywords: Preventive health service, Health care delivery, Health risk assessment, Behaviors, Risk reduction
  • AliAkbar Haghdoost , Nader Momtazmanesh , Farangis Shoghi Shafagh Aria , Hadi Ranjbar * Pages 736-742
    Background
    Several international ranking systems are available for examining the performance of universities internationally. However, it seems that in these rankings the educational functions are relatively discounted. In this study, we presented the theoretical framework, methodology, and results of 2 rounds of ERMU (educational ranking of medical universities) in Iran.
    Methods
    The indicators were designed through literature reviews, expert panels, and consensus among professionals using Delphi method. Six domains, including quantitative expansion, educational management scheme, educational management, qualitative development, and alignment with the National Master Plan for Science and Education were assessed. Nineteen educational processes and outcome-based indicators were defined at the end. Some of them, such as the number of educational disciplines, were normalized based on the number of academic staff. Using exploratory factorial analysis, the interval validity of the final instrument was assessed. Also, the internal consistency of the tool was evaluated by calculating Cronbach's alpha. Data were collected in 2 rounds in 2010 and 2014. The required data were collected and cross-validated from different sources in medical universities and in the Ministry of Health.
    Results
    The analysis yielded 2 factors, explaining a total of 61.6% of the variance for the entire set of variables. The calculated Cronbach’s alpha was 0.94. The correlation coefficient for all items was 0.88. The comparison of the results of the 2 rounds showed a significant improvement in the scores of universities in all domains.
    Conclusion
    The results showed a relatively fitted model with acceptable reliability. In addition, it seems that the ranking of medical universities has improved their performance in the study indictors. It seems that in the long-term, monitoring these indicators and the visibility of their scores may improve the educational performance of universities.
    Keywords: National, University, Ranking, Higher education, Academic performance
  • Saeed Bagheri Faradonbeh , Farbod Ebadi Fard Azar *, Aziz Rezapour , Marjan Hajahmadi , Seyed Javad Hajmiresmail Pages 743-753
    Background
    Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
    Methods
    Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
    Results
    A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
    Conclusion
    This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
    Keywords: Effectiveness, Revascularization, Medical therapy, Ischemic cardiomyopathy
  • Seyedeh Saeedeh Hosseini , Kayvan Taheri , Seyedeh Marzieh Hosseini , Mehrdad Gholami , Ebrahim Kouhsari *, Elahe Edalati , Rasoul Madani , Rokhsareh Mohammadzadeh , Abed Zahedi Bialvaei , Mohammad Sholeh , Fariba Golchin Far Pages 754-759
    Background
    Avian Influenza disease annually entails a significant economic loss to the poultry industry around the world. Influenza virus is a polymorphic virus of the orthomyxoviridae family (single-stranded RNA genome), and nucleoprotein (NP) is the structural and internal protein of the virus. The aim of the work was to purify nucleoprotein for further investigations with a simple, low-cost, fast and practical method.
    Methods
    In this study, H9N2 influenza virus was isolated in specific pathogen-free embryonated chicken eggs by allantoically inoculating 103 to 105 egg-infective doses (EID50) for 9 to 11 days, purified by 10% (W/V) polyethylene glycol (PEG) 6000 with a sucrose gradient of 60% to 30%. The influenza virus proteins were collected and prepared as fractions by preparative electrophoresis. Finally, the purified NP was subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot procedures.
    Results
    The protein analysis with SDS-PAGE and silver nitrate staining indicated that the desired samples contained purified nucleoprotein and lacked other viral proteins. The results of the investigation of lyophilized fractions containing nucleoprotein on the SDS-PAGE revealed the absence of viral RNA in nucleoprotein and its high purity.
    Conclusion
    According to this study, purified nucleoprotein can be used to produce nucleoprotein vaccines, as well as to study structural, molecular and diagnostic and therapeutic materials.
    Keywords: Avian influenza virus, H9N2, Nucleoprotein, Extraction, Purification
  • Hammad Shah* , Afrasyab Altaf , Momin Salahuddin , Muneeb Ullah Jan , Adnan Khan Pages 760-764
    Background
    Hypertension was considered as a disease of the elderly but due to unhealthy dietary and lifestyle changes its incidence has increased in younger population. Smoking and obesity are emerging concerns the world is facing globally in younger age groups. This study is therefore aimed to identify these cardiovascular risk factors among Pathan and Persian young adults.
    Methods
    It was a cross-sectional study carried out at multiple undergraduate, postgraduate educational institutes and hospitals using non-probability convenient sampling among young adults aged between 15 to 40 years for a period of six months from Apr 1st, 2017 to Sep 30th, 2017. Mean±SD was calculated for continuous variables and categorical variables were expressed as frequencies. Chi-square test and Fisher exact test were used for statistical analysis.
    Results
    A total of 708 subjects were included. Mean±SD age was 26.12±3.7 years. Out of 708, 300(42.37%) were smokers with 209 (29.52%) active and 91 (12.85%) passive smokers. Among smokers, 216 (30.5%) were males while 84 (11.87%) were females. A total of 432 (61.02%) subjects were not doing any exercise, and 636 (89.83%) were consuming junk food. A total of 165 (23.3%) subjects were overweight, and 15 (2.1%) were obese. Stage-1 hypertension was present in 72 (10.2%), while 16 (2.25%) subjects had stage-2 hypertension.
    Conclusion
    There is an increased prevalence of cardiovascular risk factors which includes hypertension, smoking, and obesity among Pathan and Persian young adults.
    Keywords: Cardiovascular, Risk factors, Hypertension, Smoking, Obesity, Young adults
  • Mina Forouzadeh , Mehrzad Kiani , Shabnam Bazmi * Pages 765-768
    Background
    The honorable medical profession is on the verge of being reduced to a business. Evidence suggests that professionalism is fading and today's doctors are faced with value-threatening problems and gradually begin to forget their main commitment as medical professionals. Many of the problems faced by doctors are rooted in non-professionalism. Mere education in the science and practice of medicine produces an inefficient medical workforce and leads to the formation of a distorted professional identity. In the past decade, educational innovations targeting the formation of desirable professional identities have been presented and are considered a vital part of medical education for the development of professionalism. The present study was conducted to examine the relationship between the formation of professional identity and professionalism. Professionalism education is essential in the formation of a desirable professional identity.
    Methods
    This review article was done in 2015 through searching databases, such as PubMed, Elsevier, Google Scholar, Ovid, SID, and IranMedex, using keywords of professionalism and professional identity, and medical education. Among the 55 found articles, 30 were assessed and selected for review.
    Results
    The formation of professional identity is a process with the following domains: professionalism, and development of a personal (psychosocial) and a cultural identity, which is derived from the unification of professional, personal, and ethical development. The main components required for the formation of a desirable identity are, therefore, rooted in the dimensions of professionalism and professional development. The need for teaching professionalism has a reciprocal relationship with the formation of professional identity.
    Conclusion
    There is a reciprocal relationship between formation of a desirable professional identity and development and strengthening of professionalism. Modern medical education should be designed to develop professional identity, and professionalism acts as an essential part of its curricula throughout the entire course of a doctor’s education, with the aim of acquiring a desirable professional identity.
    Keywords: Professionalism, Professional identity, Medical education
  • Iraj Heydari , Maryam Honardoost , Sedighe Moradi , Fatemeh Golgiri , Hamidreza Dehnad , Saba Moradi , Amir Ziaee * Pages 769-772
    Background
    Multinodular goiter (MNG) is regarded as one of the most common causes of hyperthyroidism, particularly in areas of mild-to-moderate iodine deficiency. The present study aims to explore the effects of the radioactive iodine (RAI) therapy on benign non-toxic MNG and evaluate its side effects.
    Methods
    Patients with benign non-toxic MNG entered the study. Ultrasonography was applied to calculate the percentage of the decrease in the size of the thyroid before and six months minimum after the treatment. Chi-square, Mann-Whiteny-U and T-test were done using SPSS v.18.0 (p<0.05).
    Results
    The volumes of the thyroid lobes and nodules decreased significantly due to RAI therapy (p<0.001). The total volume of the thyroid, volume of the right nodule, and volume of the left nodule decreased by 77.8%, 40.7%, and 34.6% respectively.
    Conclusion
    According to the results of the current study, RAI therapy is an effective treatment method although it has short-term side effects. This treatment option is recommended for patients with benign non-toxic MNG, notably those who cannot be a candidate for surgery. This treatment affects the size of the thyroid and its nodules significantly and decreases almost all of the complications.
    Keywords: Multinodular goiter, Nodule, Radioactive iodine therapy, Thyroid
  • Sahand Riazi, Isfahani , Maziar Moradi, Lakeh , Shiva Mafimoradi , Reza Majdzadeh * Pages 773-778
    The majority of modifiable health outcomes are attributable to factors that are outside the direct reach of the health systems and can only be reached through intersectoral actions. In recent years, Iran implemented a series of reforms in the health sector called Health Transformation Plan (HTP). This paper aimed to review health-related intersectoral actions in Iran that have focused on interventions conducted after HTP implementation and to compare the interventions against the recommendations by World Health Organization (WHO) Commission on Social Determinants of Health. Findings showed that intersectoral governance interventions are the strongest points and have the most compatibility with the recommendations, while intersectoral environmental interventions are the weakest points. Also, many of the interventions have not yet been completely implemented. Moreover, continuity and sustainability of the policies and programs are still a concern.
    Keywords: Intersectoral collaboration, Health care reform, Universal health coverage, Iran
  • Mohammad Hassan Khadem Ansari , Mahdia Gholamnejad , Khadije Meghrazi *, Hamid Reza Khalkhali Pages 779-783
    Background
    Omentin has recently been considered as an adipokine secreted from visceral fat and is expressed in the lungs, heart, ovary etc. Various studies have shown that omentin may have an anti-inflammatory role in the inflammatory process and the amount of omentin alters in some cancers, such as colorectal, prostate and renal cells cancers, changes. The serum level of omentin, however, remains unknown in non-patient smokers and the smokers afflicted with lung cancer. Therefore, this study examines the serum levels of omentin in smokers suffering from lung cancer.
    Methods
    The amount of serum omentin was measured in 45 patients with lung cancer and 61 age - and sex - matched controls (30 smokers and 31 non-smokers) using enzyme-linked immunosorbent assay (ELISA) kit. Data were analyzed using SPSS-16, and one-way analysis of variance and Scheffe post hoc test were used to determine and compare the serum levels of omentin in different types of lung malignancies. Significance level was set at p≤0.05.
    Results
    The amount of circulating omentin for healthy non-smokers and non-patient smokers was 3.55±0.57 ng/l and 5.43±1.95 ng/l, respectively (p<0.001). The serum level of omentin was 3.63±0.70 ng/l for smokers afflicted with cancer (p<0.001 compared with non-patient smokers: 5.43±1.95).
    Conclusion
    The meaningful decrease in omentin levels in smokers with lung cancer can be considered as a risk factor in smokers and can use as a significant factor in the prognosis of lung cancer in these people.
    Keywords: Smoker, Omentin, Lung cancer
  • Zohreh Yousefi Ghalejoogh , Simin Mirakhor Samani , Somayeh Shatizadeh Malekshahi , Reza Shahsiah , Jila Yavarian , Seyed Jalal Kiani * Pages 784-788
    Background
    Human papilloma virus (HPV) is involved in development of almost all cervical cancers, mainly through the subversion of cellular mechanisms of growth control. Fascin plays central role in subsequent cell transformation events. Fascin mediates stabilization of parallel actin bundles where cellular protrusions are formed; this represents primary stages of cell migration and metastasis. Immunohistochemical assays have shown up-regulation of fascin expression in many epithelial and non-epithelial neoplasms. Therefore, the aim of this study was to investigate HPV infection and fascin expression in samples of cervical cancer.
    Methods
    Of 66 patients with confirmed SCC, formalin-fixed specimens, embedded in paraffin blocks were evaluated for HPV infection with nested multiplex polymerase chain reaction (NM-PCR) and for fascin expression with immunohistochemical assays. Statistical analysis was performed using Wilcoxon rank-sum test and SPSS software. A p<0.05 was considered for statistical significance.
    Results
    Of 66 samples, 52 (78.7%) were found positive for HPV infection and fascin over-expression was shown in all squamous cell carcinoma samples.
    Conclusion
    This study showed fascin overexpression in squamous cell carcinoma of the cervix which might be involved in metastasis of cancers induced by some types of HPV, hypothetically through attenuation of inter-cellular adhesions, and induction of cell motility.
    Keywords: Fascin, Human Papilloma Virus, Squamous Cell Carcinoma
  • Maryam Rahimi , Farkhondeh Behjati , Nazanin Taheri , Shadi Hosseini , Hamid Reza Khorram Khorshid , Fatemeh Aghakhani Moghaddam , Masoud Karimlou , Saghar Ghasemi , Niloofar Bazazzadegan , Fereidoon Sirati , Elahe Keyhani * Pages 789-793
    Background
    PI3K/Akt/mTOR pathway is a crucial pathway in the angiogenesis, tumour growth and cell differentiation of several cancers. The PI3K and KIT genes are key genes of this pathway. Previous studies have reported the importance of these genes in the development of gastrointestinal carcinoma, leukaemia, and melanomas. The role of mutations and overexpression of PI3K and KIT genes in breast cancer has been previously proved. This study investigates the correlation between PI3K and KIT gene mutations in sporadic breast cancer.
    Methods
    Multiplex Ligation-dependent Probe Amplification (MLPA) technique was used to determine the Copy Number Variation (CNV) of PI3K and KIT genes in 34 breast cancer tumours and PCR-sequencing was used to detect the mutation in PI3K exons 9 and 20.
    Results
    Our results reported that 27% of patients had CNV of the KIT gene; whereas, 20% and 17.5% of patients, had mutation and CNV in the PI3K gene, respectively. We did not found a significant correlation between the mutations of PI3K and KIT genes.
    Conclusion
    About two-tenth of the patients revealed CNV and lesser than two-tenth indicated mutation in the PI3K gene, whereas one-third of the patients demonstrated CNV in the KIT gene. Thus, administration of the PI3K and KIT gene inhibitor drugs might be proposed to suppress breast cancer in patients with mutation and CNV of each of these individual genes.
    Keywords: mTOR pathway, PI3K gene, KIT gene, Breast Cancer