فهرست مطالب

  • Volume:33 Issue:1, 2019
  • تاریخ انتشار: 1397/11/12
  • تعداد عناوین: 131
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  • Max Barnish, David J Daley, Katherine HO Deane, Allan B Clark, Richard J Gray, Simon MC Horton, Zoe R, Butterfint, Phyo K Myint Pages 1-5
    Background

    The Montreal Cognitive Assessment (MoCA) has been recommended as a cognitive screening tool for clinical practice and research in Parkinson’s disease (PD), yet no normative data have been published for MoCA in PD without dementia.

    Methods

    We undertook a pooled secondary analysis of data from two studies (one cross-sectional design and one clinical trial) conducted in the East of England region. All participants were aged 18 years or over, met UK Brain Bank criteria for PD and did not have clinical dementia. Cognitive status was assessed using MoCA at baseline in both studies. The influences of age, gender, disease duration, medication load (LEDD) and mood (HADS) on cognition were examined using regression analysis.

    Results

    Data from 101 people with PD without dementia were available (mean age 71 years, 66% men). Median (IQR) MoCA was 25(22, 27). Age was found as the only predictor of MoCA in this sample. People aged over 71 had poorer MoCA (Beta=0.6 (95%CI 0.44, 0.82)) and an increased odds of MoCA <26 (Beta=0.29 (95%CI 0.12, 0.70)) as well as poorer scores on several MoCA sub-domains.

    Conclusion

    We present the normative data for MoCA in people with PD without clinical dementia. Age appeared to be the only associated factor for lower level of cognition, suggestive of Mild cognitive impairment in PD (PD-MCI) in PD without clinical diagnosis of dementia.

    Keywords: Neuropsychology, Cognition disorders, Parkinson disease, Geriatrics
  • Mehrdad Solati, Leila Kazemi, Naghi Shahabi Majd, Mansoor Keshavarz, Nima Pouladian, Nepton Soltani Pages 6-10
    Background

    Magnesium deficiency plays a key role in obesity and decreases insulin sensitivity. In our previous study, significant evidence was provided for the contribution of oral Mg supplement that could improve insulin sensitivity and body weight in animal trials. The purpose of the present study was to investigate the effects of an herbal supplement containing 300 mg magnesium sulfate on lipid profile, as well as insulin resistance and secretion in overweight patients. 

    Methods

    Seventy overweight non-diabetic volunteers with Body Mass Index (BMI) >28 kg/m2 were included in a randomized double blind placebo-controlled clinical trial (ethic number HUMS REC.1394.57) and registered in Iranian Registry of Clinical Trials (IRCT2012110124756N2 with registration number 24756). They received either placebo or an herbal supplement capsule containing 300 mg magnesium sulfate (MgSO4) for 6 months on a daily basis. Metabolic control, lipid profile and magnesium status were determined at baseline and every three months. Student t-test, repeated measure ANOVA and ANCOVA were used to compare the groups.

    Results

    There was no significant difference between groups before intervention, but daily Mg supplement for 6 months significantly improved fasting insulin level (6.71±0.11 to 6.27±0.3 three months after Mg therapy, p<0.01 vs. 6.41±0.11 in control group (5.83±0.063)  six months after Mg therapy, p< 0.0001),  HOMA-IR (1.52±0.03 )in control group to 1.36±0.03 after three months Mg therapy, p<0.05 vs 1.37±0.05 in control group to 1.22±0.02 six months after Mg therapy, p< 0.05), high density lipoprotein cholesterol (HDL) (43.57±0.82 in control group to 43.91±1.92 three months after Mg therapy, p<0.001vs 43.57±0.82 in control group to 46±0.88 six months after Mg therapy, <0.01), triglyceride (TG) (163.17±6.1 in control group to 141.2±5.84 six months after g therapy, p<0.05) and low density lipoprotein cholesterol (LDL) (112.62±3.41 in control group to 104.42±2.35 six months after Mg therapy, p<0.05).

    Conclusion

      Oral herbal supplement containing MgSO4 (300 mg/day) could improve plasma insulin level, lipid profile, and insulin resistance in non-diabetic overweight volunteers.

    Keywords: Magnesium, Overweight, Blood glucose, Lipid profile, Insulin resistance
  • Smiline Girija A.S.*, Vijayashree Priyadharsini J Pages 11-16
    Background

    Acinetobacter baumannii is an emerging nosocomial pathogen causing serious complications due to the propensity of its multi-drug resistant property. Due to the indiscriminate and wide-spread use of antibiotics, A. baumannii strains emerge as MDR-Ab, XDR-Ab and in recent years pan-DR-Ab strains. Routine therapy incorporates the application of fewer antibiotics and antibiotic surveillance data is not monitored frequently. This study is thus an attempt to screen for the frequency of antibiotic resistance profile against different classes of antibiotics as per CLSI guidelines.

    Methods

    Phenotypically and genotypically characterized 73 A. baumannii strains were utilized for the antibiogram profile using Group A, B, and U antibiotics as per CLSI recommendations using standard Kirby Bauer disc diffusion method. Interpretations of susceptible, intermediate and resistance were recorded by measuring zone diameter criteria.

    Results

    Group A antibiogram profile showed highest non-susceptibility (n=73) (100%) to ampicillin-sulbactam, ceftazidime and imipenem followed by 82.19%, 79.45%, 67.12%, 56.16% and 49.31% non-susceptible isolates against ciprofloxacin, gentamicin, meropenem, tobramycin, and levofloxacin respectively. Group B antibiogram profile showed 100% non-susceptibility piperacillin-tazobactam and to amikacin, 91.78% (n=67) resistance against ceftriaxone. Among the cyclines, 19.71% and 6.84% of isolates were resistant to doxycycline and minocycline respectively. Under Group U, 76.71% showed resistance against tetracycline. The frequency of MDR (71.23%) and XDR (39.72%) A. baumannii isolates were detected.

    Conclusion

    Periodical antibiotic surveillance is essential to curb the menace of the emergence of MDR and XDR A. baumannii in the hospital environment thus improving the patient care by the administration of alternate drug of choice or by combination therapy.

    Keywords: MDR, XDR, resistance, A. baumannii
  • Peivand Bastani, Omid Barati, Ahmad Sadeghi*, Sajad Ramandi, Javad Javan Noughabi Pages 17-22
    Background

    This study was conducted to compare the main performance indicators of Hasheminejad hospital before and after implementing PPP model.

    Methods

    This cross sectional study was conducted in Iran in 2015. Performance indicators of Hasheminejad hospital, the only Iranian unit that implemented PPP model, were applied. Data were collected based on a researcher-designed checklist after ensuring its validity and reliability. Data were analyzed applying SPSS21, and the Shapiro-Wilk test was used to examine the relevant data normalization. After confirming the normality of the data, descriptive statistics and paired t test were used to analyze the data at a significant level of 0.05.

    Results

    Dramatic variations were observed in the status of the studied indicators after the implementation of PPP in Hasheminejad hospital, and the changes were statistically significant in all these indicators (p<0.05).

    Conclusion

    It seems that implementing PPP in Hasheminejad hospital can be considered as a successful experience in Iran’s health sector. The significant improvement in this hospital’s performance indicators can emphasize the effective role of PPP in administration of this hospital. However, service quality and patient satisfaction should be considered as qualitative indicators, along with the present quantitative indicators because better judgment about the changes was achieved in this hospital after implementing PPP.

    Keywords: Public-private partnership, Performance analysis, Performance indicators, Hospital, Iran
  • Arezoo Saffarian, Yunes Amiri Shavaki, Gholam Ali Shahidi, Shahram Hadavi, Zahra Jafari* Pages 23-28
    Background

    Parkinson’s disease (PD) is a progressive neurological disorder and many PD patients experience some type of voice and speech disorders during the course of illness. In this study, the aim was to investigate the effect of Lee Silverman voice treatment (LSVT) on improving voice difficulties in patients with mild PD using voice handicap index (VHI).
       

    Methods

    This interventional study was conducted on 23 PD patients who were randomly divided into 2 groups: a treatment group (PD-T) (n=13) and a no-treatment group (PD-NT) (n=10). Neurologically healthy control (NNC) group consisted of 13 healthy participants who did not suffer from voice and speech problems and were matched with PD group by age (50-65 years), sex, and education. VHI questionnaire was completed a day before the start of LSVT and a day after the treatment fulfillment for the PD-T group; the same time spots were applied for the PD-NT and NNC groups. Statistical analyses were performed using SPSS Statistics 22.0 and significance level was set at 0.05. The multivariate analysis of variance and repeated measure analysis of variance were used for data analysis.
      

    Results

    PD groups showed a significant weakness in VHI scores before treatment compared to NNC group (p≤ 0.001). The mean of VHI scores for PD-T, PD-NT, and NNC groups before treatment was 44.31±11.23, 43.54±6.10, and 8.15±4.27, respectively. LSVT was successful in improving VHI scores in PD-T group (17.23±5.35, p≤ 0.001). However, no improvement was observed in PD-NT group (44.00±5.88).
       

    Conclusion

    Improvement in VHI score could be the result of ameliorated self-monitoring and self-regulation created by LSVT.

    Keywords: Lee Silverman voice treatment, Parkinson’s disease, Voice disorder
  • Mahnaz Ashoorkhani, Fatemeh Rajabi*, Reza Majdzadeh Pages 29-32

    Complex nature of health and disease, the impact of various socioeconomic factors on the health system arrangements and health of the society, and also the impact of health on the social and economic conditions of the society require a social approach to health. This necessity has led to the creation of new policies and programs, under the name of socialization of health, to strengthen the social approach to health in the health system of Iran. However, there must be more convergence between various stakeholders about the definition, conceptual framework, and different dimensions of this term (socialization of health). Using the experts' opinions and scientific evidence, we clarified the concepts and different dimensions of socialization of health to be used by healthcare policymakers and managers.

    Keywords: Community participation, Good governance, Social determinants of health, Accountability
  • Behzad Damari, Ali Azimi, Narges Salehi Shahrabi* Pages 33-38
    Background

    Due to highly risk-taking behaviors such as alcohol and drug use status of health literacy at workplace is a major concern for health policy makers. Substance abuse literacy (SAL) includes the individuals’ skills to obtain, understand and use substance-relevant health information. This will help to establish a healthy communication in a workplace setting and developing professional knowledge on workplace safety regulations, risky approaches and behaviours that may hurt the community workers. Since poor SAL status would inevitably cause serious harms to both community workers’ health and facilities this study aimed to determine the status of SAL among manufacturing and production workers in Iran.

    Methods

    This is a nationwide cross-sectional survey conducted on 13,600 subjects who were selected through simple randomization into 380 workplaces in 31 provinces of Iran during February 2015 to January 2016. Data were collected through an author-made structured questionnaire by some trained interviewers. The study tool was developed using the literature and then sent to some experts for approving internal validity; minor changes were applied. Internal reliability test in 30 samples yielded Cronbach’s alpha of 0.82. All the questionnaires were administered at the participants’ workplaces following obtaining their consent on releasing blinded information.

    Results

    Given that the score range was from 1 to 5, the mean for SAL in substance abuse was 4.04, so that the highest and lowest means were related to East Azerbaijan (4.22±0.74) and Hormozgan (3.69±0.73) provinces, respectively.

    Conclusion

    This study revealed that the Iranian workers SAL status was fairly high despite the reported high rate of substance abuse (30%) among Iranian workforces. This apparently contradictory finding could be resolved using Syndemics in which refers to clustering of several issues in a society that contribute to and result from socioeconomic and cultural factors and inequalities. Therefore, it is still necessary for policy makers and other researchers to take this issue into consideration in Iranian manufacturing and production plants.

    Keywords: Substance abuse literacy, Health literacy, Iranian worker, Production site
  • Hadi Bazyar, Afsaneh Ahmadi*, Ahmad Zare Javid, Dariush Irani, Mohsen Mohammadi Sartang, Mohammad Hossein Haghighizadeh Pages 39-45
    Background

    Kidney stone is a common and costly disease, but it may be improved by a healthy diet. The aim of this study was to evaluate the association between dietary intake and stone formation in patients with urinary stones in Shiraz.

    Methods

    In this cross sectional study, 110 patients with kidney stone were selected from Faghihi hospital, Shiraz. Demographic information was collected, and anthropometric indices, disease-related variables, physical activity (using IPAQ), and dietary intake (using food frequency questionnaire, analyzed by Nut 4 software, to estimate micro and macro nutrients) were evaluated. Independent sample t test and one-way ANOVA were used to compare the quantitative variables between the 2 groups and multi groups, respectively. Chi square test was also used to compare qualitative variables. The correlation between variables was determined using Pearson test.

    Results

    Out of 110 participants in this study, 37 (33.6%) were female, with the mean BMI of 27.0 ± 4.68 kg/m2, and 73 (66.4%) were male, with the mean BMI of 24.21±2.96 kg/m2. The mean intake of calcium-containing foods (p=0.02) and high-fructose beverages (p=0.03) was significantly greater in patients with calcium stones compared to those with uric acid stones. The mean intake of high-purine foods was significantly higher in patients with uric acid stones than in those with calcium stones (p=0.007). The mean intake of vitamin A (p=0.02), beta-carotene (p=0.03), and fructose (p=0.03) was significantly higher in patients with calcium stones than in those with uric acid stones, while caffeine intake was significantly higher in patients with uric acid than in those with calcium stones (p=0.01). There was a significant correlation between consumption of high-oxalic beverages (p=0.005, correlation coefficient = 0.26) and high-fructose (p=0.048, correlation coefficient = 0.18) with spontaneous stone expulsion.

    Conclusion

    There was a significant relationship between consuming vitamin A, beta-carotene, and foods containing calcium, purine, fructose, and oxalate and formation of kidney stones. Therefore, adopting a healthy diet and increasing physical activity may be effective in the treatment of kidney stones.

    Keywords: Urinary stones, Nutritional factors, Nutrients, Obesity, Physical activity
  • Haniye Sadat Sajadi, Elham Ehsani Chimeh, Reza Majdzadeh* Pages 46-51

    Over the last 4 decades, many initiatives have been implemented to accomplish equitable accessible health care for all Iranian citizens. The latest reform to address universal health coverage (UHC) is Health Transformation Plan (HTP), which resulted in significant improvements in health outcomes. Nevertheless, several challenges in the fields of sustainability of resources, service delivery, and health governance continued to exist. These challenges should be addressed in next steps to achieve the defined goals. To tackle these challenges, a number of practical solutions can be proposed, including making health financing more resilient, defining and implementing cost control policies and cost-effective package of services, changing the current method of providers’ payment, and ensuring good governance in the health system.

    Keywords: Heath Care Reform, National Health Programs, Health Policy, Iran
  • Fateme Zahedi Abghari, Yousef Moradi, Mansoureh Akouchekian* Pages 52-59
    Background

    Autism Spectrum Disorder (ASD) is a neurological disorder characterized by massive damage in various fields of development. Impaired social interaction and communication skills, unusual behavior or interests, and repetitive activities are considerably disabling in these patients. There are several challenges in diagnosis of ASD patients such as co-existing epilepsy, difference in clinician attitudes and possibly multifactorial etiology of autistic behavior among children and adults. Research in recent years has emphasized a possible connection between mutations in PTEN and macrocephaly (head circumference > 97th centile).

    Methods

    Articles in English Language were searched from international databases including Medline (PubMed), Google Scholar, Scopus, and CINHAL from January 1998 to January 2016.

    Results

    The results showed that among 2940 patients with behavioral disorders, 2755 individuals had ASD, and 35 cases with macrocephaly had mutations in PTEN. About 77% of the articles (7/9) analyzed mutations in PTEN in patients with head circumference more than 2SD away from the mean, but did not check mutations in this gene in other ASD patients without macrocephaly. To the best of our knowledge, this study is the first systematic review on human PTEN mutations and classical autistic behavior.

    Conclusion

    We conclude that the presence of macrocephaly may not be sufficient to examine the PTEN mutation in this group; however, surveying this gene in all cases of macrocephaly seems to be necessary.

    Keywords: PTEN, Autism Spectrum Disorder, Macrocephaly, Systematic Review
  • Saeideh Mazloomzadeh*, Fatemeh Karami Zarandi, Alireza Shoghli, Hossain Dinmohammadi Pages 60-64
    Background

    The association between Metabolic syndrome (MetS), its components and mortality has not been clearly established. The aim of this study was to determine the effects of Mets and its components on all cause and cause-specific mortality and to examine whether MetS or its components were better predictors of mortality.

    Methods

    In this retrospective cohort study, we used data from the Zanjan Healthy Heart Study performed in 2003 on 4000 persons. Based on the definitions provided by the NCEP- ATPIII, 1051 participants with MetS and 1219 with none or one of its components at study entry were enrolled. Information regarding the mortality and morbidity of 502 participants with MetS and 523 controls was collected in 2013 by telephone. Cause of death was defined as Cardio-Vascular Disease (CVD) or non-CVD. Data were analyzed using the Cox Proportional Hazards model to estimate the hazard ratios predicted by MetS and its individual components.

    Results

    The median duration of follow-up was 104±10.7 months. Thirty-five deaths occurred, including 18 cardiovascular deaths. The proportion of those with CVD, hypertension, diabetes or hospital stay was statistically higher in MetS patients than controls (p<0.0001). The hazard ratios of all-cause and cardiovascular mortality for those with MetS were 1.75 (%95CI: 0.88-3.47) and 3.66 (%95CI: 1.2-11.1) higher than controls, respectively. Among the components of MetS, only hypertension predicted a higher risk of all-cause and CVD mortality after adjusting for age and sex.

    Conclusion

    The results of this study indicated that MetS was associated with a higher risk of CVD mortality, morbidity, and hospital stay. Among the components of MetS, the association of hypertension was stronger compared to MetS as a whole. Therefore, this study confirms that MetS is a risk factor for CVD mortality, but not beyond the risk associated with its individual components.

    Keywords: Metabolic Syndrome, Mortality, Hypertensionn
  • Leila Hosseini Ghavam Abad, Fariba Asghari, Ali Bandehagh, Sedigheh Najafipour, Shoaleh Bigdeli* Pages 65-68
    Background

    Respecting patients’ privacy is an essential professional responsibility for physicians and other health team members. In this regard, this study investigates medical students’ knowledge and attitude about confidentiality and disclosure of patients’ information.

    Methods

    In this cross-sectional study, 160 medical students of Iran University of Medical Sciences participated who were selected using stratified random sampling. Data were gathered using a valid and reliable self-report questionnaire. Student's knowledge and attitude toward medical confidentiality were assessed using self-administered and researcher-made questionnaires. Cronbach's alpha coefficients for knowledge and attitude levels were 79.7 and 82.2, respectively.

    Results

    The average of medical students' responses to knowledge and attitude questions were 56.6% (9.6/ 17) and 55.3% (9.4 out of 17), respectively. On average, females had an acceptable attitude about 57.5% of the questions, whereas this was 50.9% for males. On average, females had an acceptable knowledge about 59.5% of the questions, whereas this was 50.6% for males. Therefore, female’s attitudes and knowledge were more correct than their male counterparts (p<0.001).

    Conclusion

    The low level of knowledge and attitude of medical students towards medical confidentiality indicates that revision of Iranian medical education curriculum to reinforce attention and knowledge of medical students on this issue to render appropriate care to patients is a necessity. Medical students’ knowledge and attitude towards patient’s confidentiality rights is not fulfilling.

    Keywords: Confidentiality, Knowledge, Attitude
  • Jalil Koohpayehzadeh, Zahra Mirzaei*, Hamid Zahedi, Mahmoud Reza Alebouyeh, Zahra Naghizadeh Moogari Pages 69-74
    Background

    The quality improvement of medical education programs and the ongoing reform of the curriculum should be done in the light of clinical training fields and identifying the strengths and improving the weaknesses. Therefore, this study was conducted to evaluate the validity and reliability of ATEEM (Anesthetic Trainee Theatre Educational Environment Measure) questionnaire for assessing learning environment of anesthesiology residents in educational centers affiliated to 3 main medical schools in Tehran, Iran.

    Methods

    This study was conducted on first to fourth year anesthesiology residents using a questionnaire. Validity (face, content, construct) and reliability of ATEEM questionnaire was investigated. Construct validity was measured by confirmatory factor analysis, stability of reliability by test-retest, and internal consistency by Cronbach's alpha.

    Results

    A total of 156 questionnaires out of 190 were fully answered, returned by residents of anesthesiology, and analysis were performed (82% response rate; 44.5% male (n=69); 55.5% female (n=86)). The age range of respondents was 26 to 48 years. The mean total ATEEM score was 114.03 out of 160. Face and content validity of the questionnaire was approved. Content validity ratio (CVR) and content validity index (CVI) were 0.63 and 0.88, respectively. Fitness indices in confirmatory factor analysis were greater than 0.9, and RMSEA (root mean square error of approximation) index was less than 0.08 (0.07). This indicator measures the acceptability of fitness and it is an appropriate measurement model. The average reliability coefficient was 0.73 and the overall Cronbach's alpha coefficient was 0.959.

    Conclusion

    The results of this study showed that the Persian version of the ATEEM questionnaire, with appropriate psychometric properties, can be used to evaluate the anesthetic trainee theatre learning environment used in hospitals.

    Keywords: Validity, Reliability, Learning environment, Anesthesiology residents, ATEEM questionnaire
  • Reza Rahmani*, Akbar Shafiee, Kambiz Parazaran, Najmeh Reshadati Pages 75-79
    Background

    N-terminal pro-brain natriuretic peptide (NT-ProBNP) increases during myocardial ischemia and has a potential for the diagnosis of patients with coronary artery disease (CAD). We aimed to determine the incremental diagnostic value of NT-ProBNP in the selection of patients with positive myocardial perfusion imaging (MPI) for coronary angiography. We also tested the association between the level of NT-ProBNP and severity of CAD based on the vessel score and Gensini score.

    Methods

    In this cross-sectional study, stable angina patients with positive MPI who were assessed by coronary angiography in Imam Khomeini Hospitalwere enrolled. After the collection of demographic and clinical data, NT-ProBNP was measured in all patients on the day of coronary angiography, and its association with the presence of CAD, vessel score and Gensini score was tested.

    Results

    We enrolled 170 patients (mean age61.2±10.1 years, 86 males (50.6%)).  Seventy-two (42.3%) patients had at least one stenotic vessel. NT-Pro BNP was significantly higher in the CAD-positive group (OR=1.01, 95% CI: 1.00-1.02; p=0.008) and could independently predict the presence of CAD at a cut-off point of 69.5, with a sensitivity of 55.6%, specificity of 82.5% and diagnostic accuracy of 61.7%. The Gensini score had a modest correlation with NT-Pro BNP (r=0.60, p<0.001). The combination of MPI result and NT-Pro BNP could predict the presence of CAD (OR=14.57, 95% CI: 4.28, 49.56; p<0.001).

    Conclusion

    Serum level of NT-Pro BNP alone and its combination with the results of MPI can significantly predict the presence of CAD and therefore, highlights the need for performing coronary angiography.

    Keywords: Coronary artery disease, NT-Pro brain natriuretic peptide, Myocardial perfusion imaging, Coronary angiography, Diagnosis
  • Hamed Ghaffari*, Mahmoud Navaser, Bahram Mofid, Seied Rabi Mahdavi, Reza Mohammadi, Asieh Tavakol Pages 80-86
    Background

    Image-guided radiotherapy (IGRT) is recommended to reduce the risk of geometrical miss when modern radiotherapy technologies with high grades of conformity are used. The purpose of this study was to evaluate the efficacy of fiducial markers (FMs) for electronic portal imaging in prostate cancer radiotherapy in term of evaluating the complications associated with FMs implantation, quantifying inter-fraction prostate motion, and determination of optimal planning target volume (PTV) margins.

    Methods

    In this single institution, prospective, consecutive study, 27 patients underwent implantation of three-gold seed FMs into the prostate gland before prostate radiotherapy. Prior to computed tomography planning, all patients were asked to report any complication associated with FMs implantation that have experienced to date. Daily pre-treatment electronic portal images were captured, and prostate position errors were corrected if they were greater than 2 mm along three translational directions. Optimal PTV expansions were computed using van Herk formula [PTV-margin= 2.5Σ + 0.7σ].

    Results

    FMs implantation was successful with an acceptable toxicity profile in all patients. Without IGRT, margins of 5.4 mm, 5.8 mm and 5.5 mm, in vertical, longitudinal and lateral directions, respectively, are needed for a 95% confidence level of complete clinical target volume (CTV) coverage in each treatment session. The PTV margins of  3.0 mm, 3.3 mm and 4.0 mm in corresponding directions were calculated when FMs based electronic portal imaging was applied.

    Conclusion

    FMs based electronic portal imaging is an effective tool for prostate cancer IGRT.

    Keywords: Fiducial markers, Prostate cancer, Radiotherapy, IGRT
  • Mahboube Shahrabi Farahani, Monireh Mohsenzadegan, Jaleh Taeb, Mohammad M Farajollahi* Pages 87-94
    Background

    The main property of a successful conjugation of antibodies to nanoparticles is keeping the potency of antibody for binding the antigen, and an oriented conjugation can do that. Under such ground, this study was carried out to explore the efficiency of two conjugation methods in binding iron nanoparticles to an antibody produced against PSCA (prostate stem cell antigen) using in vitro labeling of PC3 cells 

    Methods

    In this experimental study, we conjugated dextran-superparamagnetic iron oxide nanoparticles (dexSPIONs) to anti-PSCA antibody by two different methods, including targeting carbohydrate moieties in FC domain and the free amine group of amino acid side chains. Ultimately, Iron staining was done by anti-PSCA antibody-dexSPIONs in PC3 cells to detect antibody binding to the cells.

    Results

    A strong blue dye was induced by iron staining in conjugated dexSPIONs on the membrane of PC3 cells by the former method than the second one. Moreover, cells treated with 20 nm diameters of dexSPIONs showed higher resolution of blue color than those treated with 100 nm nanoparticles.

    Conclusion

    This oriented conjugation method promoted the efficiency of targeting tumor antigens, and the presence of iron particles might enhance MRI image intensity in vivo by targeting PSCA-overexpressing cells in future studies.

    Keywords: Anti-PSCA antibody, Conjugation, DexSPIONs, PC3 cells
  • Majid Taheri, Mohammad Tavakol, Mohammad Esmaeil Akbari, Amir Almasi Hashiani, Mahmoud Abbasi* Pages 95-100
    Background

    Metastasis in Colorectal Cancer (CRC) is important because of the costs imposed on the individual. Self-Rated Health (SRH) can be useful for preventing cancer. Considering the role of Socio-Economic Status (SES) in CRC, our study was conducted to evaluate the relationship between demographic, SES, SRH, and metastasis of this type of cancer in Markazi province, Iran.

    Methods

    This cross-sectional, descriptive study (April to July 2018) was conducted on 411 patients suffering from CRC. These patients were hospitalized in one of the medical centers affiliated to Arak University of Medical Sciences (Arak, Iran), and with non-random sampling (available sampling) they were imported to the study. A reliable and valid questionnaire about levels of SES and SRH was filled by patients. For analyzing the data, Binomial logistic regression and chi-square tests were executed using Stata 11 software.

    Results

    The mean age was 60.01 years. According to the results of this study, as compared with poorest SES patients, the OR estimate of metastasis was 0.80 (95% CI: 0.36, 1.78) among the richest SES patients, in patients with age of >60 years was 9.92 (95% CI: 1.53, 64.39) in comparison with patients with age of <40 years, in male patients was 3.26 (95% CI: 1.76, 6.04) compared with female ones; in divorced/widowed patients was 0.52 (95% CI: 0.11, 2.51) in comparison with single ones; among those with academic level of education was 4.28 (95% CI: 1.49, 12.26) compared with illiterate patients; and compared with poor SRH-age of patients, was 3.78 (95% CI: 2.09, 6.85) among those with good SRH-age.

    Conclusion

    Patient's education and SES are important variables in metastasis and SRH of CRC in Iranian patients. All diagnostic tests and medical possibilities should be available for all individuals with adequate interventions. Patient’s education and awareness should also be increased.

    Keywords: Socio-economic status, Metastasis, Self-rated health, Colorectal cancer
  • Manijeh Alavi, Maziar Moradi Lakeh, Ameneh Setareh Forouzan, Homeira Sajjadi, Mohsen Shati, Mohammad Reza Khodaie Ardakani* Pages 101-108
    Background

    Responsiveness as a nonmedical, nonfinancial aspect of a health system’s goals requires special attention, particularly in people with physical disabilities. This study aimed to investigate the predictors of poor responsiveness of rehabilitation centers in Tehran.

    Methods

    A cross sectional study was conducted to investigate 610 individuals with physical disabilities who referred to 10 comprehensive rehabilitation centers in Tehran using Quota sampling in 2016-2017. The following questionnaires were used in this study: Health System Responsiveness questionnaire, recommended by World Health Organization (WHO); Activities of Daily Living (ADL); and Instrumental Activity of Daily Living (IADL). Multiple logistic regression models were used to determine the sociodemographic characteristics (sex, age, perceived social class, etc.), self-assessed health, and physical functioning [(eg, Instrumental Activities of Daily Living (IADL)] as predictors of poor responsiveness in comprehensive rehabilitation centers of Tehran.

    Results

    The mean years of education of respondents was 12.57 (SD=5.07). The majority of the participants perceived themselves as belonging to the middle class. Among the participants, 17.1% were completely dependent in their instrumental activities of daily living (IADL). Respondents who were not satisfied with their health insurance accounted for 40.2% of the sample. Also, 20.9% of the participants reported poor responsiveness. Based on the logistic regression model, variables of education, perceived social class, satisfaction with health insurance, and IADL were predictors of overall poor responsiveness after adjusting other covariates.

    Conclusion

    Level of education was a strong predictor of poor responsiveness. Insurance companies should make policies to facilitate people's access to rehabilitation services and increase customer satisfaction. Moreover, rehabilitation service providers should pay special attention to those with physical disabilities who are more severely disadvantaged.

    Keywords: Physical rehabilitation center, Poor responsiveness, Iran
  • Shadab Shahali, Hedyeh Riazi*, Shima Alaei, Mohammadali Emamhadi, Fatemeh Salmaney Pages 109-113
    Background

    Sexual violence can lead to serious consequences. Few studies have simultaneously evaluated Perceived Social Support and Self-Esteem of sexual violence victims. This study aims to investigate the relationship between self-esteem and perceived social support among sexual violence victims.

    Methods

    This study was a cross-sectional study which was conducted in forensic medical centers and all health centers affiliated to Shahid Beheshti University of Medical Sciences of Tehran. This study included 66 women in the sexual violence group (Women were considered sexual violence victims if vaginal or anal penetration had occurred) and 147 subjects in the non- sexual violence group (Women with no experience of sexual violence). Rosenberg Self-esteem Scale and Social support Multidimensional Scale of Perceived Social Support were used. Data were analyzed using IBM SPSS statistical software version 22. The significance level for all tests was considered as p<0.05.

    Results

    There were significant differences in the levels of perceived social support in all subscales between the two groups and it was higher in non-sexual violence group (p<0.001). There was no statistically significant difference in the self-esteem level between the two groups. There was a minor significant positive correlation between self-esteem level of the sexually abused victims and perceived social support level (r=0.274, p=0.026). Others relationships were not found to be statistically significant.

    Conclusion

    Our results indicate that the female victims of sexual violence had low social support from their family, friends in their life, However friend's support had a minor positive effect on their self-esteem.

    Keywords: Sexual violence, Social support, Self esteem
  • Behzad Bijani, Abbas Allami*, Farzaneh Jafari, Fatemeh Hajmanoochehri, Soroush Bijani Pages 114-119
    Background

    Accidental exposure to sharp instruments is an important problem for health care students. Thus, the aim of this study was to determine the rate of immunity in health care students 2 decades after national neonatal hepatitis B (HB) vaccination.

    Methods

    All junior students attending medicine, nursing and midwifery schools were screened for anti-HBs. One dose of hepatitis B vaccine was offered to all participants who did not have antibodies to HB surface antigen (anti-HBs) of > 10 IU/L; then, they were tested for anti-HBs after a month. The participants were classified into 3 groups: postboosting nonimmune, postboosting immune, and preboosting immune. Chi square test and ANOVA were used for data analysis.

    Results

    In the first step, 65.20% of participants did not show immunity, but after receiving a booster dose, only 6.0% remained nonimmune. The mean age of nonimmune students was significantly higher than that of students who had postboosting immune and preboosting immune status (p=0.001 and 0.002, respectively). Also, the mean injection time from last shot was higher in postboosting immune group compared to preboosting immune group (p<0.001). Also, prebooster anti-HBs level was significantly different among participants with suboptimal response and those who developed anamnestic response, indicating preserved immune memory (p=0.001).

    Conclusion

    High anamnestic response to HBV booster dose indicates sufficient immunity to HBV in the majority of health care students. However, identifying students who cannot respond to a booster dose of vaccine seems to be necessary at the beginning of health care courses.

    Keywords: Hepatitis B, Vaccination, Medical student, Immunologic memory
  • Parvin Mirmiran, Hoda Hadavi, Azadeh Mottaghi*, Fereidoun Azizi Pages 120-126
    Background

    Advanced glycation end products (AGEs) are a heterogeneous group of macromolecules that are formed by the non-enzymatic glycation of proteins, lipids, and nucleic acids. A number of food preparation methods can increase AGEs content. The aim of the present study is to assess the relationship between dietary consumption of AGEs and the risk of obesity and central obesity.

    Methods

    This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) on 4245 subjects who participated in its fifth phase (2011 to 2014). Dietary data were collected using a validated semi-quantitative food frequency questionnaire (FFQ). Participants’ characteristics, anthropometric measures, and blood samples were also obtained by trained staff. Multivariable linear regression and Logistic regression was conducted using SPSS (Version 20; Chicago, IL), and P values < 0.05 were considered significant.

    Results

    Our results show that abdominal obesity was increased with higher intakes of dietary AGEs, an association, which remained significant after adjustment for potential confounders (OR=1.56 and 95% CI, 1.16 to 2.84). The relationship between abdominal obesity and dietary AGEs (dAGEs) intake was found to be independent of energy and macronutrient intake. We also found a relationship between consumption of dAGEs and a few anthropometric measurements, such that a significant positive correlation was observed between BMI, WC, BAI and higher quartiles of dAGEs intake, with the correlation being stronger for BAI (β= 0.24 (0.10-0.39)).

    Conclusion

    Our study emphasizes that higher intake of dAGEs does increase the chance of abdominal obesity, and dAGEs might be a link between modern diets and obesity.

    Keywords: General obesity, Abdominal obesity, Advanced glycation end products
  • Ali Asghar Farshad, Roksana Mirkazemi*, Ali Falahati, Seyed Hosein Tabatabaei, Fereshteh Taheri, Shidrokh Ghaemi Mood Pages 127-132
    Background

    Health needs assessment (HNA) is essential for allocation of limited resources to the most prioritized problems. HNA in work places has gained increasing importance. Kaveh industrial city is the largest and oldest industrial city in Iran, with a wide range of different industries, making it an exemplary industrial city in Iran. This study was done to conduct health needs assessment of workers in Kaveh industrial city. 

    Methods

    In this study, intensive HNA approach and qualitative method were used. In-depth interviews and Focus Group Discussions (FGDs) were conducted to collect information related to health risk factors, and Delphi method was used to prioritize these risk factors. A total of 74 key informants participated in this study, which constituted more than 80% of the total related experts of Kaveh industrial city.

    Results

    The main identified health challenge was inefficiency of the existing Health, Safety and Environment (HSE) control and monitoring system. The most important physical health risk factors were smoking and obesity and the most prioritized psychosocial risk factors were stress and lack of appropriate management and organizational culture. Ergonomic issues and noise pollution were the prioritized work environmental factors and inappropriate placement of pollutant industries in the industrial city was the most prioritized bioenvironmental risk factor. Unsafe road to industrial zone and poor safety devices used by workers were the most prioritized occupational injuries risk factors.

    Conclusion

    Addressing the identified health needs of workers in Kaveh industrial city is of high importance. Also, redefining the HSE control and monitoring system should be prioritized.

    Keywords: Health needs assessment, Health promotion, Workers health, Industrial city
  • Kamyar Mansori, Masoud Solaymani Dodaran, Alireza Mosavi Jarrahi, Ali Ganbary Motlagh, Masoud Salehi, Alireza Delavari, Ali Hosseini, Mohsen Asadi Lari* Pages 133-142
    Background

    This study aimed to determine effective factors on geographic distribution of the Incidence of Colorectal Cancer (CRC) in Tehran, Iran using Geographically Weighted Poisson Regression Model.

    Methods

    This ecological study was carried out at neighborhood level of Tehran in 2017-2018. Data for CRC incidence was extracted from the population-based cancer registry data of Iran. The socioeconomic variables, risk factors and health costs were extracted from the Urban HEART Study in Tehran. Geographically weighted Poisson regression model was used for determination of the association between these variables with CRC incidence. GWR 4, Stata 14 and ArcGIS 10.3 software systems were used for statistical analysis

    Results

    The total number of incident CRC cases were 2815 in Tehran from 2008 to 2011, of whom, 2491 cases were successfully geocoded to the neighborhood. The  median IRR for local variables were : unemployed people over 15 year old (median IRR: 1.17), women aged 17 years or older with university education (median IRR: 1.17), women head of household (median IRR: 1.06), people without insurance coverage (median IRR: 1.10), households without daily consumption of milk (median IRR: 0.85), smoking households (median IRR: 1.07), household’s health expenditure (median IRR: 1.39), disease diagnosis costs (median IRR: 1.03), medicines costs of households (median IRR: 1.05), cost of the hospital (median IRR: 1.09), cost of medical visits (median IRR: 1.27).

    Conclusion

    The spatial variability was observed for most socioeconomic variables, risk factors and health costs that had effects on CRC incidence in Tehran. Spatial variability is necessary when interpreting the results and utterly helpful for implementation of prevention programs.

    Keywords: Spatial epidemiology, Colorectal cancer, Socioeconomic, Risk factors, Health expenditures
  • Maryam Ramezanian, Ali Akbar Haghdoost, Mohammad Hossein Mehrolhassani, Masoud Abolhallaje, Reza Dehnavieh, Behzad Najafi, Ali Akbar Fazaeli* Pages 143-146
    Background

    Accurate economic forecast has important effects on governmental policy and economic planning, and it can help policymakers to make decisions for future and create new infrastructures for the development of new forecasting methods. This study calculated total health expenditure, public health expenditure and out of pocket (OOP) payment for 2016-2020. 

    Methods

    Autoregressive Integrated Moving Average Process (ARIMA) is one of the most important forecasting models. In this study, five-year values were forecasted using EViews8 software according to health expenditures in Iran from 1971 to 2015.

    Results

    Applying annual data for total health expenditure, resulted in the ARIMA (1,1,1) model being the most appropriate to predict these costs. The results of this study indicate that total health expenditures will reach from about 1228338 billion IRR in 2016 to 2698346 billion IRR in 2020 and the amount of out of pocket (OOP) will become more than 41% of total health expenditure in 2020.

    Conclusion

    Total health expenditures in 2020 will become more than two halves in 2016. These expenditures indicated there is a need for continued governmental support of this sector during the upcoming years.

    Keywords: ARIMA model, Health expenditures, OOP, Forecast
  • Mahnaz Ashoorkhani, Reza Majdzadeh, Hamed Hosseini, Mohammad Hossein Taghdisi* Pages 147-150
    Background

    The aim of this study was to determine the effectiveness of an educational intervention on the quality of health research-based news, given the sensitivity of disseminating incorrect information.

    Methods

    An uncontrolled before-after study was conducted among health news producers in Tehran from November 2011 to March 2012. The intervention that included educational content in the form of a workshop was evaluated in advance. The outcome of measuring the scientific quality of news extracted from medical and health research results was considered for authenticity and accuracy. The health research-based news quality assessment tool was used. In this study, 32 individuals voluntarily entered the program, and their produced news was collected in 4 stages. To determine the effectiveness of the educational intervention, paired t-tests were used. SPSS version 17 was used for statistical analysis and p<0.05 was considered significant.

    Results

    The mean score (±SD) of the participants' produced news was 0.40 (±0.089) before and 0.61 (±0.086) after the intervention, which increased by 0.21±0.09 (p<0.001). Of the news collected from the participants as baseline data, 544 (65%) articles aimed at increasing public knowledge and awareness. Almost all the news had been gathered from interviews, and only 41 (4.8%) news articles were based on health research results.

    Conclusion

    The educational intervention proved effective in promoting the quality of health research news. Only a few health journalists participated in this study, and thus the need to educate health news producers is felt. Since interviews with health researchers and experts were the largest source of news, interventions need to target other groups who affect the quality and accuracy of the news.

    Keywords: Mass media, Journalism, Education, Intervention, Medical news
  • Mostafa Hosseini, Mehdi Yaseri, Hadi Asady, Ahmed Eleojo Musa, Jalil Koohpayehzadeh, Ali Rafei, Koorosh Etemad, Mohammad Mehdi Gouya, Fereshteh Asgari, Mahmoud Yousefifard* Pages 151-157
    Background

    In 2017, American College of Cardiology (ACC) and the American Heart Association (AHA) presented a new guideline for assessing blood pressure in adults. This study aimed to assess the prevalence of hypertension in Iranian adults based on ACC/AHA 2017 guideline. 

    Methods

    Data from 9801 Iranian adults (59.2% women) aged between 20–69 years were obtained from the sixth round of National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD) performed in 2011. Blood pressure was classified as normal, elevated blood pressure, and stage 1 and 2 hypertension using a weighted analysis and 2017 ACC/AHA guidelines. Data were presented as prevalence and 95% confidence interval (95% CI). All analyses were performed in Stata/SE 14.0.

    Results

    Overall prevalence of hypertension in Iranian men was 52.0%. Also, 32.9% (95% CI: 29.9-36.0) and 19.1% (95% CI: 16.9-21.6) of men had stage 1 and 2 hypertension, respectively. In addition, 44.3% of women had hypertension, of whom 26.3% (95% CI: 24.5 - 28.2) had stage 1 and 18.0% (95% CI: 16.1-20.1) stage 2 hypertension. Furthermore, 16.5% (95% CI: 14.4-18.9) and 9.6% (95% CI: 7.86-11.7) of men and women had elevated blood pressure, respectively. 

    Conclusion

    The findings of this study indicated that adopting the 2017 ACC/AHA guidelines showed a higher prevalence of adult hypertension (48.2%) in Iran. In this study, the prevalence of hypertension in men was higher than in women, which was steadily increased by age in older adults in both sexes.

    Keywords: Adult hypertension, ACC, AHA guidelines, Prevalence, Iran, High blood pressure
  • Reza Tahmasebi, Majid Motamedzade, Sadaf Torkashvand, Mehrdad Anbarian*, Meysam Olfatifar, Fatemeh Sarvi, Maryam Farhadian Pages 158-164
    Background

    Dutch Musculoskeletal Questionnaire (DMQ) is used to examine physical and environmental risk factors and to identify high-risk groups for exposure to the risk factors of musculoskeletal disorders at workplace. The aim of this study was to develop the Persian version of the DMQ and to assess its psychometric properties.

    Methods

    This study was conducted on 212 employees of Gas Transmission Company. Using a standard forward-backward translation procedure, the English version of the questionnaire was translated into Persian and culturally adapted. Content validity was established by 10 expert opinions. The intraclass correlation coefficient (ICC) was used for the statistical analysis of reproducibility. Kuder-Richardson-20 was used for internal consistency and confirmatory factor analysis for structural validity.

    Results

    This study revealed high internal consistency and good test-retest reliability for the Persian version of the questionnaire. The means of the content validity ratio (CVR) and content validity index (CVI) for the total 35 items of the questionnaire were 0.96 and 0.91, respectively. The internal consistency of the factors was satisfactory, ranging from 0.83 to 0.88. Confirmatory factor analysis confirmed the existence of 7 factors in the questionnaire and an acceptable fit for the Persian version of the DMQ.

    Conclusion

    The Persian version of the DMQ has acceptable psychometric properties. Thus, it can be used as a valid instrument to assess workload and to identify high-risk groups of musculoskeletal disorders at workplace.

    Keywords: Ergonomics, Dutch musculoskeletal questionnaire, Validity, Reliability
  • Nushin Karkuki Osguei, Nicholas CG Mascie Taylor* Pages 165-174
    Background

    To see which socioeconomic and demographic variables   associate with the nutritional status of under five-year old Nepalese children. This nationwide study provides a comprehensive analysis on of risk factors for childhood acute and chronic undernutrion.

    Methods

    The Nepal Demographic and Health Survey 2006 was used as a cross sectional data source. A total of 3630 children were analysed. Standard Z-score were used for children. Anaemia was also defined using international norms. The statistical analysis used was binary logistic regression, which was performed using SPSS software package for Windows. The cut-off for a significant result was <0.05.

    Results

    The results showed that 1680 (46.3%) of children were stunted, 1384 (38.1%) were underweight, 513 (14.1%) were wasted and 1631 (44.9%) were anaemic. Underweight and stunting showed significant association with mother’s education and ethnicity. All nutritional factors were associated with ecological zone and standard of living. Also, underweight and wasting showed a significant relationship with religion.

    Conclusion

    Maternal education, ecological zone, ethnicity and standard of living were the main predictors of child nutritional status.

    Keywords: Children undernutrition, Standard of living, Stunting
  • Saman Sargazi, Omid Kooshkaki, Javad Zavar Reza, Ramin Saravani*, Hossein Zarei Jaliani, Shekoufeh Mirinejad, Fatemeh Meshkini Pages 175-180
    Background

    Breast cancer (BC) is a complex disease, but current treatments are not efficient enough considering increased relapse and decreased survival rate among patients. Poly (ADP-ribose) polymerase inhibitors are recently developed anticancer agents which target cells with defects in homologous recombination (HR) pathway. This study wishes to assess whether the combination of AZD2461 as a newly developed PARP1 inhibitor and valproic acid (VPA), a histone deacetylase inhibitor could effectively reduce the growth of MCF-7 cells with no fundamental DNA repair defect. 

    Methods

    Both trypan blue dye exclusion assay and MTT viability test were used to evaluate cell death. γ-H2AX levels, as a marker of DNA repair, were measured using in cell ELISA method. The Student's t-test and non-parametric analysis of variance (ANOVA) were applied for our data analyses where p-value <0.05 was considered statistically significant.

    Results

    As calculated by CompuSyn software, IC50 values for VPA and AZD2461 were 4.89 mM and 42.83 µM respectively following 48 hours treatment. Also, the trypan blue exclusion assay results showed a concentration- and time-dependent decrease when MCF-7 cells were treated with both agents (p<0.05). Combination analysis showed a mild antagonism (CI>1.1) while γ-H2AX levels found not to be significantly increased in MCF-7 cells co-treated with VPA+AZD2461 compared to each agent alone (p=0.29).

    Conclusion

    Our findings revealed that the combination of VPA and AZD2461 could decrease cell viability of MCF-7 cells, but it was not able to significantly increase unrepaired DNA damage sites. The mechanism responsible for drugs combination was not of synergism or addition. Determining the type of involved cell death mechanisms might be followed in further studies.

    Keywords: Breast cancer, Valproic acid, Combination therapy, AZD2461
  • Narjes Khalili, Maziar Moradi Lakeh*, Mohammad Heidarzadeh Pages 181-182

    This is a letter to editor in responce to review article entitled " Low birth weight in Iran: Implications from a systematic review of the literature and meta-analysis in the period 1999-2017" by Ebadi et al. published in the Medical Journal of the Islamic Republic of Iran (2018; 32 (1): 68-77).

    Keywords: Low birth weight, Iran
  • Fatemeh Safi, Alireza Kamali, Marzieh Rezaei*, Mahboubeh Rezaei, Mahammad Rafiei Pages 183-189
    Background

    Hysterosalpingography plays an important role in diagnostic work-up and treatment planning for infertile women. This procedure is usually uncomfortable and painful. The present study plans to investigate the effect of intramuscular Hyoscine-N-Butyl Bromide (HBB) on fallopian tube spasm and pain perception during and after hysterosalpingography (HSG) in infertile women.

    Methods

    This randomized single-blind controlled clinical trial (IRCT2017021132455N2) was conducted on infertile women scheduled for HSG in one radiology clinic affiliated to Arak University of Medical Sciences between July and August 2017. Patients were selected by convenience sampling and were randomly assigned to HBB (n=50) and a control group (n=50). Women received 20 mg/1cc HBB intramuscularly in the intervention group, 30 minutes before the procedure. Women in the control group did not receive any medication. The patients were requested to complete the Numeric Pain Rating Scale after injection of the dye, and also 30 minutes following the end of the HSG. Presence or absence of tubal spasm was determined after checking the radiographic images. For the data analysis using SPSS version 18, descriptive statistics, and analytical tests such as independent sample t-test, Mann- Whitney test, chi-square or Fisher’s exact tests and logistic regression and ANCOVA were used.

    Results

    Statistically significant differences were not observed in pain scores between the HBB and the control groups at the point of dye injection and 30 minutes after ending the HSG (p>0.05). Also, tubal spasm in the HBB group was lower than in the control group, but the differences were not statistically significant between the two groups (p=0.37).

    Conclusion

    The use of intramuscular HBB before HSG has no advantage in reducing tubal spasm and the induced pain during dye injection and 30 minutes after the HSG procedure. Thus, we don’t recommend HBB use before the HSG in order to relief from pain and spasm.

    Keywords: Pain, Spasm, Fallopian tubes, Hysterosalpingography, Infertility
  • Mahdi Khodadoust, Reyhane Mohamadi*, Leila Janani, Zakiye Javadi, Amir Sadeghi Pages 190-198
    Background

    Phonological awareness (PA) is a fundamental predictor of reading disability. However, researches on reading have indicated that PA assessment alone is not sufficient to prevent reading problems. Rapid automatized naming (RAN) has been suggested as another influential factor in reading deficits independent of PA. This study investigated the impact of phonological awareness on rapid automatized naming.

    Methods

    This was a randomized clinical trial study in which 62 Persian monolingual first graders were recruited from 3 schools using convenience sampling. Inclusion criteria were lack of deficits with sensory-motor skills and knowledge of the Persian alphabets. Measures of PA and RAN were utilized. The participants were randomly assigned into either the intervention or the control group. The intervention group was divided into small groups of 4-6 children who received thirty 40-minute training sessions in PA. T test, Mann-Whitney, and Wilcoxon tests were used for data analysis.

    Results

    The results revealed that the RAN time was significantly reduced (p≤0.001), with a significant increase in PA scores (p≤0.001). In addition, there was a significant inverse relationship between some of the measures of the phonological awareness subtests and rapid automatized naming (eg, phonemic blending & RAN (numbers): ρ=-0.52 with p≤0.001).

    Conclusion

    The findings showed that in the initial assessment, PA and RAN had a significant relationship, but RAN could be significantly improved by PA training.

    Keywords: Rapid automatized naming, Phonological awareness, Reading, Predictors of reading, Double-deficit hypothesis
  • Behzad Mohsenpour, Amjad Ahmadi*, Anvar Mohammadi Baneh, Katayoon Hajibagheri, Ebrahim Ghaderi, Shahla Afrasiabian, Samaneh Azizi Pages 199-201
    Background

    Zinc deficiency can increase the risk of infectious diseases. Given that recurrent urinary tract infection is a common complication, this study examines the association between serum zinc levels and recurrent urinary tract infections.

    Methods

    In this case-control study, serum zinc levels for 48 patients with recurrent urinary tract infections were compared with the serum zinc levels of the same number of people in the control group who were matched in terms of location and age. Using SPSS ver. 18, univariate analysis was performed through t-test, correlation coefficient; and multivariate analysis was carried out through multiple regression tests. Significant level was considered as less than 0.05.

    Results

    There was a weak correlation between age and serum zinc level (r=-0.205, p=0.045). Mean serum zinc level of the test group and the control group were 96.83 (±11.25) and 76.72 (±17.06) microgram/deciliter (p=0.001), respectively. Level of zinc reduced with aging; in addition, the group with recurrent UTIs had lower zinc levels than the control group (p=0.010, R2=0.377).

    Conclusion

    According to the results of this study, serum zinc levels of people with recurrent urinary tract infections were lower than that in the control group. It seems that zinc levels are a risk factor for recurrent urinary tract infections.

    Keywords: Urinary tract infection, Micronutrients, Zinc, Recurrent infections, Nutrition
  • Marzieh Shirazikhah, Arash Mirabzadeh, Homeira Sajadi, Mohammad Taghi Joghataei, Akbar Biglarian, Farahnaz Mohammadi Shahboulaghi*, Hamid Sharif Nia, Kelly A Allen Pages 202-209
    Background

    Access to rehabilitation services is considered to be a right for all people.
    One of the most important indicators for access to rehabilitation services is an individual’s general acceptance of rehabilitation. This tool was designed based on relevant studies and experiences of rehabilitation specialists to design a questionnaire to specifically measure patient acceptability of physical rehabilitation services.

    Methods

    In this study, an exploratory sequential mixed methods design was used. The first phase included a review of the literature and analysis of relevant studies, focus group discussions, and qualitative content analysis. In the second phase, construct validity was assessed by exploratory and confirmatory factor analysis. Also, convergent and divergent validity were measured. Reliability was evaluated by internal consistency (Cronbach's alpha and McDonald's Omega) and construct reliability. Statistical procedures were calculated by SPSS-AMOS24 and JASP0.9.2 software

    Results

    A total of 200 questionnaires were completed by members of Iranian Disability Campaign. Three factors and 25 items were identified according to results of the first phase of this study. In the second phase, face validity was confirmed. To assess the content validity ratio, 9 items, with the mean of content validity ratio (CVR) < 0.49, were deleted, while the content validity index (CVI) < 0.79 was revised. The kappa coefficient < 0.6 was fair and scale content validity index (SCVI) under 0.9 was considered appropriate. Results of exploratory factor analysis showed that 48% of the variance of the acceptability of physical rehabilitation services was based on patients’ satisfaction, ethical behavior, and patient centered services. Confirmatory factor analysis confirmed the suitability of the final model. Convergent and divergent validity and reliability of the measure, the Physical Rehabilitation Services Acceptability
    questionnaire was fulfilled.

    Conclusion

    Findings indicated that the proposed constructs that promoted the Acceptability of Physical Rehabilitation Services Questionnaire had good validity and reliability in participants with physical disabilities.

    Keywords: Psychometric properties, Acceptability, Physical rehabilitation
  • Seyed Kazem Malakouti*, Fariba Karimzadeh, Sara Minaeian, Azar Islami, Mahdi Rezaei, Roshanak Ghods Pages 210-217
    Background

    It has been widely acknowledged that change and constant modification is the key to survive for any organization among their rivals. Since success in implementing changes in the organization strongly depends on the organizational culture, this study aims to assess the organizational culture in Iran University of Medical Sciences. The results of this study can be beneficial in initiating a movement towards the third – and fourth generation of universities.

    Methods

    This study is descriptive-correlational. The Organizational Culture Assessment Instrument (OCAI) was employed to collect data. A questionnaire was sent to the faculty members via email, and the responses were collected and analyzed.

    Results

    Out of the 982 faculty members, 189 participated (20.7%) in this study. Analysis showed that the organizational culture of the university is congruent and harmonious and in the current state, it is primarily hierarchical (31%) and market-oriented (28%) with emphasis on stability and control in the organization. Whereas, faculty members tend to move the organizational culture of the university towards adhocracy (30%) and clan culture (29%) 

    Conclusion

      University administrators must strengthen the culture of innovation and creativity based on the needs of the market. This only can be achieved by supporting teamwork in their move towards desired change.

    Keywords: Culture, Organization, University, Faculty, Organizational culture, Third-, fourth generation universities, Hierarchical, Clan, Market-Oriented, Result-oriented
  • Majid Reza Khalajzadeh, Mehrzad Kiani, Fariba Borhani, Shabnam Bazmi, Saeid Nazari Tavakkoli, Mahmoud Abbasi* Pages 218-221
    Background

    Ethical attitudes and personal values play a significant role in clinical decision-making; however, they have been given limited attention by professionals in laboratory medicine. Studies suggest that individual attitudes are not static and that professionals learn ethical attitudes through a variety of formal and informal learning methods. This study was conducted to investigate changes in the attitudes of clinical laboratory professionals after teaching them ethics and to compare the results among the 3 groups.

    Methods

    Four topics were selected in the field of medical laboratory ethics as teaching materials. A questionnaire including 22 items was designed and validated. Teaching sessions for the 3 study groups were held. All 65 clinical laboratory participants completed the questionnaire before and after the classes. Paired t test and ANOVA were used to assess differences among groups.

    Results

    Significant differences were found in the mean scores of ethical attitudes before and after the educational intervention among the lecture-based teaching group (p=0.016), problem-based learning group (p=0.001), and all participants (p=0.004). However, no significant difference was found between the mean scores before and after the intervention in role-playing group (p=0.623).

    Conclusion

    Teaching by lecturing and problem-based learning was more effective to change ethical attitude of the laboratory professionals than the role-playing method. Thus, we suggest the implementation of teaching ethics using these methods to improve the ethical attitude of clinical laboratory professionals.

    Keywords: Medical ethics, Attitude, Teaching method, Laboratory
  • Fatemeh Varse, Leila Janani, Yousef Moradi, Masoud Solaymani‐Dodaran, Hamid Reza Baradaran, Shahnaz Rimaz* Pages 222-228
    Background

    Randomized clinical trials have been considered as the gold standard for evaluating the effectiveness and safety of medical interventions; however, there are major barriers to their design, conduct, analysis, and reporting. They are multidisciplinary and involve different steps and face a variety of challenges that may vary from one country to another. The aim of this study was to provide a comprehensive presentation of the challenges of clinical trial studies in different steps including design, conducting, analysis, and reporting.

    Methods

    In this study, all original articles conducted during 1991-2017 that reviewed the barriers to clinical trial studies at one of the steps of design, conducing, analysis, and reporting of the results in Medline (through PubMed), Embase, Web of Sciences, Scopus, and Google Scholar were considered. The searched keywords were as follow: challenges, barriers, and randomized clinical trial.

    Results

    The following barriers in different steps of randomized clinical trials were identified: general barriers include insufficient knowledge and understanding of clinical research and research methodology, barriers to ethical and regulatory systems, and lack of funding. The investigator-initiated trials may face similar problems to those of sponsor-initiated trials, such as handling regulatory systems, administrative and financial issues, multiple languages, and different patient compensation approaches. The challenge related to design was poor planning. Other challenges were lack of manpower and financial resources, inappropriate statistical methods for analysis (analysis challenges), and challenges related to reporting which include selective reporting.

    Conclusion

    Based on the results of this systematic review, the most important challenges were barriers related to handling ethical and regulatory systems, patient recruitment, and lack of budget and skilled staff for conducting clinical trials. Training to improve the quality of randomized clinical trial studies in different steps and levels was the most important recommendation in these studies.

    Keywords: Barriers, Challenges, Clinical trials, Systematic review
  • Seifolah Jahantab Nejad, Akram Azad* Pages 229-234
    Background

    Performance Oriented Mobility Assessment (POMA) is a commonly used screening tool for identifying patients at risk of falling. The purpose of this systematic review was to determine the overall predictive accuracy of POMA for falls in community-dwelling older adults. This review could provide useful information to use POMA in both research and clinical settings.

    Methods

    In this study, PubMed, EMBASE, CINHAL, Cochrane Library, EBSCO, and SCOPUS were searched to identify studies published from 1987 to 2017 that aimed at validating POMA and reporting predictive value with sufficient data to calculate sensitivity and specificity. The methodological quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy studies (QUADAS-2).

    Results

    Of the 121 identified studies, 12 met the inclusion criteria and were entered in the final analysis. Fall rate ranged from 5% to 61% in the included studies. The POMA cutoff point for discriminating fallers from non-fallers varied from 15 to 26. Sensitivity and specificity of the POMA ranged from 24-91 to 37-97, respectively.

    Conclusion

    Due to heterogeneity of the type of studies, participants, the definition of fall, and use of different versions of POMA, it was not possible to determine a specific cutoff point for POMA. In addition, using the same version and scoring method of POMA and controlling the significant potential confounders (eg, age, gender, and comorbidities) would provide better information about the predictive accuracy of POMA for falls in older adults.

    Keywords: Falls, Older adults, Sensitivity, Specificity, Systematic review
  • Mozafar Khazaei, Mona Pazhouhi*, Saber Khazaei Pages 235-242
    Background

    Glioblastoma multiforme (GBM) is the most malignant primary brain tumor. Temozolomide (TMZ) is a chemotherapeutic agent that has been used in GBM treatment. Resistance to TMZ is a major obstacle to successful GBM treatment. The aim of the present study was to investigate the effect of TMZ and tranilast on human GBM cell line (U87MG).

    Methods

    In this in vitro experimental study, the effect of TMZ and tranilast on cell proliferation was measured using the MTT assay. Median effect analysis was performed to determine the TMZ and tranilast interaction. Lactate dehydrogenase assay was used to determine TMZ and tranilast cytotoxicity. Cell fluorescent staining and real-time PCR were used for apoptosis evaluation. The effect of TMZ and tranilast on U87MG nitric oxide (NO) production was evaluated by Griess assay.

    Results

    TMZ and tranilast had a significant dose- and time-dependent inhibitory effect on cell proliferation. The mean combination index values represented a synergistic effect, and dose reduction index values suggested the advantages of reducing the toxicity, adverse effects, and drug resistance in combination of TMZ and tranilast. Apoptosis cell death was induced by TMZ and/or tranilast in cells. TMZ and tranilast reduced NO production in cells.

    Conclusion

    TMZ and tranilast combination inhibited the GBM cells growth effectively.

    Keywords: Drug combination, Drug resistance, Glioblastoma multiforme, Temozolomide, Tranilast
  • Ahmad Tavakoli*, Mohammad Hadi Karbalaie Niya, Farah Bokharaei Salim, Mohammad Farahmand, Morteza Izadi, Ruhollah Dorostkar, Hossein Keyvani Pages 243-248
    Background

    Military populations are more prone to respiratory infections worldwide. There is a dearth of research about the role of viral pathogens in the etiology of respiratory infections in military trainees in Iran. Hence, we aimed to investigate the molecular epidemiology and clinical symptoms of respiratory viruses among this population.

    Methods

    This cross-sectional study was performed on 400 military trainees with symptoms of respiratory infection, referred to the military medical clinic center in the basic military training camp of the General Staff of the Armed Forces of the Islamic Republic of Iran. Nucleic acid extraction from the throat or nasopharyngeal swab samples was performed by an automated extraction system. The extracts were then analyzed by the CLART® PneumoVir array system for the detection of respiratory viruses.

    Results

    All military trainees were male, aged between 18 and 57 years (mean: 21.69 years). Sore throat (75.5%), rhinorrhea (63.2%), cough (59.2%), fever (59.2%), and nasal congestion (50.5%) were amongst the most common symptoms. Overall, viral pathogens were detected in a total count of 124 (31%). The most commonly detected viruses were rhinovirus (7.2%), respiratory syncytial virus A (7.2%) and influenza B virus (6%).

    Conclusion

    This study was an important first step for understanding the etiological role of viral pathogens in respiratory infection among military trainees population in Iran. Our results indicated that rhinovirus, respiratory syncytial virus A and influenza B virus are important viral pathogens causing respiratory infection in military trainees, respectively. However, further multi-center studies with larger sample size are strongly recommended to confirm our findings.

    Keywords: Military trainees, Respiratory infection, Microarray, Iran, Viral infection
  • Abedin Saghafipour, Ahmad Mousazadeh Mojarrad, Niloofar Arzamani, Zakyeh Telmadarraiy, Rezvan Rajabzadeh, Kourosh Arzamani* Pages 249-254
    Background

    Crimean-Congo hemorrhagic fever (CCHF) is a prevalent tick-borne disease in different regions of Iran. This molecular and serologic study was performed to investigate the Crimean-Congo hemorrhagic fever virus (CCHFV) in collected ticks and in blood samples of some domestic animals in North Khorasan, Northeast of Iran.

    Methods

    In this cross sectional study, 136 blood samples from domestic animals (sheep, goats, and cows) collected in the Northeast region in Iran were examined using IgG ELISA assay. Ticks (n = 1478) were collected from sheep, goats, and cows. Out of all collected ticks, 62 specimens were investigated for CCHF virus genome using RT-PCR technique. The data were descriptively presented by median and 95% confidence interval (CI).

    Results

    CCHFV infection rate was 8.1% in studied ticks. Two species of ticks, Hy. anatolicum (n=3; 15%, 95% CI 9.41–20.59) and Rh. sanguineus (n=2; 6.9%, 95%CI 4.33–8.58), were infected with CCHFV genome and were probable vectors of CCHF virus in the area. Infection rate was 15.4% for CCHFV in tested domestic animals. Serologic tests detected CCHFV specific IgG antibodies in 16.2% (95% CI 13.49–18.83) (99/16) and 19.2% (95% CI 13.26–25.20) (26/5) of sheep and goats, respectively.

    Conclusion

    The present study showed that domestic animals and ticks were infected with Crimean-Congo hemorrhagic fever virus and that the disease was endemic in North Khorasan province, Iran. However, further surveillance and prevention programs are recommended.

    Keywords: Crimean-Congo hemorrhagic fever, Ticks, Molecular technique, Serological test, Iran
  • Parisa Mokhles, Amjad Ahmadi, Ramesh Rahhagh, Nasrin Soofizadeh*, Ebrahim Ghaderi Pages 255-258
    Background

    Detection of pelvic masses is of great value for scheduling a proper treatment process and is an important factor for detection. Frozen section is a diagnostic method for the evaluation of pelvic tumors during surgery. The purpose of this study was to measure the compatibility of the frozen section method for histopathological specimens of female pelvic masses with pathologic results of tumor markers.

    Methods

    This retrospective study was performed on 188 female pelvic mass specimens during 2014-2016. Medical files for all patients with injury of female genital system who had undergone frozen section surgery was compared with the results of pathology and tumor marker tests. SPSS version 19 was used for statistical analysis. The results were analyzed by Kappa test.

    Results

    Based on the final pathology of the 188 specimens, 150 (79.8%) were benign, 8 (4.2%) intermediate, and 30 (16%) malignant. Sensitivity, specificity, and validity of frozen section in benign tumors were calculated as follow: 96.7 Confidence Interval (CI95% : 92.6–98.9%), 97 (CI95%: 84.7–99.9%), and 96.8%; in intermediate tumors, the respective numbers were: 71.4 (CI95% :29–96.3%), 98.3 (CI95% :95, 2–99%, 7%), and 97.3%; and in the malignant tumors the numbers were: 96.3 (CI95% :81.9–99%), 97.4 (CI95% :93. 4–99.3%), and 97.2%. Positive and negative predictive values were calculated as follow: 99.3 (CI95% :96.3–99.9%) and 86.8% (CI95% :71.9–95.6%) in benign tumors; 62.5 (CI95% :24.5–91.5%) and 98.9% (CI95% :96–99.9%) in intermediate tumors; and 86.7 (CI95% :69.3–96.2%) and 99.3% (CI95% :96.3–99.9%) in malignant tumors.

    Conclusion

    The results of this study showed that the frozen section method has managed to keep its value and place among all diagnostic methods regarding pelvic masses to an acceptable extent. Except for the intermediate tumors, the frozen section method showed great accuracy in dealing with pelvic masses.

    Keywords: Tumor, Frozen section, CA125
  • Sina Ahmadi, Homeira Sajjadi, Farhad Nosrati Nejad, Naser Ahmadi, Salah Eddin Karimi, Moein Yoosefi, Hassan Rafiey* Pages 259-265
    Background

    This study aimed to evaluate lifestyle changes and their impact on hypertension control and why and how lifestyle modifications are recommended for patients with hypertension. Four non pharmacological strategies have been recommended by physicians for hypertension control for hypertensive patients in Iran: healthier diet, smoking cessation, physical activity, and weight loss.

    Methods

    Among participants of Iran STEPS Non-communicable Disease Risk Factors Survey (STEPs), 7879 hypertensive patients aged ≥25 years were selected. All statistical analyses were calculated using STATA software version 14. Means, proportions, and multiple binary logistic regression models were used. Two-tailed p values of <0.05 were considered statistically significant.

    Results

    The results of this study showed that about three quarters of people with high blood pressure had been recommended lifestyle strategies by their physician for blood pressure control. Of the participants, 41% reported that they had been recommended only lifestyle modification for their blood pressure (BP), while 35% reported that they were recommended both lifestyle changes and medications as part of their treatment. Healthier diet, 71.9% (70.8-72.9), and smoking cessation, 23.8% (21.4-25.6), were the most and least frequently recommended strategies, respectively. Also, the rates of recommendations on smoking cessation, weight loss, increased physical activity, and healthier diet were more among women, married, and illiterate individuals, respectively.

    Conclusion

    Because of the changes and transitions in the lifestyle and dietary habits in the modern world, policies and training programs should be developed to improve the recommendations on lifestyle modification. Also, educational programs should be developed to increase patient’s acceptance of lifestyle modifications and physical activity.

    Keywords: Hypertension, Lifestyle, Physical activity, Recommendation, Non pharmacology
  • Zahra Hadian Jazi, Hamid Peyrovi*, Armin Zareian Pages 266-274
    Background

    Social responsibility in nursing is a complex concept that is completely associated with the context and healthcare system of every society. This study was conducted to analyze the concept of nurse’s social responsibility in Iran.

    Methods

    This analysis was done using a hybrid model, which consists of three phases: a literature review in the theoretical phase, semi-structured interviews in the fieldwork phase, and combination of the results of the two previous phases in a final analytical phase.

    Results

    The four main themes extracted in the theoretical phase included: “Multi-dimensional and comprehensive approach”, spirituality-based, learner-based and an evolutionary-process. In the fieldwork phase, all the themes obtained in the previous phase were confirmed, and one more theme emerged as “being relative”. In the final phase, with the combination of the results of two previous phases, the final definition of the concept was presented.

    Conclusion

    Clarifying the social responsibility of nurses and highlighting it in nursing will definitely lead to satisfaction in patients and clients, professional development and reduction of health care costs. Also, by identifying facilitators, inhibitors and social responsibility concepts, nursing managers and nursing educators will be able to design and implement their management and training activities based on scientific findings based on the findings that are necessary for the correct learning and implementation

    Keywords: Social responsibility, Nursing, Hybrid, Concept analysis
  • Batoul Okhovat Isfahani, Saeid Bitaraf, Mohammad Ali Mansournia, Amin Doosti Irani* Pages 275-280
    Background

    Tuberculosis (TB) is one of the ten leading causes of death, especially in developing countries. We aimed to assess the inequality in the incidence and prevalence of TB and TB/HIV based on the human development index (HDI) globally.

    Methods

    In this ecological study, the data on the incidence and prevalence of TB, HIV, and TB/HIV co-infection in 168 countries were obtained from the World Health Organization (WHO). The HDI of these countries in 2000, 2005, 2010, and 2015 was also obtained from the United Nations Development Program (UNDP). The concentration index was used to assess the inequality of the incidence and prevalence of TB and TB/HIV based on the HDI globally.

    Results

    The concentration index for the incidence of TB according to the HDI was -0.32 (95% CI: -0.46, -0.17), -0.36 (95% CI: -0.49, -0.23), -0.37 (95% CI: -0.52, -0.22), and -0.36 (-0.52, -0.21) in 2000, 2005, 2010, and 2015, respectively. The same pattern was observed for the incidence and prevalence of TB/HIV. The results showed that TB and TB/HIV mainly concentrated in countries with a lower HDI.

    Conclusion

    According to the results of this study, the incidence of TB and TB/HIV and the prevalence of TB/HIV concentrated in the countries with a lower HDI. In addition, inequality in TB and HIV based on the HDI did not change from 2000 to 2015. Therefore, it seems that public health programs, especially in low-income countries, should be revised and the World Health Organization and the United Nations should provide more technical and financial help for these countries.

    Keywords: Inequality, Tuberculosis, HIV, Human development index
  • Behshid Farahmand, Esmaeil Ebrahimi Takamjani, Hamid Reza Yazdi, Hassan Saeedi, Mohammad Kamali, Masumeh Bagherzadeh Cham* Pages 281-287
    Background

    Leg length discrepancy measurement is an essential part of musculoskeletal clinical assessment, and tape measurement is a common clinical method. This study aimed to systematically review the results of the findings of studies on validity and reliability of the tape measurement method and the quality of reporting the literature on this topic.

    Methods

    A search was performed in PubMed, EBSCO, Science Direct, Web of Knowledge, Scopus, Embase, and Google Scholar using selected keywords from inception to December 2017.This systematic review was based on the PRISMA guideline. After a systematic selection process, the quality of the included studies was assessed independently by 2 reviewers using the Brink and Louw Scale for quality assessment.

    Results

    A total of 11 studies were finally considered for this systematic review. Two studies were about the validity of (a measurement tool) studies and 4 were reliability analysis only. Validity and reliability analyses were simultaneously applied to 5 studies. Also, 9 out of 11 studies were deemed to be of high quality based on Brink and Louw Scale. Studies showed high (ICC=0.7) to very high (ICC=0.9) levels of interrater and intrarater reliability. The validity of the methods ranged from low to very high depending on subjects.

    Conclusion

    Tape measurement method has acceptable reliability and validity in healthy people, but it does not have acceptable validity in measuring obese people and patients with musculoskeletal disorders. Thus, using a suitable method for LLD leg length discrepancy measurement seems to be necessary for obese and individuals with leg length discrepancy.

    Keywords: Leg length discrepancy, Validity, Reliability
  • Yadollah Hamidi, Seyed Mohammad Mahdi Hazavehei, Akram Karimi Shahanjarini, Mohammad Ali Seif Rabiei, Maryam Farhadian, Shohreh AliMohammadi, Seyedeh Melika Kharghani Moghadam* Pages 288-294
    Background

    Health promoting hospitals (HPHs), in addition to their routine diagnosis and treatment services, concentrate on health enhancement and disease prevention. This study was conducted to systematically review studies conducted in the field of health promoting hospitals (HPH) in Iran to achieve HPH standards.

    Methods

    Electronic search was conducted from October to February 2016 in Persian and English databases. Search was done IranMedex, SID, ISI Web of Knowledge, ScienceDirect, PubMed, and Google Scholar with the following keywords: Health promotion hospital (s), health promoting hospital (s), health promotion hospitals, HPH, and Iran. Based on inclusion and exclusion criteria and the aim of the study, 10 studies were selected to be reviewed.

    Results

    The results showed that HPH standards in studied hospitals were very poor in overall standard and that the standard of management policy had the lowest mean. Studies conducted in the order modeling HPH in Iran showed that factors of patient empowerment and society had the greatest impact and needs assessment had the lowest impact. The results of interventional studies were reviewed in this study and it was found that implementing standards of HPH and educational interventions increase the standard of HPH.

    Conclusion

    The review of the HPH studied indicated that the most important challenge in achieving the standards of health promotion hospitals is Iran’s hospital policy, which is more treatment-oriented.

    Keywords: Health Promotion, Health Promoting Hospital, Iran Hospitals, HPH
  • Amir Shabani, Mosleh Mirzaei Khoshalani*, Seyedreza Mahdavi, Masoud Ahmadzad Asl Pages 295-300
    Background

    Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) are used to screen patients with bipolar disorders and have been examined in some psychiatric settings. The present study aimed to assess the validity and reliability of these 2 tools on inpatients in a general hospital.

    Methods

    In a cross-sectional study in 2011, a total of 207 inpatients admitted to different wards of Rasoul Akram hospital, Tehran, were selected by systematic random sampling. Demographic questionnaire, MDQ, and BSDS were completed. Also, Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) was performed for all participants within 72 hours. The SCID-I was used as the gold standard of psychiatric diagnoses to identify the predictive validity of the 2 screening tests. Sensitivity and specificity indices were identified using Roc curve. The 2 screening tools were recompleted by 20% of the patients (n=43) after 3-7 days to measure test-retest reliability using paired t test and correlation between measures in 2 separate occasions.

    Results

    In this study, 101 female and 106 male (m=36.9±15.5 yrs.) patients were entered the study, of them 56 (32 males) had bipolar disorder according to SCID-I. The most common bipolar disorder was bipolar disorder type II (9.7%). Pearson’s test showed a high test-retest reliability for both MDQ (r=0.72, p<0.001) and BSDS (r=0.77, p<0.001). For MDQ, the scores 5 (sensitivity=0.60; specificity=0.73) and 6 (sensitivity=0.56; specificity=0.77) were the best cutoff points. Positive and negative predictive values for the mentioned cutoff points were 0.45 and 0.83 (for the score 5) and 0.48 and 0.82 (for the score 6), respectively. The best cutoff point for BSDS was 11 with the sensitivity, specificity, and positive and negative predictive values of 0.74, 0.69, 0.47, and 0.87.

    Conclusion

    The Persian versions of MDQ and BSDS have acceptable validity and reliability to screen Persian patients with bipolar spectrum disorders in a general hospital.

    Keywords: Bipolar disorder, Screening, Mental disorders, Bipolar spectrum diagnostic scale, Mood disorder questionnaire, Sensitivity, specificity, Psychometrics
  • Sajjad Rastegar, Jalal Beigi, Ehsan Saeidi, Ali Dezhkam, Tofigh Mobaderi, Hamed Ghaffari*, Ali Mehdipour, Hamid Abdollahi Pages 301-304

    Reject analysis is as a quality indicator and critical tool for dose and image quality optimization in radiology departments. By reducing image rejection rate (RR), radiation dose to patients can be reduced effectively, yielding increased total cost-effectiveness. The aims of this study were to assess the rate of image rejection at 2 direct digital radiography (DR) departments to find the sources of rejection and to observe how radiology students and radiographers deal with image rejection. Two radiology departments were surveyed during a 3-month period for all imaging procedures. Type of examination, numbers, and reasons for digital image rejection were obtained by systems and questionnaire. A predefined questionnaire, including 13 causes for rejection, was filled by radiographers and students. Out of the 14 022 acquired images, 1116 were rejected, yielding an overall RR of 8%. Highest RRs were found for examination of cervical spine and lumbosacral. Positioning errors and improper patient preparation were the main reasons for digital image rejection. The image RR was small, but there is a need for optimizing radiographic practice, and enhancing radiographer’s knowledge may enhance the performance.

    Keywords: Digital radiography, Image rejection, Quality assurance, Radiation safety
  • Ensieh Pourhosseingholi, Behshid Farahmand, Azam Bagheri*, Mohammad Kamali, Morteza Saeb Pages 305-312
    Background

    Ankle foot orthoses (AFOs) are frequently prescribed to improve gait deviation and normalize walking pattern in patients with drop foot hemiplegia disorder. This study was to review the efficacy of different techniques of AFO construction and biomechanics parameters of AFOs. Furthermore, this study aimed to provide a guideline for researchers in detail and help them choose a sufficient measurement instrument.

    Methods

    Information sources included MEDLINE, CINAHL, Scopus, PubMed, and the Full Cochrane Library up to December 25, 2015. The inclusion criteria include: (1) type and method of controlled clinical trial studies; (2) age of hemiplegia groups (3); AFOs as an intervention; and (4) kinetic and kinematic parameters, and energy expenditure as an intervention of gait performance.

    Results

    Considering eligibility criteria such as study design, setting, time frame and Language 9 papers with Pedro scores of 5 to 8 for methodological quality were included in the review.

    Conclusion

    The findings of this review can help to develop guidelines for the best AFO reporting as an intervention and to prevent vagueness of results in the different types of AFOs.

    Keywords: Adolescent, Hemiplegia, Child, Gait, Orthoses, Brace, Systematic review
  • Adeleh Poursaleh, Golnaz Esfandiari, Farahnaz Sadegh Beigee, Nahal Eshghifar, Mohammad Najafi* Pages 312-316
    Background

    Vessel endothelial cells are extensively applied to study the mechanism of atherosclerosis. Some cellular sources including human umbilical artery endothelial cells (HUAECs) and human umbilical vein endothelial cells (HUVECs) are mostly applied in the experimental studies. We described a method for isolating the human endothelial cells from the human thoracic aorta.

    Methods

    Normal aortic samples were prepared from subjects with brain death in Masih Daneshvari Hospital. The endothelial cells were isolated using collagenase and were evaluated by the measurement of CD31 marker. Furthermore, the digestion efficacy was studied by vessel histological analysis, and the adhesion mechanism was investigated by leukocyte endothelial adhesion assay kit.

     Results and Conclusion

    The isolation protocol is found as a fast and simple technique with a proper cellular load to separate the endothelial cells from the human aorta.

    Keywords: Human aortic endothelial cell, Cell isolation, Protocol
  • Hamideh Javadinasab, Iravan Masoudi Asl*, Abbas Vosoohgmoghaddam, Behzad Najafi Pages 317-323
    Background

    Sustainable health financing is one of the main challenges of policymakers in the health system. Thus, this study aimed to investigate the sustainable financing of health promotion services in 7 selected countries and to analyze the related documents in Iran in 2018.

    Methods

    This was a comparative and qualitative study (document analysis). In the comparative phase, the studies related to the selected countries- Australia, England, Germany, Japan, Turkey, Sweden, and Denmark- were investigated. In the second phase of the study, through a qualitative method of content analysis, 60 related documents were examined from 2005 to 2018. The initial evaluation of the documents was done using the Scott method and data were analyzed using Nvivo 8 software.

    Results

    Based on the main findings of the study, there were a variety of approaches to the sustainable financing of health promotion services: excise taxes on goods; health-related behaviors regarding tobacco and alcohol consumption and gambling; using the capacities of social insurance funds in Germany and Turkey; and relying on the government budget in all the studied countries. According to the results of documents analysis related to the sustainable financing of health promotion in Iran, 3 main issues and 11 sub issues were identified.

    Conclusion

    Using any of these methods or a combination of them depends on the political, social, and cultural structure of each country. The provisions of the law seem to be almost comprehensive; however, implementation, operationalization and monitoring of these elements are of significant importance.

    Keywords: Health promotion, Iran, Excise tax, Sustainable financing, Sin tax
  • Ahmad Reza Khatoonabadi, Jafar Masumi* Pages 324-328
    Background

    The present study will be a longitudinal investigation of language abilities in individuals with mild cognitive impairment (MCI). The research question will include whether there will be an evidence for language impairment in individuals with MCI, and if so, what aspects of language will be the most affected and whether language abilities will be significantly changed over a 12-month period.

    Methods

    We will diagnose 30 individuals with mild cognitive impairment (MCI), Alzheimer’s disease (AD), and controlled participants using Montreal Cognitive Assessment-Basic (MoCA-B), as a cognitive test, and by asking expert opinions and conducting interviews. Participants will be selected from memory clinics and nursing homes in Tehran during 2018-2019. A comprehensive language test (Barnes Language Assessment (BLA)) will be performed to obtain baseline performance in the elderly. These tests will be repeated after 3, 6, and 12 months. Repeated measures analysis of variance (ANOVA) will be used to determine whether there will be a significant change in participants' language abilities over a 12-month period. In the case of deficient language performance, a discriminant function analysis will be used to identify the language task type that will be highly sensitive to change.

     Results and Conclusion

    The present study will provide evidence for the nature of language change and will be done in a-year course on individuals with MCI and AD and on healthy elders. Also, in this study, the relative sensitivity of various language components to MCI will be determined, and the relationship between language performance and performance on (MoCA-B) neuropsychological test will be examined.

    Keywords: Mild cognitive impairment (MCI), Alzheimer’s disease, Language profile, Early language impairment
  • Ahmad Hajebi, Morteza Naserbakht*, Alberto Minoletti Pages 329-335
    Background

    Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family.

    Methods

    This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers, selected from the outpatient department of a psychiatric hospital in Tehran, Iran, using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Spearman correlation coefficient and linear regression method. Data were analyzed using SPSS software (Version 21) and significance level was set at p< 0.05.

    Results

    The level of burden experienced by most of primary caregivers was higher than moderate. The scores obtained in the subscales of emotional over involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers, respectively, and the scores had a significant direct correlation with the burden experienced by the caregivers. The findings of multiple linear regression showed that lower family income (β= -0.33, p< 0.001), higher duration of disorder (β= 0.19, p= 0.006), and younger age at onset of the disorder (β= -0.26, p= 0.001) were predictive of higher burden of disease on caregivers.

    Conclusion

    Based on the results, some demographic factors of the primary caregivers, patients, and their family significantly affected the burden experienced by the primary caregivers. Most of the caregivers had high expressed emotions and a significant direct association existed between the expressed emotions and the burden experienced.

    Keywords: Schizophrenia, Burden, Caregiver, Expressed emotion, Demographic characteristics
  • Tahereh Manoochehrabadi, Zohreh Sharifi*, Fatemeh Yari Pages 336-341
    Background

    Membrane-derived microparticles (PMPs) are produced from platelets during activation, storage, and apoptosis. PMP can transfer some adhesion molecules such as CXCR4 to CXCR4-negative cells. In this study, the ability of PMPs to deliver CXCR4 molecule to CXCR4-null targets (Daudi, K562 and U937 cell line) was evaluated and the different concentrations of PMPs were examined to transfer CXCR4.

    Methods

    In this experimental study, PMPs were prepared using serial centrifugations. After confirmation of PMP with flow cytometry, PMP concentration was evaluated using the Bradford method. CXCR4-negative cell lines (1×105 cells/ml) were cultured in RPMI1640 with 10% FBS and 1% antibiotic. PMPs in 7 different concentrations were added to cell culture plates and incubated for 1 hour at 37ºc and 5% CO2. The presence of CXCR4 on cells was analyzed by flowcytometry.

    Results

    In this study, characterization of PMPs and cell lines were done by flow cytometry. Then, the PMPs’ ability to transfer CXCR4 to null cells (Daudi, K562 and U937 cell lines) was evaluated in 7 concentrations (10, 20, 50,125, 250, 500, 1000 μg/mL); incubation lasted for 1 hour. The best result of transferring CXCR4 by PMP was done in the concentration of 250µg/mL.

    Conclusion

    PMPs in different concentrations can transfer CXCR4 to target cells. Also, the increase of PMPs concentration up to 250µg/mL can increase the CXCR4 presence on null cells.

    Keywords: CXCR4, Microparticles, Platelet
  • Nazanin Asgharihanjani, Mohammadreza Vafa* Pages 342-345
    Background

    Insulin-like growth factor1 (IGF1) is a polypeptide that structurally is similar to human pro-insulin, one of the factors that is altered in obesity and many related diseases, hence a large body of research devoted to evaluate it. 

    Methods

    In this mini-review, we briefly explain the role of IGF1 in different conditions, including obesity, cardiovascular disease, and cancer through the results of review and original articles in both animal and human studies.

    Results

    The short-term metabolic effect of IGF-1 is insulin-like, and its long-term effect is growth factor-like. IGF1 has different roles in the initiation and progression of different diseases, because in some cases, the anti-apoptotic effect, can help cell survival while in others, it may lead to cancer or increment of adipocytes.

    Conclusion

    It is highly recommended to consider the different impacts of IGF1 in health and diseases prevention in future studies and interventions.

    Keywords: IGF1, Obesity, Cardiovascular disease, Cancer, Apoptosis
  • Nader Roushan, Nasser Ebrahimi Daryani, Zahra Azizi, Helia Pournaghshband, Ali Niksirat* Pages 346-352
    Background

    The differentiation between Ulcerative Colitis (UC) and Crohn’s Disease (CD) is an important issue for choosing the appropriate treatment. Endoscopic Ultrasonography (EUS) has been used to distinguish different layers of the gastrointestinal wall. We performed this study to evaluate the accuracy of EUS in differentiating colonic UC from CD compared to standard tests (colonoscopy, pathology, imaging, and clinical presentation).

    Methods

    This is a prospective, single-blinded diagnostic accuracy study, on 70 patients (30 UC, 30 CD, and 10 healthy controls). After obtaining informed consent, patients underwent a complete workup and were referred to an endosonographist who was blind to the diagnosis. The thickness of mucosa, submucosa and the total wall (TWT) of mid-sigmoid colon were measured by Pentax radial echoendoscope EPKI-7000 with Avius Hitachi ultrasound system (Japan). Statistical analyses were performed using the SPSS statistical software (v23). Statistical significance was considered if P-values were less than 0.05.

    Results

    Our study revealed a sensitivity of 100% (90.7-100%) and specificity of 90.9% (70.8-98.8%) for EUS to differentiate UC and CD compared to standard diagnostic tests. Mean mucosal thickness in patients with UC was significantly greater than patients with CD, while, the mean sub-mucosal thickness was significantly greater in patients with CD (p<0.001). The sensitivity and specificity of mean mucosal thickness for differentiating UC from CD and controls were 92.3% and 88.6% with a cut-off point of 1.1 mm (p<0.001). Moreover, sensitivity and specificity of mean submucosal thickness for differentiating CD from UC and controls were 100% and 86.1% with a cut-off point of 1.08 mm (p<0.001).

    Conclusion

    EUS can be used as an efficient modality with acceptable accuracy to differentiate Crohn’s disease and Ulcerative Colitis and to determine disease activity.

    Keywords: Endoscopic ultrasonography, Intestinal wall thickness, Sensitivity, Specificity, Crohn’s disease, Ulcerative colitis
  • Soheila Rabiepoor, Alireza Khodaei, Rohollah Valizadeh* Pages 353-357
    Background

    Self-efficacy is an important psychological and motivational factor for continuation of exclusive breastfeeding. This study aimed to examine the effect of husband participation on self-efficacy of breastfeeding in postpartum period.

    Methods

    This study was a single-blind clinical trial (IRCT2014012115163N2) conducted on 66 pregnant women who referred to health centers of Urmia in 2014. Convenience sampling method was used to select the participants and then they were randomly allocated to control and intervention groups using RANDBETWEEN function in Excel.  Participants in the intervention group had 2 training sessions with 4-week interval. They could also use telephone counseling over study time. Those in the control group received the routine pregnancy care, and their breastfeeding self-efficacy was compared 1 month after delivery using Dennis Breastfeeding Self-Efficacy questionnaire. The data were analyzed using SPSS version 20. Chi square, independent and paired samples t test were used.

    Results

    In this study, the mean score of breastfeeding self-efficacy in the intervention and control groups after intervention was 50.36±8.65 and 44.12±10.41, respectively, which showed a statistically significant difference (p=0.017).

    Conclusion

    According to the results, one of the considerable strategies to enhance self-efficacy of breastfeeding is to involve husbands in prenatal care, which should be considered by the authorities and health professionals, including doctors, nurses, and midwives.

    Keywords: Breastfeeding, Prenatal care, Self-efficacy
  • Fahad Saqib Lodhi, Adeel Ahmed Khan, Owais Raza, Tabrez Uz Zaman, Umer Farooq, Kourosh Holakouie Naieni* Pages 358-363
    Background

    Family system has been found to affect the satisfaction level among the family members. The objective of our study was to determine the satisfaction level and its predictors among joint and nuclear family systems in District Abbottabad, Pakistan.

    Methods

    We conducted a population-based cross-sectional study in all 52 :union: Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select 2063 participants from both nuclear and joint family houses. Proportionate sampling was done for selecting mohalla from each UCs, and then subsequently households from respective mohalla’s. Simple random sampling was done for selecting the 18 years and above-aged participant for the study. A structured demographic questionnaire was used to collect information from study participants. Univariate and multivariate logistic regression analysis was done to find out the predictors of satisfaction level among joint and nuclear family systems using SPSS version 20 A p-value of <0.05 was considered as significant.

    Results

    Level of satisfaction was found to be higher among people living in the joint family system i.e., 87.5 % v/s 81 % (<0.001) compared to the nuclear family system. Multivariate regression analysis of nuclear family system showed that people having higher education level and higher socioeconomic status (SES) were more satisfied as compared to no education & low SES respectively. While, in the joint family system, only high SES was a significant predictor of satisfaction in the joint family system as compared to low SES.  

    Conclusion

    Our study reported a high level of satisfaction among joint and nuclear family systems in Pakistan. High education level and high SES were identified as important predictors of satisfaction among both systems.

    Keywords: Satisfaction, Predictors, Family system, Pakistan
  • Ghazal Kharaji, Afsaneh Nikjooy*, Ali Amiri, Mohammad Ali Sanjari Pages 364-368
    Background

    Urinary incontinence (UI) is more common than any other chronic disease. Stress urinary incontinence (SUI), among the various forms of urinary incontinence, is the most prevalent (50%) type of this condition. Female urinary continence is maintained through an integrated function of pelvic floor muscles (PFMs), fascial structures, nerves, supporting ligaments, and the vagina. In women with SUI, the postural activity of the PFMs is delayed and the balance ability is decreased.  Many women, by learning the correct timing of a pelvic floor contraction during a cough, are able to eliminate consequent SUI. Timing is an important function of motor coordination and could be affected by proprioception. This study was conducted to review and outline the literature on proprioception as a contributory factor in SUI.

    Methods

    PubMed, Scopus, and Google Scholar databases were systematically searched from 1998 to 2017 for articles on the topic of pathophysiology, motor control alterations, and proprioception role in women with SUI.

    Results

    A total of 6 articles addressed the importance of proprioception in motor control and its alterations in women with SUI. There were also publications on postural control, balance, and timing alterations in women with SUI in the literature. However, there was no research on measuring proprioception in the pelvic floor in this group.

    Conclusion

    Both the strength of the PFMs and the contraction timing and proprioception are important factors in maintaining continence. Thus, conducting research on PFMs proprioception in women with SUI, as a cause of incontinence, is encouraged.

    Keywords: Stress urinary incontinence, Pelvic floor muscles, Proprioception, Balance, Postural activity
  • Masoud Nakhzari Moghaddam, Parvin Yavari*, Alireza Abadi, Narges Rostami Gooran Pages 369-374
    Background

    Under-5 mortality is an important health indicator of a country’s development and every country is committed to decrease it. Children under-5 years are vulnerable to the imbalance of socioeconomic inequality and are dependent on the adults to remain healthy. The aim of this study was to determine the association of socioeconomic factors with under-5 mortality in Zabol.

    Methods

    This descriptive cross sectional study was performed on 2001 children younger than 5 years who were under the coverage of Zabol University of Medical Sciences between 2011 and 2015. The data were collected using standard questionnaires on mortality of infant and children 1-59 months old, questionnaires determining socioeconomic condition, and health center data files. The analyses were performed using SPSS software version 21, and significance level was set at 0.05 for all tests.

    Results

    The most common causes of death under 5 years of age included immaturity, congenital defects, and respiratory diseases. In the logistic regression model, father's addiction, maternal literacy, socioeconomic level, and household family size were significantly associated with under-5 mortality (P<0.05). Moreover, there was a correlation between a congenital defect in the Zahak region and immaturity in the Hamun region with under-5 mortality.

    Conclusion

    Low socioeconomic status, parental addiction, and low education level were the most probable risk factors for under 5 mortality.

    Keywords: Socioeconomic status, Under-5 mortality, Risk factor, Zabol
  • Vahid Naseri Salahshour, Mohammad Taher, Mahmood Karimy, Ahmadreza Abedi, Neda Fayazi, Mahbobeh Sajadi*, Hamid Abredari Pages 375-379
    Background

    Anxiety and its control is a public health problem worldwide. This study was conducted to determine the effect of family members’ presence on the anxiety level of patients who were candidates for esophagogastroduodenoscopy (EGD).

    Methods

    This randomized controlled trial study was performed in Shahid Chamran hospital in city of Saveh in IR Iran. In this study, 96 patients who were candidates for EGD and met the inclusion criteria were assigned into control and intervention groups by simple random sampling method. The demographic questionnaire and Spiel Berger's State and Trait Anxiety Questionnaire (STAI) were used to measure anxiety.

    Results

      No significant difference was found between the 2 groups in the mean level of anxiety before intervention (p=0.13). After intervention, the level of anxiety decreased significantly in the intervention group (p=0.001). However, the mean level of anxiety was not significant in the control group after intervention (p=0.09).

    Conclusion

    The results of the present study showed that the presence of family members during endoscopy may reduce the patient’s anxiety level, and thus it is recommended as a non-pharmaceutical, beneficial, and safe intervention.

    Keywords: Anxiety, Family member, Esophagogastroduodenoscopy, Clinical trial
  • Khashayar Hesamizadeh, Ahmad Tavakoli, Mehri Nikbin* Pages 380-385
    Background

    Hepatitis C virus (HCV) infection is a cause of major liver complications, particularly in patients infected with human immunodeficiency virus (HIV). This study aimed to evaluate the efficacy of pegylated interferon (Peg-IFN) and a fixed dose of ribavirin treatment among Iranian HCV mono-infected and HCV/HIV-co-infected patients.

    Methods

    A total of 214 HCV mono-infected and HCV/HIV co-infected patients attending Liver Disease Center in Tehran were assigned to receive treatment with Peg-IFN-α2a or -α2b plus ribavirin for 24-48 weeks. Sustained virologic response (SVR) was used as the primary efficacy endpoint of Peg-IFN and ribavirin therapy.

    Results

    Treatment with Peg-IFN and ribavirin has been associated with a considerably higher rate of SVR (24 weeks for HCV genotype 3 and 48 weeks for HCV/HIV co-infected and HCV genotype 1 patients). Overall, the clearance of HCV-RNA at the end of therapy occurred in 48.6% of patients. Adverse events leading to treatment discontinuation were seen in 14% of patients.

    Conclusion

    This retrospective study revealed a relatively well-tolerated response in both HCV mono-infected and HCV/HIV co-infected patients during treatment with Peg-IFN and ribavirin. However, the recent revolutionized interferon-free therapies for chronic HCV infection should be taken into account for achieving a greater response and minimal adverse events.

    Keywords: Hepatitis C, HIV, Pegylated interferon, Ribavirin, Iran
  • Mohammadreza Vafa, Fatemeh Azizi Soleiman, Seyyed Morteza Kazemi, Masood Salehi, Farid Zaeri, Behnaz Abiri, Homa Sadeghi, Morteza Safavi* Pages 386-392
    Background

    Low levels of 25-hydroxyvitamin D (25(OH)D) have been related to depression and anxiety. It seems that anemia is associated with vitamin D deficiency. We aimed to evaluate the effects of iron-vitamin D co-supplementation versus vitamin D alone on depression scores in anemic females with low levels of serum 25-hydroxyvitamin D.

    Methods

    This randomized controlled trial was conducted on eighty premenopausal females who were recruited between May 2015 and October 2015 from primary health care centers. Women with anemia and low concentrations of 25(OH)D were randomized to either 1000 IU/d vitamin D plus 27 mg/d iron (D-Fe) or vitamin D plus placebo supplements (D-P) for 12 weeks. Depressive and anxious symptoms were evaluated with the Beck Depression Inventory (BDI) with subscales 1–13 and 14–21 and Beck Anxiety Inventory (BAI). To compare the groups, Mann–Whitney or chi-squared tests were used and within groups comparison was performed using Wilcoxon signed ranks test. The study was registered on www.clinicaltrial.org as NC 01876563.

    Results

    The serum concentrations of 25(OH)D were increased significantly in both groups at the end of the study. In both groups, there was a significant improvement in total BDI, the BDI subscale, and the BAI scores (p<0.001). No differences were found between groups (p>0.05).

    Conclusion

    Although the potential positive effect of vitamin D on mental health was evident, iron plus vitamin D co-supplementation did not demonstrate any significant benefits over vitamin D alone, neither in depression score reduction nor anxiety symptoms.

    Keywords: Iron, Vitamin D, Depression, Anxiety, Anemia
  • Zhaleh Abdi, Bahareh Yazdizadeh*, Elham Ahmadnezhad, Mahboubeh Rahimi, Reza Majdzadeh Pages 393-397

    Achieving universal health coverage (UHC), which means ensuring access to high quality and equitable services by all without financial hardship, requires local evidence. To find interventions appropriate to local needs, local knowledge and evidence are required in addition to global evidence. Thus, every country should have its own plan for research production and utilization and strengthening researchers’ capacities to achieve UHC. To accomplish the goals of UHC, the research system should be able to determine the research priorities and agenda, collect resources, improve the capacity for evidence generation, and maximally utilize the country’s capacity for finding local solutions by establishing research networks. In this study, inputs for UHC research priority setting in Iran and its challenges have been discussed.

    Keywords: Universal health coverage, Health system research
  • Batool Mousavi, Mohammadreza Soroush, Farzaneh Maftoon*, Kazem Mohammad, Ali Ayoubian Pages 398-401
  • Sadrieh Hajesmaeel Gohari, Elahe Gozali, Sharareh Rostam Niakan* Pages 402-410
    Background

    Virtual Reality (VR) as a computer technology that simulating real environments and situations exploited in numerous healthcare areas such as chronic diseases. The significance of timely treatment and rehabilitation of patients with chronic conditions is high due to the long lasting nature of these conditions. This paper sought to perform a review of published works in the field of VR application in chronic conditions for treatment and rehabilitation purposes.

    Methods

    We searched the MEDLINE database through PubMed in April 2016 for retrieving published papers from January 2001 to December 2015. From 117 retrieved papers, 52had the inclusion criteria, and their full texts were accessible. Data were extracted from papers based on following items: the name of the first author, year of the study, applied VR methods, type of condition and disease, number of subjects that participated in the study, and finally the status of success and failure of VR application. Data were analyzed using descriptive analysis.

    Results

    Results of the reviewed investigations have been considered in two main categories including treatment oriented papers (n=38, 73%) while twenty of these papers have been conducted on phobias (53%); also, there are rehabilitation-oriented experiments (n=14, 27%) while thirteen of these papers have been performed on stroke. In 40 papers (77%), the VR technology application reported proper and in 11 papers (21%) the application of VR resulted in relatively proper outcomes and only there is a work (2%) with poor results for VR intervention.

    Conclusion

    VR technology has been increasingly used in recent years for treatment and rehabilitation purposes among patients affected by chronic conditions in order to motivate them for more successful management.

    Keywords: Virtual reality, Chronic disease, Therapeutic, Rehabilitation
  • Saeed Dastgiri, Leila R. Kalankesh*, Negar Saberi, Parisa Ziasarabi Pages 411-414
    Background

    Worldwide, 1-6 percent of infants have at least one congenital anomaly that can lead to long-term consequences. This may have significant impacts on individuals, families, health-care systems, and societies. The aim of this study was to estimate the Population Attributable Fraction (PAF) of some congenital anomalies by three selected risk factors (obesity, diabetes and smoking) in the northwest of Iran and to estimate the number of preventable defects at birth in the population if we could reduce 50 percent of the exposure rate to these three risk factors at population level.

    Methods

    The regional data on smoking, obesity, and diabetes were entered in Population Estimate of Attributable Fraction of Congenital Conditions Everywhere (PEACE) software developed by International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). It calculates the PAF for congenital anomalies attributed to exposure to those three risk factors.

    Results

    This study showed that main anomalies attributed to "obesity" include Spina Bifida 40.1% (95% CI: 31.7-47.7), Hydrocephaly 26.8 (95% CI: 9.3-42.3) and Anencephaly 17.4 (95% CI: 1.6-31.9). The highest attributable defect to "smoking" was Cleft lip w/out Palate 5.8% (95% CI: 4.3-7.4), whereas for "diabetes" it was Tetralogy of Fallot 33.3 (95% CI: 17.2-49.5). A similar pattern was found when assumed in the model, the impact of 50 percent reduction in the exposure to each of the risk factors on preventable cases of birth defects in the population.

    Conclusion

    Obesity, diabetes, and smoking in women of childbearing age increased the risk of occurrence of congenital anomalies. However, obesity and diabetes had a remarkably greater impact compared to smoking. More studies are needed to investigate the role of passive smoking as a risk factor for the occurrence of birth defects.

    Keywords: Birth defects, Congenital anomalies, Obesity, Diabetes, Smoking
  • Behzad Damari*, Elham Ehsani Chimeh Pages 415-422
    Background

    Resource generation, stewardship, financing, and provision of health care services are 4 major functions of the health system. In this study, human resource management, as a vital aspect of resource generation, was studied and some interventions have been suggested for Iran.

    Methods

    This was a mixed method study.  Data were collected through the review of the relevant articles and government documents, interviews with human resources managers and experts in the health sector, and focus group discussions with selected authorities. The interview questions were based on a model proposed by the WHO.

    Results

    The collected data were categorized into 3 broad sets: description of the current status, factors contributing to the current status, and suggested interventions for improvement. Lack of a comprehensive human resources management policy and inattention to the human resources management in the developmental plans are some of the most common problems in Iran’s health sector. Also, unequal distribution, unemployment, migration of graduates, and inadequate and ineffective participation of faculty members in universities are some other problems referred to as lack of a unified stewardship and dearth of a comprehensive human resources planning. Suggested interventions have focused on stewardship function of the health care system.

    Conclusion

    A policy brief on the human resources for health needs should be developed and added as a separate article to the upstream documents of the country (eg, Iran’s 20-year outlook plan). Implementing and monitoring operational plans for policy execution at Ministry of health has a major role in executing the adopted strategies.

    Keywords: Health workforce, Human resources for health, Health care system, Human resources management, Labor market, Strategic planning
  • Ahad Bakhtiari, Mahshid Nasehi, Arash Rashidian*, Mohammad Arab, Saeed Sharafi, Soheil Mokhtari Pages 423-428
    Background

    According to the Global tuberculosis (TB) Report 2014, released by World Health Organization (WHO), difference between estimated number of TB patients and the number of patients who are registered by the National Tuberculosis Programs (NTBP) is about 3 million annually in the world. In the current study, we investigated the level of under-reporting of TB cases between labs with poor collaboration background with NTBP in Tehran.

    Methods

    In the context of TB, this is an inventory study that evaluating the level of under-reporting of TB cases. To do inventory study, first, after selecting laboratories based on poor collaboration background with NTBP and developing patient’s list we matched the patient’s list with the MoHME’s database then, patients that were not recorded in NTBP’s list were identified, and those with available telephone numbers were called.

    Results

    Out of 23 selected labs, 10 (5 private, 5 public (other than PHC)) had individuals with positive results. 71.6% of all samples are tested in public labs. Out of 23633 performed tests, 1396 individuals were positive. The under-reporting was, 62.5% and 39% in public and private laboratories, respectively.

    Conclusion

    Public and private sector laboratories will be able to significantly reduce their failure to report if they comply with the recommended requirements and standards of the NTBP in their Processes and software for registering patient information.

    Keywords: Tuberculosis, National Tuberculosis Programs (NTBP), Underreporting, Inventory study
  • Maryam Ramin, Monireh Khadem, Fariborz Omidi, Mehran Pourhosein, Farideh Golbabaei, Seyed Jamaleddin Shahtaheri* Pages 429-434
    Background

    Selecting an effective sample preparation method to measure target pesticides in biological matrices is a serious challenge for researchers. This study aimed to optimize the dispersive liquid-liquid microextraction (DLLME) technique to obtain a simple, valid, and fast method with high efficiency to detect chlorpyrifos in urine samples.

    Methods

    DLLME, coupled with high performance liquid chromatography equipped with ultra violet detector, was used to extract chlorpyrifos pesticide in human urine samples. Different affecting parameters on the efficiency of the method were optimized using one factor at a time method.

    Results

    The limit of detection and enrichment factor of the method was 0.5 and 230 µg L-1, respectively. Linear calibration curve with 1-500 µg L-1 concentration range was used. The relative standard deviation (RSD) for 6 replicate experiments at the concentration of 200 µg L-1 was less than 5%. The relative recoveries of spiked urine samples were 96.3%, 102.3%, and 98.7% at 3 different concentration levels of 50, 200, and 1000 µg L-1, respectively.

    Conclusion

    Compared to other extraction techniques, the optimized DLLME resulted in some advantages such as shorter extraction time, high extraction efficiency, and good enrichment factor for the extraction of chlorpyrifos from human urine samples.

    Keywords: Chlorpyrifos, Dispersive liquid-liquid microextraction, Urine, HPLC
  • Mitra Zarrati, Nahid Aboutaleb, Elhameh Cheshmazar, Raheleh Shokouhi Shoormasti, Elham Razmpoosh, Farinaz Nasirinezhad* Pages 435-442
    Background

    Obesity has been suggested to be well correlated with altered levels of complete blood count (CBC) parameters. In this study, the relationship of body mass index (BMI) and circulating leptin levels with CBC among obese and overweight adults was examined.

    Methods

    CBC and biochemical parameters, WBC and hematological profiles, leptin levels, related factors to liver, and kidney and lipid profiles were measured among 184 obese and overweight people aged 18–60 years.  Statistical analysis was performed using SPSS software. To assess the normality of data, the Kolmogorov–Smirnov test was used. Logarithmic transformation was performed for some variables with non-normal distribution. The association between 2 quantitative variables was measured using bivariate correlation (Pearson or Spearman). Pearson correlations and multiple regression analysis were performed to assess the correlation between variables. Simple and multiple regression analyses were performed to predict some variables. P- value <0.05 was considered significant.

    Results

    Hematocrit, insulin, fasting blood sugar, uric acid, TG, LDL-C, VLDL-C, and ALT were positively correlated with BMI (p=0.041, r=0.149 for hematocrit; p≤0.001, r=0.520 for insulin; p≤0.001, r=0.363 for FBS; p≤0.001, r=0.309 for uric acid; p=0.015, r=0.189 for TG; p=0.030, r=161 for LDL-C; p=0.019, r=0.181 for VLDL-C; p≤0.001, r=0.299 for ALT), whereas urea and HDL-C were negatively correlated with BMI (p≤0.001, r=-0.368 for urea; p≤0.001, r=-0.297 for HDL-C). Moreover, LDL-C and insulin were positively correlated with leptin (P = 0.011, r = 0.194 for LDL-C, P = 0.013, r = 0.114 for insulin) and hematocrit, urea, creatinine, TG and VLDL-C were negatively correlated with leptin (p=0.040, r=-0.162 for hematocrit; p≤0.001, r=-0.305 for urea; p=0.007, r=-0.219 for creatinine; p=0.025, r=0.188 for TG; p=0.007, r=-0.218 for VLDL-C). Our analysis showed that white blood cell was positively correlated with leptin (β=17.36, p=0.048). Also, other CBC parameters had no significant correlations with BMI and leptin.

    Conclusion

    According to the findings of this study, BMI had a negative association with urea and HDL-C, while BMI had a positive association with insulin, hematocrit, FBS, uric acid, TG, VLDL-C, LDL-C, and ALT. Furthermore, leptin had a negative association with hematocrit, creatinine, and urea, TG, VLDL-C and a positive association with LDL-C and insulin among the participants of this study.

    Keywords: Obesity, Overweight, Complete blood count, Leptinn
  • Fatemeh Sarvi, Mohammad Ebrahim Ghaffari, Mostafa Eghbalian, Mahmoud Khodadost, Iraj Mohammadfam, Mojtaba Khazaei, Ali Reza Soltanian* Pages 443-448
    Background

    Patient safety practice reduces the adverse events that may occur in the health care system during procedures, diseases, and diagnoses. Failure and negligence in identifying and resolving health care system errors may result in financial and physical harm.  Thus, this study aimed to investigate the psychometric properties of the Patient Measure of Safety in Hospitals (PMOS).

    Methods

    This study was conducted on 264 patients in 4 hospitals. The patient measure of safety questionnaire has 44 items and 9 domains. To translate the PMOS questionnaire, standardized forward-backward procedure was used, and a panel of experts assessed the face and content validity of the Persian version. Internal consistency, confirmatory factor analysis (CFA), and test-retest method were used to test the validity and reliability of the instrument. Also, AMOS (version 23) and SPSS (version 16) software were used for data analysis and modeling.

    Results

    The average CVI score was 0.85, indicating well results in the Persian context. CVR score was 0.65. The indices of goodness of fit were acceptable for Iranian sample (CFI=0.91, TLI=0.89, RMSEA=0.063, relative/normal Chi-Square Statistic (X2/df)=2.85). All items were significantly loaded on the domains, except the 33rd and 38th items that were related to the eighth domain. Thus, the final Persian version was developed with 8 domains and 42 items. Internal consistency was acceptable for these domains, and test-retest method showed a good reliability (r=0.984).

    Conclusions

    The Persian version of PMOS is an appropriate instrument to assess the safety of patients in Persian language communities. Also, PMOS is an optimal tool to identify and avoid preventable errors.

    Keywords: Hospital, Patient, Safety, Validity, Reliability, Statistical model
  • Maryam Karimi Jaberi, Ali Gholami, Bahman Cheraghian, Jamile Abolghasemi, Masoud Solaymani Dodaran, Abdolhossein Madani, Yaghoob Ashoori, Mehdi Darabi, Solayman Moosapoor, Mohsen Asadi Lari* Pages 449-453
    Background

    Gastric cancer is the fourth most common form of cancer and the second most common cause of death in the world. It is also one of the most common cancers leading to mortality in Iran. Therefore, this study aimed to determine the survival rate of patients with gastric cancer and its affecting factors in the south of Iran (Hormozgan province). 

    Methods

    In this study, all patients with gastric cancer (119 patients) that were diagnosed and registered during 2008 to 2013 in Hormozgan province, were studied. All patients were followed to the end of 2015. Kaplan-Meier method and Cox proportional hazards model were used to draw survival curves and to determine the effective factors on the survival rate of surveyed patients. Moreover, Log-rank test was used to evaluate whether or not survival curves for different groups are statistically equivalent (p<0.05).

    Results

    The mean age of the study population was 58.9±14.91, and most of them were men (72.3% (86 persons)). After diagnosis, the survival rates for 1, 2, 3, 4, and 5 years were 62.2%, 49.4%, 43.7%, 39.7%, and 38% respectively. Survival in men were lower than women, but according to log-rank test this difference was not statistically significant (p=0.325). Also patients with advanced stage cancer had significantly lower survival in comparison to individuals with early stage disease (p<0.001). Based on multiple Cox proportional hazards model, job status of the patients and stage of cancer   were effective factors on patients’ survival.

    Conclusion

    Based on the findings of the present study, the survival rate was decreased over time after diagnosis. Stage of a cancer at the time of diagnosis is the most important factor affecting the survival of surveyed patients. This shows that there is a crucial need to diagnos the gastric cancer in early stages.

    Keywords: Gastric cancer, Survival rate, Kaplan-Meier, Cox proportional hazards model, Log-rank
  • Maryam Ghasemi, Parvaneh Afshar, Somayyeh Sheidaie, Yosef Moeini, Lale Vahedi Larijani* Pages 454-460
    Background

    Skin cancer is one of the most common types of cancer and its annual mortality rate is increasing. The induction enzyme of cyclooxygenase COX-2 causes biosynthesis of prostaglandin and thromboxane during inflammation of the body. Increasing the expression of COX-2 has an important role in the development and progression of malignant epithelial cancers and other types of cancers. Considering the diagnostic status of the marker, this study aimed to evaluate the expression of COX-2 for diagnosis and differentiation of benign skin pigmented neoplastic lesions from malignant melanoma types.

    Methods

    In this diagnostic study, the immunohistochemistry of COX-2 maker in 82 paraffin blocks of pigmented benign and malignant skin neoplasms of patients (49 men; 33 women) and its association with clinicopathological features of the tumor was evaluated. Data were analyzed using chi-squared and t test in SPSS18. Significance level was set at less than 5%.

    Results

    The findings showed that 20 patients (24.3%) had malignant melanoma and 13 had significant COX-2 (3+ High), while COX-2 marker was not detected in other benign and malignant pigmented skin neoplasms (p<0.001). A significant association was found between COX-2   marker and grade (p<0.001), but there was no significant correlation with other clinicopathological tumor criteria. Sensitivity, specificity, PPV and NPV value of the COX-2 marker were 65%, 100%, 89.9%, and 100%, respectively.

    Conclusion

    Because of the high level of COX-2 in malignant melanoma skin marker, it can be used to distinguish benign and malignant neoplastic lesions (SCC and BCC) from melanoma and to provide effective therapeutic strategies through specific COX-2 enzyme inhibitors.

    Keywords: Cyclooxygenase-2, Neoplastic lesions, Skin cancer, Melanoma, Immunohistochemistry
  • Akram Sarabi Asiabar, Hamid Asadzadeh Aghdaei, Samin Zamani, Saied Bokaie, Mohammad Reza Zali, Mohammad Mehdi Feizabadi* Pages 461-466
    Background

    Crohn's disease is one of the most significant intestinal disorders and is known as inflammatory bowel disease; Campylobacter spp. are one of the leading causes of bacterial gastroenteritis in humans.

    Methods

    In this study, 60 tissue samples, including 30 cases with Crohn’s disease and 30 cases with no inflammatory bowel disease, were collected. Patients were referred to Taleghani hospital and Behboud clinic between March 2015 and May 2016. Biopsies were used for DNA extraction and assessment of Campylobacter jejuni in patients with Crohn's disease and controls using polymerase chain reaction and quantitative real-time polymerase chain reaction. All positive amplified fragments were sequenced. The gene encoding 16S rRNA, specific to Campylobacter genus, was amplified

    Results

    The results were positive for Campylobacter genus in patients with Crohn's disease compared to healthy individuals. The quantitative real-time PCR showed a significantly higher prevalence of Campylobacter jejuni, particularly in hippurate hydrolase in tissue specimens of patients with Crohn's disease compared to control group. The correlation between Campylobacter jejuni and diarrhea symptoms in patients with Crohn's disease and controls was investigated. One positive case of Campylobacter jejuni found in patients without diarrhea was compared with 13 patients with diarrhea.  
      

    Conclusion

    The present study demonstrated the alarmingly high rate of Campylobacter jejuni prevalence in Crohn's disease patients with diarrhea symptoms. However, further investigation is needed to determine the possible causing factors of this disease.

    Keywords: Crohn disease, Campylobacter genus, Campylobacter jejuni, Real-time PCR, Inflammatory bowel disease
  • Aidin Aryankhesal, Roghayeh Mohammadibakhsh*, Yadollah Hamidi, Saeideh Alidoost, Masoud Behzadifar, Rahim Sohrabi, Zeynab Farhadi Pages 467-474
    Background

    Burnout is one of the main factors in reducing the performance quality among hospital staff. Appropriate interventions can reduce burnout among physicians and nurses and result in promotion of the quality of services provided at hospitals. The present study aimed to provide a more comprehensive understanding of the interventions on burnout reduction among hospital physicians and nurses.

    Methods

    Studies were searched from January 2000 to June 2017 in PubMed, Embase, Scopus, Cochrane, and Web of Science. Randomized clinical trials (RCTs) and pretest-posttest studies that had interventions to reduce the burnout of physicians and nurses were included. However, studies conducted on medical and nursing students and nonmedical providers or beyond hospitals were excluded. 

    Results

    Based on the study inclusion criteria, 12 RCTs and 6 pretest-posttest studies were included in the review. Most of the included studies were from Netherlands, the United States, and England. The interventions included team-based program, EMH-approach, and coping and communication skills training. Most of the interventions had a positive effect on burnout reduction. Nevertheless, some studies had no significant impact.

    Conclusion

    The results showed that the most interventions used to improve burnout were improving communication skills, teamwork, participatory programs, and psychological interventions (Yoga, meditation, and mindfulness). The impact of these interventions can increase mental health in the long term. Burnout is a complicated problem and should be treated by combining interventions.

    Keywords: Burnout, Mental health, Nurses, Physicians, Hospital, Systematic review
  • Fariba Zamankhani, Kambiz Abachizadeh*, Soheila Omidnia, Alireza Abadi, Mohammad Ali Heidarnia Pages 475-480
    Background

    Overall human health has been considered as physical, mental, and social health. The aim of the present study was to develop and measure Social Health Index in Iran by regions. Policymakers can implement evidence-based interventions by gaining knowledge about social health status.

    Methods

    To develop Social Health Index, social health indicators were collected by literature review and indicators whose information existed in provincial level. The final list of indicators was derived based on expert opinions. Then, data were normalized by comparative standardization. Using additive model, the total score of social health was calculated and provinces were ranked.

    Results

    Based on the composite index, including 39 indicators, a healthy society is properly characterized by lack of drug use, child labor, divorce, unemployed academics, child abuse, and smoking. The highest and lowest social health belonged to Yazd and Sistan and Baluchistan provinces, respectively.

    Conclusion

    This study showed the provinces’ social health as an important tool for evidence-based policymaking. To monitor social health status, similar studies should be conducted every 3 to 5 years.

    Keywords: Social health, Indicator, Measurement, Iran, Province
  • Nahid Farrokhyar, Khalil Alimohammadzadeh*, Ali Maher, Seyed Mojtaba Hosseini, Mohammadkarim Bahadori Pages 481-485
    Background

    Hospital services are the most expensive medical service in modern health care systems. Intense care beds, in particular, are more important. The present study was conducted to design and validate a measuring tool for the factors affecting the distribution of hospitals' intensive care beds in Iran.

    Methods

    In this mixed method study, first, all known factors affecting the distribution of hospitals' intensive care beds were extracted by reviewing related literature. Then, all 60 confirmed items were categorized into different dimensions. Face validity and content validity of the questionnaire was done by 20 medical experts through qualitative and quantitative methods. Validity and reliability indices, content validity index (CVI), content validity ratio (CVR), and Cronbach's alpha were measured. SPSS software were used for data analysis and significance level was set at less than .05.

    Results

    From the 60 suggested items, 34 were confirmed by the expert panels and all items had CVR and CVI scores higher than 0.83 and 0.81, respectively. CVR and CVI for all 34 items were 0.88 and 0.89, respectively. Also, Cronbach's alpha coefficient (0.75) indicated a suitable internal consistency. The value of S-CVI / Ave was also calculated to be 0.92.

    Conclusion

    In this study, a valid tool was designed to identify the factors affecting the distribution of hospitals' intensive care beds. This tool consists of 6 dimensions: demographic, geographic, economic, sociopolitical, organizational, and constructional.

    Keywords: Intensive care beds, Rationing intensive care beds, Distribution of beds
  • Mehdi Mirzaei Alavijeh, Dilana Schaafsma, Behzad Karami Matin, Farzad Jalilian* Pages 486-492
    Background

    Fecal occult blood test (FOBT) is one of the common screening tests for colorectal cancer. This study was designed to determine the socio-cognitive determinants related to FOBT uptake for colorectal cancer screening based on intervention mapping (IM).

    Methods

    A total of 500 individuals aged over 50 years were randomly selected to participate in this study in Kermanshah, Iran, in 2016. Data were collected by interviews based on a questionnaire and analyzed by SPSS16 using bivariate correlation, linear, and logistic regression models.

    Results

    Of the 500 respondents, 468 (93.6%) signed the consent form and voluntarily participated in the study. Almost 11.1% of the participants had a history of FOBT uptake. Socio-cognitive variables accounted for 38% of the variation in the outcome measure of the intention to uptake FOBT. Perceived self-efficacy (OR = 3.345 & 95% CI: 1.342, 8.339), perceived susceptibility (OR = 2.204& 95% CI: 1.320, 3.680), attitude (OR = 1.674& 95% CI: 1.270, 2.137), and perceived severity (OR = 1.457& 95% CI: 0.954, 2.224) were the strongest predictors of fecal occult blood test uptake.

    Conclusion

    IM-based analysis of behavior may provide insights to design interventions for modifying individuals’ beliefs about the usefulness of FOBT uptake to prevent colorectal cancer.

    Keywords: Early detection of cancer, Self-efficacy, Attitude, Disease susceptibility
  • Elaheh Akbari, Abbas Ebadi, Mohammad Kamali, Yoones Amiri Shavaki*, Mehdi Dastjerdi Kazemi Pages 493-499
    Background

    The lack of screening test battery has made it difficult for early identification and intervention of Persian-speaking children with risk of reading problems prior to formal education. The purpose of this study was to develop and introduce a Persian prereading test battery based on the multidimensional reading perspective for screening preschool children.

    Methods

    First, the predicators of reading skill and dyslexia along with the subscales of each predictor were identified through literature review and holding expert’s panel. The batteries of tests were performed on 48 typically-developing children (5.6–6.6 years old) selected using the random (cluster) method. The Pearson correlation coefficient, item analysis and then reliability were measured.

    Results

    The 5-component test battery with 8 subtests was formed. Findings indicated there were moderate and significant correlations between subtests (all r>0.4, p<0.001). Internal consistency reliability for the subscales was 0.51 to 0.89.

    Conclusion

    The Persian test battery of prereading skills including phonological awareness, identification of first and closing phonemes, visual discrimination skill, rapid automatic naming and phonological working memory may identify children who are at risk. A longitudinal study is warranted to evaluate its detailed psychometric properties.

    Keywords: Reading, Literacy, Phonological awareness, Preschoolers, Screening
  • Vafa Saber, Seyyed Javad Seyyed Tabaei*, Seyyed Ali Tabatabaei, Mohammad Soleimani, Ali Haghighi Pages 500-504
    Background

    Toxoplasma gondii (T. gondii) is the most common parasite that can lead to a disease called toxoplasmosis. In this study, serological and molecular complementary tests have been conducted to detect or diagnose this parasite.

    Methods

    A total of 71 patients with clinical symptoms of ocular toxoplasmosis and 20 patients with other ocular infections were evaluated. Serum and buffy coat samples were collected and tested using enzyme-linked immunosorbent assay (ELISA) and nested polymerase chain reaction (nPCR) assessments. Superficial T. gondii B1 gene was evaluated in PCR. The ocular toxoplasmosis patients were followed-up 2 weeks after the first sampling and 4 weeks following the first laboratory testing. The main outcome measures were the efficiency of the diagnostic procedure and positive and negative predictive values (PPV and NPV).

    Results

    Overall, of the samples, 69% were PCR+, IgG+, and IgM-, and 4.2% showed PCR+, IgG+, and IgM+. In the first follow-up, after 2 weeks, from the 41 referred patients, 29 (70%) showed PCR+, IgG+, and IgM-, which confirmed the results of the first sampling. In the second follow-up, 9 (47%) patients were PCR+, IgG+, and IgM-. A correlation was observed between the first referral and the follow-ups. Also, from 71 patients, diagnosed clinically as ocular toxoplasmosis, the disease was confirmed in 73.2% and 26.8% of those suffering from other ocular infections. Of the 20 control group samples, 55% showed PCR-, IgG+, and IgM-. The sensitivity, specificity, negative and positive predictive values, and negative and positive likelihoods were analyzed for IgG and IgM antibodies and for PCR using ELISA method.

    Conclusion

    As the ophthalmologic signs of T. gondii may be mimicked by other infections, clinical methods may be complemented by laboratory approaches for a definite diagnosis. This would assist clinicians to achieve timely diagnosis and successful therapy and to control the infection.

    Keywords: Ocular toxoplasmosis, Toxoplasma gondii, Molecular approaches, Serology
  • Pejman Hamouzadeh, Ali Akbarisari*, Alireza Olyaeemanesh Mir, Saeed Yekaninejad Pages 505-510
    Background

    Physician shortages in rural areas is a universal concern, and most countries face this challenge. Many attributes influence the physician preferences about the choice of working location. The aim of this systematic review was to investigate which attributes were included in discrete choice experiment studies and which of them valued the most by physicians.

    Methods

    The following databases were searched: PubMed, Embase, and Web of Science Core Collection. Further studies were retrieved from reference lists of included studies, and grey literature. Studies used discrete choice experiments methods to elicit preferences for working in the deprived area, focus on physicians or medical students, and published between 2000 and 2017 in the English language were included.

    Results

    The literature search yielded 192 studies, of which 14 studies met inclusion criteria. The attributes and attribute levels were identified by literature review and qualitative research. The number of attributes varied from five to ten, and the most frequent number was six attributes. In most studies, maximum of sixteen different scenarios were given to the study samples. The “salary or income” attribute was the most important in fifty percent of the studies and the attributes related to “study and education” was at the next level.

    Conclusion

    Financial attributes are not the only significant attributes considered by the physicians for deciding where to practice, but also the other non-financial attributes are important. It is suggested that based on the economic, social and cultural conditions of each country, a specific incentive package, including a set of financial and non-financial incentives, is developed to attract physicians to the deprived areas.

    Keywords: Physician, Discrete choice experiment, Preference, Deprived area, Systematic review
  • Habibolah Rezaei*, Alireza Yousefi, Bagher Larijani, Reza Dehnavieh, Nima Rezaei, Maryam Kazemi, Peyman Adibi Pages 511-516
    Background

    Forecasting is the process of predicting future behavior. In reviewing databases, no predicted value associated with international collaboration publications in Iran was found. Thus, the present study aimed at forecasting Iran’s international collaborative articles in medical sciences.

    Methods

    The number of Iran’s articles and international collaborative articles in medical sciences written over 56 years was extracted from SCOPUS. Data were extracted from 1960 up to 2016. The time series method was used for forecasting using the Minitab software Version 17.

    Results

    There was no increase in the number of medical articles from Iran from 1960 to 2001. However, the data showed incremental growth between 2001 and 2016. This was similar to Iran’s medical sciences international collaboration articles. In 2016, the percentage of Iran’s international collaboration articles was 15.2, which is expected to reach 19.9 in 2025.

    Conclusion

    An investigation was performed on the number of international collaboration articles in the field of medical sciences in Iran. Future trends show an incremental growth. The number of Iran’s articles can be increased with international cooperation. However, an increase or decrease in Iran’s articles without international cooperation has to be investigated.

    Keywords: Forecasting, International cooperation, Interrupted time series analysis, Medicine, Iran
  • Rokhsareh Mohammadzadeh, Behrooz Sadeghi Kalani, Maryam Kashanian, Mojgan Oshaghi, Nour Amirmozafari* Pages 517-522
    Background

    Gardnerella vaginalis is considered as the predominant microorganism found in bacterial vaginosis (BV). The aim of this study was to evaluate the prevalence of virulence factors in G. vaginalis associated with BV or non-BV cases and their correlations with this disorder.

    Methods

    A total of 102 vaginal specimens were collected from patients during their visit to Akbar Abadi hospital in Tehran, Iran. Bacterial vaginosis was determined by Nugent score and Amsel’s criteria. Polymerase chain reaction (PCR) was used for the detection of G. vaginalis 16S rRNA, vaginolysin, sialidase and phospholipase genes. To evaluate the association between the presence of vly, pho, and sld genes and BV. Pearson Chi-square test was applied using SPSS software. P-value ≤0.05 was considered as significant.

    Results

    Totally, 27.4% of the patients were suffering from BV. Gardnerella vaginalis was found in 100% women with BV and in 56.7% women with normal vaginal discharge. The prevalence of vly, sld and pho genes in BV-associated G. vaginalis was 10 (35.7%) (95% CI [0.18, 0.53]), 19 (67.8%) (95% CI [0.51, 0.85]) and 6 (21.4%) (95% CI [0.06, 0.37]), respectively. The prevalence of the aforementioned genes in non-BV associated G. vaginalis was 20 (47.6%) (95% CI [0.33, 0.63]), 28 (66.6%) (95% CI [0.52, 0.81]), and 5 (11.9%) (95% CI [0.02, 0.22]), respectively. Our results showed no statistically significant association between the presence of the virulence genes and BV associatedness of this microorganism.

    Conclusion

    Our results showed the presence of G. vaginalis in all BV patients and relatively high prevalence in healthy individuals. The prevalence rates of the three virulence genes were different in BV and non-BV associated G. vaginalis; however, the differences were not statistically significant.

    Keywords: Gardnerella vaginalis, Bacterial vaginosis, PCR
  • Morteza Arab Zozani, Ali Janati*, Mohammad Zakaria Pezeshki, Rahim Khodayari Zarnaq Pages 523-527
    Background

    Overuse and underuse of health care services are progressively recognized in all health systems around the world. There is evidence of overuse and underuse of health care services in Iran. In this study, it was aimed to summarize the evidence of overuse and underuse of health care services in the Iranian health care system.

    Methods

    This study will be conducted in 5 steps using a sequential explanatory multimethod design, literature review, systematic review, qualitative interview, expert panel, and policy Delphi method. This study was approved by Tabriz University of Medical Sciences (ethical confirmation number:  IR.TBZMED.REC.1396.908).

    Conclusion

    There is a strong evidence of worldwide overuse and underuse of health care services. Designing context-based prevention strategies by conducting comprehensive and systematic studies will improve the appropriate use of routine services and help patients, physicians, and providers make evidence-based decisions.

    Keywords: Medical overuse, Underuse, Health care services, Policy package, Iran
  • Amin Daemi, Hamid Ravaghi*, Mehdi Jafari Pages 528-534
    Background

    Reducing neonatal mortality is an important measure to reduce the overall under-five-years’ mortality. Identifying the risk factors is the first step in this regard. This study performed with the aim of determining the risk factors of the neonatal mortality in Iran.

    Methods

    Databases of SID, MagIran, IranMedex, IronDoc and Google Scholar for the Persian resources and Scopus, Science Direct, PubMed, Ovid, EMBASE, ISI web of science and Cochrane for English resources were searched up to January 2017. The inclusion criteria were the studies analyzing at least one risk factor for neonatal mortality in Iran with a control group and multivariate regression analysis. Eight papers met the inclusion criteria. The risk factors were extracted and tabulated.

    Results

    Of the 1713 records retrieved, 8 were eligible to include in the analysis. Preterm birth, low birth weight, smoking and addiction, and anomaly were the important risk factors of neonatal mortality in Iran. Moreover, an extended list of potential risk factors identified on most of which the evidence was controversial and insufficient. The factors categorized into modifiable and identifiable ones.

    Conclusion

    On the modifiable risk factors, proper intervention, and on the non-modifiable ones, early detection and special care may be helpful in preventing the babies from death. Population-based studies with large sample size and multivariate analysis are needed to make clear the effect size of the identified risk factors.

    Keywords: New born, Mortality, Risk factor, Iran
  • Reza Alibakhshi*, Keivan Moradi, Keyghobad Ghadiri Pages 535-540
    Background

    The analysis of haplotypes/mini-haplotypes in the PAH gene has been used as an informative tool in several genetic anthropology studies. Considering the notion that Iranian population is one of the most heterogeneous i the world, this study was conducted to evaluate the association of VNTR-STR mini-haplotypes with the PAH gene mutations in PKU patients in Kermanshah province.

    Methods

    A total of 24 unrelated Kurdish PKU patients with the known PAH gene causing mutations and 72 healthy controls were selected. The DNA fragments containing VNTR and STR systems were amplified by polymerase chain reaction (PCR). For VNTR system, PCR products were separated using electrophoresis on 2.5% agarose gel. For STR system, the samples were analyzed using DNA sequencing analysis version 5.2 software.

    Results

    Overall, 5 PAH-VNTR-alleles, including VNTR3, 7, 8, 9, 12, and 3 PAH-STR-alleles, including STR238, 242, and 250, were detected in this study. VNTR3 and 8 alleles had the most frequency among healthy controls. Also, 6 different mini-haplotype alleles were found to be associated with PKU chromosomes. The 2 most prevalent mutations in Kermanshah province, IVS2+5G>C and IVS9+5G>A, were strongly linked to mini-haplotypes 9/242 and 8/238, respectively.

    Conclusion

    The distributions and frequencies of VNTR alleles in Kurdish population have the most similarity to alleles previously described in European Caucasian families. Moreover, since the most common mutations in Kermanshah PKU chromosomes are rare and this was the first study on mini-haplotypes VNTR/STR among Iranian Kurdish PKU patients, given that this study was the first of its kind, it was not possible to compare its results with that of other studies on Iranian and non-Iranian populations.

    Keywords: PAH, VNTR, STR, Mini-Haplotype, Iran
  • Miami Kadhim Yousif*, Abdul Haleem Ali Al Muhyi Pages 541-545
    Background

    Climate change represents a possible threat to patients with bronchial asthma. The purpose of this study was to investigate any association between specific meteorological conditions and the rate of hospital admission for bronchial asthma and wheezy chest.

    Methods

    A retrospective study was conducted to observe the effects of changes in some meteorological variables on children aged 1-13 years with bronchial asthma and wheezy chest. Data were obtained from hospital registries for the study period involving all patients admitted with the diagnosis of wheezy chest and bronchial asthma. The meteorological data were obtained from the Iraqi World Meteorological Organization and Seismology and consisted of the mean monthly values of humidity, rain, temperature, dust, wind, and thunderstorms. The correlation between the mean monthly admission for bronchial asthma and changes in weather variables were investigated.

    Results

    There were 1043 admissions for asthma or wheezy chest (7.76%). Out of all asthma cases, 75% (n=783) were 1-5 years, while 25% (n=260) were 6-13 years. Male patients predominate 67.8%, with a male to female ratio of 2:1. Hospital admissions for asthma and wheezy chest showed a seasonal variation especially for younger children. Higher monthly admission rates were associated with high relative humidity, rain, increase in wind speed, and lower temperature, whereas rising dust and thunderstorms did not show notable effects on children's admission for asthma.

    Conclusion

    The findings suggested that changes in weather conditions, especially high relative humidity and cold weather, may trigger asthma attacks especially in younger children, and thus protective measures are recommended for at risk children.

    Keywords: Childhood asthma, Climate change, Wheezy chest
  • Freshteh Osmani, Ebrahim Hajizadeh*, Parvin Mansouri Pages 546-550
    Background

    Data types are recurrent events in studies in which each person may experience an event at different times. One of the most popular approaches to analyze recurrent event data is obtaining an estimate of the means/rate of events at different times. In this context, determining the variability over time can help better understand the effect of factor on the response. In this study, we applied smoothing methods to estimate coefficients in time-dependent rate model, and we also showed its application in data of psoriasis patients.

    Methods

    In the present study, psoriasis patients who experienced relapse that led to hospitalization during 2005 and 2014 in the Dermatology Department of Imam Khomeini hospital in Tehran were examined. To investigate the rate of relapse during a year, time-dependent rate model was used and variability of the effects was assessed using Wald test. Both b-spline and kernel methods were used to estimate time varying coefficients in rates model. Finally, results from methods were compared based on the obtained estimates.

    Results

    Based on the results of the Wald test, the effect of season on the occurrence of psoriasis was significantly different (p<0.01). Also according to the estimated coefficients from both b-spline and kernel methods, there was little difference between them.

    Conclusion

    In situations in which the effect of a variable is different at different times, using time-dependent coefficients rate model can lead to a better estimate of the effect of variable on the response. On the other hand, smoothing methods can smooth the effects of the variables that vary over time.

    Keywords: Recurrent event, Regression spline, Kernel, Rates model, Psoriasis
  • Georgia Tsaousi, George Stavrou, Katerina Kotzampassi* Pages 551-552
  • Mohammad Hossein Mehrolhassani, Saeid Mirzaei, Samira Sadat Poorhoseini, Nadia Oroomiei* Pages 553-558
    Background

    According to census 2011, general fertility rate in Iran was 1.6 children. The United Nations published a low population growth scenario for Iran in 2010, and if Iran continues to experience population replacement and does not have a plan to balance it, it will experience a population of 31 million, with a high percentage of elderly people in the next 80 years. This study was conducted to identify the causes of a decrease in population growth rate.

    Methods

    This was a secondary study conducted by reviewing the scientific texts, papers, and upstream documents. The upstream documents contain all national documents related to population decline in Iran. Causal layered analysis (CLA) was used for data analysis.

    Results

    The 9 most important identified causes for a decrease in population were litany (child mortality, maternal mortality, diseases burden, fertility rate, marriage squeeze, abortion, marriage age, high-risk behaviors, and badly supervised and neglected children. Also, 5 causes in structural layer were urbanization, education rate, economic participation rate and unemployment rate, new structures, a change in family structure, and intergenerational gap. Moreover, three causes in discourse layer included welfare, materialism, individualism, and 2 causes in metaphor layer were changing the perception of life and family formation, and women as workforce.

    Conclusion

    It seems that the decrease in population growth in Iranian society is less the result of social planning and population control and more the result of the value and structural changes that have been occurred due to modernization in the society. It is recommended that policymakers primarily address the discourse and metaphor layers to solve the problems.

    Keywords: Causal layered analysis (CLA), Population decreasing, Iran
  • Vida Bitarafan, Alireza Esteghamati, Kamal Azam, Somaye Yosaee, Kurosh Djafarian* Pages 559-565
    Background

    There are many factors related to etiology of metabolic syndrome (MetS) including obesity. Spexin, a peptide hormone released from adipose tissue, is the most down-regulated gene in obese, compared to non-obese adipose tissue. Hence, it potentially contributes to the progression and development of metabolic diseases. This study was designed to evaluate serum concentration of spexin in patients with MetS compared to weight-matched and normal-weight controls.

    Methods

    In this case-control study, 153 participants (51 per group) were collected from October 2014 to June 2016. The study groups were all matched for age and sex and included overweight/obese individuals with MetS and 2 control groups without MetS (including weight-matched and normal-weight participants). Body composition and serum concentration of spexin and leptin were measured.

    Results

    Serum leptin and spexin levels were significantly higher and lower, respectively, in normal-weight compared to overweight/obese groups with/without MetS (p< 0.02). No significant difference was observed in serum leptin and spexin concentrations between the overweight/obese groups with/without MetS (p≥ 0.05). Also, spexin, with cutoff value of 4.6, had 78% sensitivity and 82% specificity for diagnosing overweight/obese from normal-weight participants. Spexin had 78% sensitivity and specificity, with cutoff value of 4.35, in diagnosing MetS participants from normal-weight group.

    Conclusion

    This study found no correlation between the circulating level of spexin and MetS development. Higher serum concentration of spexin in normal-weight adults compared to the obese participants illustrated the potential role of this novel peptide in obesity.

    Keywords: Metabolic syndrome, Obesity, Spexin, Leptin
  • Azam Rahmani, Vinnaras Nithyanantham, Arezoo Fallahi, Leila Allahqoli*, Narges Sadeghi Pages 566-574
    Background

    Sexual health education is a controversial issue within the Iranian context. Thus, the present study was conducted to explore the necessity of sex education among young single women and develop and examine the psychometric properties of the Sexual Health Education Necessity Scale.

    Methods

    This was an exploratory mixed method study. Young single women (51 women in the first phase and 110 women in the second phase of the study) aged 18-34 years were recruited in the study. In the first phase, qualitative methods were applied to generate items. In the second phase, psychometric properties, such as face, content, and construct validity, and reliability of the Sexual Health Education Necessity Scale were evaluated. In the first phase, an item pool was developed that included 17 statements related to sexual health education necessity. In the second phase, item reduction was applied using exploratory factor analysis and the final version of the questionnaire containing 9 items was developed.  Also, content, face, and construct validity were assessed. Moreover, Cronbach’s alpha coefficient and test-retest were calculated to evaluate the reliability of the questionnaire. SPSS software (version 21) was used for data analysis and p value less than 0.05 was considered as significant.

    Results

    In the qualitative phase, 4 key themes emerged regarding sex education, which included the effects of sex education, principles of sex education, content of sex education, and organizations responsible for sex education. An item pool containing 17 statements was generated and used for psychometric evaluation. The results of the exploratory factor analysis showed a 2-factor solution for the scale, which collectively accounted for the 56.04% of the variance. Final CVR and CVI were found to be 0.96 and 0.97, respectively. The Cronbach’s alpha coefficient and test-retest of the instrument was found to be 0.78 and 0.80, respectively.

    Conclusion

    Sexual Health Education Necessity Scale can be used for exploring dominant beliefs that may be obstacles for providing sex education in conservative societies; therefore, correcting these beliefs could help to design an appropriate sexual health education program.

    Keywords: Psychometric evaluation, Sexual health education, Young single women, Exploratory mixed method
  • Mozhgan Moghtaderi, Shirin Farjadian*, Saeed Hossieni Teshnizi, Maryam Hadibarhaghtalab Pages 575-578
  • Negin Afrang, Maryam Honardoost* Pages 579-583
    Background

    Melanoma has been known as an aggressive type of skin cancer in recent years. Reports have distributed the spread rate of melanoma among white skin populations. Also, many studies have mentioned several causes of melanoma. Ultraviolet radiation was represented to be the most important reason for occurrence of melanoma. However, recent studies have found that a combination of factors, such as environmental and genetic factors, can contribute to occurrence of various cancers, specifically melanoma.

    Methods

    Different studies have been conducted on the efficacy of genetic disorders in melanoma. These surveys marked the key role of specific biomarkers in molecular and cellular processes, and investigations have found the expression of several genes in these processes. In addition, aberrant expression of these genes due to mutation and methylation can affect the whole process.

    Results

    The expression process of these genes is regulated by microRNAs. These new biomolecules have been considered as negative regulators because of managing molecular and cellular processes. MicroRNAs are small conserved regulators attached to their targets leading to rearrangement of gene expression. Adherence of these noncoding RNAs can cause mRNA degradation or inhibit its translation.

    Conclusion

    Recently, the application of specific genes in melanoma has been studied. In this review, the way melanoma is regulated because of these biomarkers and their demand through cell cycle in diagnosis, prognosis, and therapeutic periods was considered.

    Keywords: Melanoma, Biomarkers, Cell cycle, Biomolecules
  • Shadi Naderyan Feli, Seyed Mojtaba Yassini Ardekani, Hosein Fallahzadeh, Ali Dehghani* Pages 584-590
    Background

    The metabolic syndrome is highly prevalent among patients with schizophrenia. This study was conducted to determine the prevalence of metabolic syndrome and the risk of cardiovascular disease in the next 10 years among schizophrenic patients.

    Methods

    This cross sectional study was performed on 100 Iranian patients with schizophrenia in 2016. The prevalence of metabolic syndrome was determined by adult treatment panel III criteria, and 10-year cardiovascular risk was calculated by Framingham Risk Score. SPSS software was used to perform statistical analysis. Chi-square and Fisher's exact or extended Fisher's exact tests were used to compare dichotomous variables. Also, Mann-Whitney U test was applied to compare the quantitative variables. Significance level was considered to be less than or equal to 0.05.

    Results

    In this study, 83 participants (83%) were male and 17 (17%) were female. The prevalence of metabolic syndrome was 27% (21.7% in males and 52.9% in females, p=0.015). Among all components of metabolic syndrome, low HDL-C in men and abdominal obesity in females were the most common disorders. Based on Framingham Risk Score, 76%, 16%, and 8% of patients had low, intermediate, and high level of risk, respectively. A significant difference was observed between the level of risk among participants with and without metabolic syndrome (p=0.042).

    Conclusion

    In this study, patients with schizophrenia showed a high prevalence of metabolic syndrome, but most of them had low risk of developing cardiovascular disease. These results suggest regular screening and early interventions to modify the risk factors of metabolic syndrome.

    Keywords: Antipsychotic, Cardiovascular disease, Metabolic syndrome, Schizophrenia
  • Nahid Dehghan Nayeri, Mahboobeh Shali, Atefeh Vaezi, Nasrin Navabi, Fatemeh Ghaffari* Pages 591-596
    Background

    Cardiac patients’ beliefs about illness and treatment can disturb their treatment process, treatment regimen adherence, and daily activities. Exploring these beliefs by the use of appropriate, valid, and accurate scales can be helpful in false beliefs reforming by nurses and finally, result in life quality promotion. Therefore, this study is conducted to design and psychometry a questionnaire probing about cardiac patients’ beliefs about illness and treatment.

    Methods

    The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the role of cultural beliefs about illness and treatment in two steps, including the literature and related tools review and fieldwork (semi-structured interviews with cardiac patients). Seventeen studies were checked in the literature review. Twenty-two cardiac patients were selected and interviewed by purposive sampling. The interviews continued up to the data saturation. The data analysis was conducted in both steps using conventional content analysis and textual content analysis. The quantitative step was a methodology study accomplished in two parts. The questionnaire items were formed using the data and items pool in the first part while the psychometric properties of the questionnaire were checked using face, content and construct validity and the reliability was probed using internal consistency and stability in the second part. The data were transferred into SPSS software program, version 18.0 for Windows (α<0.05) 

    Results

    319 codes were extracted from the analyzing phase which formed 6 categories including prognosis, prevention, contexts, treatment efficiency, mentality and lifestyle as well as 9  sub-categories including understanding the danger, attitude toward disease, attitude toward treatment, society’s culture, feeling hopeless, treatment regimen ignorance, self-curing, trying to survive and physical outcomes.
    The items pool was formed using literature reviews and interviews. A 30-itemed questionnaire was formed after the psychometric process. The Kaiser-Meyer-Olkin (KMO) index and the Bartlett’s test of sphericity showed good results. Six components from the exploratory content analysis including prognosis, prevention, contexts, treatment efficiency, mentality, and lifestyle gained 51.7% variance totally. The interclass correlation coefficient was 0.83 in responding to the items for two times.

    Conclusion

    This study developed a questionnaire about cardiac patients’ beliefs regarding their illness and treatment. It can be used for the educational, research, and treatment purposes as a questionnaire with short, easy, and grammatically simple items that have appropriate validity and reliability. Using this scale can be helpful in evaluating clients’ beliefs and recognize their educational needs.

    Keywords: Belief, Cardiac patients, Tool design, Exploratory mixed methods
  • Mehrdad Saeidi Borujeni, Seyed Ali Hosseini, Nazila Akbarfahimi*, Elaheh Ebrahimi Pages 597-604
    Background

    The Cognitive Orientation to daily Occupational Performance (CO-OP) approach, top-down, client-centered and goal-oriented approach originally developed for children with Developmental Coordination Disorder (DCD) in 2001 and since used in other populations and settings. The purpose of this scoping review was to examine the extent (number) and nature (features and characteristics) of the literature on CO-OP in adult’s populations.

    Methods

    In this scoping review, 8 online databases were searched up to April 2018 to identify articles that addressed CO-OP in adult’s populations. The articles were selected based on inclusion and exclusion criteria. Two raters reviewed all documents independently. Articles were categorized according to diagnosis.

    Results

    Fifteen studies were identified. To examine application and effectiveness of CO-OP in adult’s populations we included individuals with chronic stroke (>6 months post-stroke; n=7), with TBI (n=3), with acute stroke (<6 months post-stroke; n=4) and the older adult populations comprised those with self-reported cognitive difficulties but no diagnosis of dementia, depression, or cognitive impairment (n=1). In all cases, CO-OP showed to be useful and efficient.

    Conclusion

    CO-OP has been applied in TBI, stroke and age-related executive changes appropriately. The results have shown that CO-OP efficiently improved performance and satisfaction in trained and not trained client chosen goals.

    Keywords: Evidence-based practice, Occupational performance, Rehabilitation, Intervention, Neurological conditions
  • Soheila Aminimoghaddam*, Ara Omranipoor Pages 605-607

    Ectopic pregnancy is an urgent clinical condition that represents a serious hazard to reproductive power, and thus threatens woman's health. Commonly, methotrexate is considered for early resolution of placental tissue. Despite its potential advantages such as minimizing hospitalization and quick recovery, its high skin and gastrointestinal side-effects and requiring time monitoring may limit its application. Recently, high effectiveness of the single-agent chemotherapy agents, such as Actinomycin D, has been suggested. Herein, a case of methotrexate-resistant EP that was successfully treated with Actinomycin D was described.

    Keywords: Ectopic pregnancy, Actinomycin-D, Beta HCG
  • Zahra Jorjoran Shushtari, Seyed Ali Hosseini*, Homeira Sajjadi, Yahya Salimi, Armita Shahesmaeili, Tom A.B. Snijders Pages 608-614
    Background

    An adequate perception of the degree to which one is at risk of having or contracting HIV is necessary for behavioural change and the adoption of safe behaviours. There are limited data regarding HIV risk perceptions among female sex workers in Iran. This study aimed to determine the HIV risk perception status and its association with sexual behaviours among female sex workers in Tehran.

    Methods

    A cross sectional study was conducted among 170 female sex workers in Tehran. Participants were recruited using a combination of snowball, purposeful, and convenience sampling methods. Multiple logistic regression was used to identify adjusted associations between background factors, sexual behaviours, and HIV risk perception. The analysis was conducted by the “logistf” package in the R statistical system. P-value less than .05 was considered as statistically significant.

    Results

    Among the participants, 122 (77%) reported high HIV risk perception. Most female sex workers with high HIV risk perception reported that they did not consistently use condoms (n=120, 98%. Female sex workers with a higher frequency of sex work (AOR=1.18, 95% CI: 1.08, 1.31), inconsistent condom use (AOR=0.15, 95% CI: 0.02, 0.66),  a history of HIV testing (AOR=5.1, 95% CI: 1.2, 26.0), and low HIV knowledge (AOR=0.97, 95% CI=0.95, 0.996) were more likely to report high HIV risk perception.

    Conclusion

    Most female sex workers with risky sexual behaviours had a high HIV risk perception. Effective educational programs are suggested to enable female sex workers to correctly assess their own HIV risk and change risk behaviors based on self-assessment of actual risk.

    Keywords: HIV risk perception, Sexual behaviours, HIV, AIDS, Female sex workers
  • Hassan Joulaei, Mozhgan Fardid, Kamran Bagheri Lankarani* Pages 615-616

    We appreciate the authors for analyzing Health Transformation Plan (HTP) and its challenges toward Universal Health Coverage (UHC). Although the authors made all their efforts to put forward the background of Iran’s health system before HTP implementation and the challenges it faces during its progress, we think some major issues are not expressed precisely.HTP.In conclusion, we do believe that HTP aimed to reduce the inequality of utilization, increase the financial protection and improve the quality of care. However, not paying proper attention to existed health system especially HNS, improper prioritization of the intervention package, insufficient attention to the prerequisites of such a plan including sustainable financial resources and lack of real support from all stakeholders were the main errors of implementing HTP. We also would like to add the importance of upgrading the managerial skills of health system at national level as a major precondition due to its momentous role in all reforms.

    Keywords: Health Plan Implementation, Iran, Health Policy
  • Morteza Hemmat, Haleh Ayatollahi*, Mohammadreza Maleki, Fatemeh Saghafi Pages 617-620
    Background

    Health information technologies (HIT) have some benefits and may have some potentially negative impacts. Therefore, it is difficult to plan for future health information technologies. This study aimed to investigate the key and non-key health information technologies which could be considered for the future strategy development in Iran.

    Methods

    In this study, experts and policymakers in the field of health information technology were invited to take part in a qualitative study. Purposive sampling was used to select the most informant people, and 13 interviews were conducted. The method of framework analysis was used to analyze data.

    Results

    The four main themes emerged from data analysis were 1) immediate, cheap, stable, and secure access to the health records of the society, 2) equitable access to health care resources and services, 3) knowledge management in healthcare services, and 4) governmental/central electronic services for the health system. To cover the mentioned areas, a number of key and non-key technologies were discussed by the interviewees.

    Conclusion

    In this study, a number of key and non-key health information technologies were recognized. While the findings can help policymakers to pay more attention to the key technologies to improve healthcare delivery, these technologies need to be prioritized in terms of their importance for the country.

    Keywords: Health information technology, Information technology, Foresight, Qualitative research, Decision making, Policymaker
  • Nahid Ahmadian Yazdi, Kamran Soltani Arabshahi, Shoaleh Bigdeli*, Saeideh Ghaffarifar Pages 621-627
    Background

    Empathy is a key clinical skill in the medical profession, and many studies have reported a decline in it among medical students during their years of education; especially, in the clinical stage, and this affective decline persists in the physician-hood. This study aimed to explore the participants' perceptions about challenges for promoting clinical empathy in training stages

    Methods

    A qualitative design using content analysis was applied. Semi-structured interviews were applied to obtain data. Individual interviews were conducted with 14 interns and six clinical professors. The data were analyzed through conventional content analysis and the credibility, trustworthiness, and conformability of the data were confirmed

    Results

    Data analysis led to the extraction of two main categories, including overt and covert challenges, and also four categories and nine sub-categories.

    Conclusion

    Resolving clinical empathy challenges in medical students requires financial and human resources, and training on the principles of effective doctor-patient interactions. Furthermore, professionalism should be strengthened in professors, and both official and hidden curricula should be revised accordingly.

    Keywords: Medical students, Qualitative study, Empathy, Challenge
  • Ghazaleh Khalili Tanha, Ahmadreza Sebzari, Mitra Moodi, Fatemeh Hajipoor, Mohsen Naseri* Pages 628-633
    Background

    Breast cancer (BC) is well-known as the most common malignancy and the first leading cause of cancer-related death among women worldwide. Evidence suggests that familial history and age are important risk factors for the development of this disease in Iran. Mutations in BRCA1 and BRCA2 genes are the cause of 5 to 10% of hereditary BC. Recent studies demonstrated that mutations in BRCA1 were observed in high-risk women with family histories of BC. However, to date, the mutations have not been elucidated in BC patients from east of Iran. The purpose of this study was to analyze BRCA1 mutations in BC patient from South Khorasan Province.

    Methods

    In the present study, 88 BC patients (11 positive family history) were screened for mutations in BRCA1. The analysis of BRCA1 was carried out by SSCP (single-strand conformation polymorphism) for shorter exons and direct sequencing in the case of longer ones.

    Results

    Twenty-eight of the patients (31.8%) had a synonymous mutation (c.4308T>C) in exon 13. A missense mutation (c. 4837A>G) was presented in exon 16 with a frequency of 56.8 %. In exon 11 three missense mutations were observed, and the frequency rate for c.3113A>G was 32.5%, for c.3119G>A was 5%, and the highest frequency belonged to c.3548A>G with 72.4% in familial BC and 45.4% in the non-familial group.

    Conclusion

    In our study, five mutations were found, but none of the founder mutations were identified in this population. Two missense mutations in exon 16 (56.8%) and in exon 11 (65%) had the highest frequency in South Khorasan Province.

    Keywords: Breast Neoplasms, BRCA1 Gene, Single-Stranded Conformational Polymorphism (SSCP)
  • Haniye Sadat Sajadi*, Elham Ehsani Chimeh, Reza Majdzadeh Page 634

    We thank Joulaei et al (1) for their insightful comments on our paper on Universal Health Coverage in Iran (2). They criticized some parts of Iran's Health Transformation Plan (HTP), and we do not disagree with some of their comments on HTP. However, we think that an evidence-based approach is needed for an in-depth analysis of HTP, which is beyond our correspondence and Joulaei et al.’s comments. Therefore, we only focus on the criticisms made to our correspondence which was related to the starting point of HTP as to whether public hospitals were an appropriate starting point or whether the primary health care (PHC) should have been the starting point for HTP. While we believe that strengthening PHC is a strategic approach and vital to achieve Universal Health Coverage (UHC), at the same time, starting HTP from hospital services was a tactically correct decision, as public policymakers were looking for a showcase of using targeted subsidies funds to do something sensible for people in social welfare. The inpatient services were an urgent challenge which caused extreme public dissatisfaction. Much earlier, the first measure taken in the health transformation plan of Turkey was prohibition of holding the corpse hostage in hospitals due to unpaid hospital costs. While this was not a significant intervention for strengthening the health system, it softened the ugly face of the system and had tangible results for people. The second reason was the ease of implementing interventions in hospital services; 70% of outpatient services are provided by the private sector in Iran, which is not well-manageable by the government. In contrast, the public sector is the largest provider of inpatient services, providing inpatient care to almost 80% of the population. As a result, intervention in public hospitals, compared to outpatient services, has been more feasible. The third reason was the chance of achieving the desired results in a shorter time. The impacts of promotive and preventive measures appear in the long-term, while curative affair measures have short-term impacts.In sum, we entirely agree that reform is useful when it addresses the most fundamental challenges of the health system. However, the progressive realization of UHC is a crucial principle, meaning that the reform should be a long-term plan which must gradually be evolved (3). Starting HTP from the public hospital should not be considered as a disadvantage since, in reality, it has attracted enough attention and support; however, HTP should have not ended up in the hospital, and it had to address other aspects that were essential for a fundamental transformation such as PHC.

    Keywords: Universal health coverage, Health system, Health sector reform
  • Soodeh Khoramian, Zahra Soleymani*, Nasrin Keramati, Masoud Motasaddi Zarandy Pages 635-644
    Background

    Cochlear implantation (CI) is an achievement that facilitates the acquisition of language skills in deaf children throughout the world. The use of this technology has a positive effect on all components of language acquisition (syntax, semantic, pragmatic, etc.). However, this positive impact is influenced by various factors. Understanding the strengths and weaknesses of studies on the development of language abilities can help improve these studies. Consequently, in the future, it will lead to the improvement of language rehabilitation in these children. Limited studies on children with CI in have been done so far. This article summarized the outcomes of scientific articles on the clinical efficacy of CI on Persian speaking children. This study also provided a clear picture of these studies by examining the quality of their methodologies and tools.

    Methods

    Articles indexed in Google Scholar, Web of Science, Medline, Scopus and Iranian databases (Danesh Gostar, Magiran, and SID) were searched using keywords “language,” “Cochlear implant”, “Persian/ Farsi” in English and Persian languages with “and/or”.  Original articles investigated on children younger than 13 years old with hearing impairment and CI were included.

    Results

    Five hundred and twenty-three articles were found based on the keywords. Among all of these, 485 were excluded due to the title and the abstract; we selected 38, of which 24 were repeated. Finally, 14 articles remained. We reviewed the articles based on the preferred reporting items for systematic review and meta-analysis (PRISMA) and checklist and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

    Conclusion

    Similar to international studies, Persian speaking children with CI have slower language development than their peers with normal hearing, but they are better than their peers who use hearing aids. The results of reviewing on quality of the articles showed that the studies could not meet reasonable quality because of the lack of a standard test in different aspects of Persian language and the absence of patients’ databanks. These results also can be used by other nationalities that recently have started surveys on children with CIs.

    Keywords: Cochlear implant, Child, Language, Iran, Developmental language disorders, Persian
  • Hossein Moameri, Shahrzad Nematollahi, Mehdi Yaseri, Hasan Ahmadi Gharaee, Roya Karimi, Kourosh Holakouie Naieni* Pages 645-651
    Background

    The effect of maternal mental health during pregnancy on Cesarean section through implications of pre- and postnatal birth have narrowly been investigated. The aim of the present study was to investigate the effect of maternal mental health during pregnancy on the type of delivery in the suburbs of Bandar Abbas. 

    Methods

    This study used data of 200 mothers registered in a prospective cohort study on pregnant women in the suburbs of Bandar Abbas, South of Iran, during 2016-18. The presence of depression, anxiety, or stress in expecting mothers were measured by DASS-21 questionnaire and the outcome defined as having Cesarean section (Cesarean section) was measured at postpartum. The relative risk (95% CI) was calculated using Cox regression models. All analyses were performed using STATA statistical package, with a significance level of 5%.

    Results

    Information of 196 mothers were collected (98% response rate); the mean age of the participants was 27.28 (±5.62) years. The prevalence of depression, anxiety, and stress was 13.8% (27), 40.4% (40), and 7.6% (15), respectively. Nearly 40% of mothers went through Cesarean section. Compared to mothers with good mental health, the risk of Cesarean section was 96% higher in depressed mothers (RR=2, 95% CI: 1.43–2.74) (p=0.001), 81% higher in anxious mothers (RR=1.81, 95% CI: 1.29-2.53) (p=0.003), and 75% higher in stressed mothers (RR=1.75, 95% CI: 0.86-3.56) (p=0.121).

    Conclusion

    The findings of this study showed that poor mental health, especially anxiety and depression, during pregnancy could increase the risk of Cesarean section. Accordingly, screening protocols for mental health status and prenatal counseling sessions are suggested for pregnant mothers to increase their informed decision on types of delivery.

    Keywords: Mental health, Cesarean section, Prospective studies, Cohort studies
  • Maedeh Amini, Farid Zayeri* Pages 652-658
    Background

    Shift work can be defined as work activity scheduled in which employees work outside standard daytime hours. Some reports have shown that shift work is associated with several health problems. The main objective of this research was to explore the effect of shift work on body mass index (BMI) over time among Iranian petroleum industry staff.

    Methods

    This longitudinal study sample was consisted of 3,686 (1,872 day workers and 1,814 shift workers) petrochemical industries staff in Mahshahr, southwest of Iran, from 2012 to 2015. The weight and height of these staff were measured using standard techniques and equipment. Multiple-group latent growth curve modeling was used to determine the effect of shift working on BMI trajectories over this period of time via Mplus software, version 6.0.

    Results

    The mean (±SD) age of the shift workers and day workers were 38.96 (±8.36) and 43.33 (±8.35) years, respectively. Findings from the modeling approach showed that the slope of BMI in shift workers on average was 0.14 kg/m2 greater than the day workers in years under study (p<0.001).

    Conclusion

    The findings of the current study suggest that shift work can be considered as a potential risk indicator for higher weight gain in petrochemical staff. Hence, health policy-makers should organize health screening programs and periodical checkups to find high-risk staff and control unhealthy lifestyle factors in these industries.

    Keywords: Shift work, Body mass index, Longitudinal, Latent, Growth curve modeling
  • Pouran Raeissi, Masood Taheri Mirghaed*, Razieh Sepehrian, Mahnaz Afshari, Mohammad Reza Rajabi Pages 659-665
    Background

    Medical malpractice represents a serious problem in the health system and is one of the risk factors for patient safety which damages the patient and increases costs for the patient and the health care provider. The importance of these complaints against physicians is that litigation may continue for a long time and become problematic for patients and physicians. The objective of this study was to investigate the complaints of medical malpractices which were referred to Iran Medical Council to provide solutions to reduce the complaints and improve service delivery.

    Methods

    Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, and Iranian databases, such as MagIran, SID, and Irandoc, were searched from 01/01/1990 to 07/01/2018. Also, the grey literature (via Google Scholar) was searched. Studies written in English or in Persian were searched, and keywords used included malpractice, negligence, medical malpractice, physician impairment, Iran, and professional impairment.

    Results

    Nearly 1455 complaints (36%) of the total number of 3977 complaints were proved to be medical malpractice, and physicians were acquitted in 2542 (64%) cases. Most complaints were from gynaecologists, accounting for 43% of all complaints, followed by orthopaedic specialists who ranked second with 21.4% of the total complaints. The most type of failure was due to lack of skill (30.4%), followed by negligence (29.2%). Imprudence or indiscretion (26.3%) and noncompliance with governmental requirements (14.1%) were also in the next ranks, respectively.

    Conclusion

    Improving patient and physician relationships, observing medical ethics, increasing the scientific and technical skills of the medical staff, and following the guidelines and medical protocols will prevent medical malpractice. Therefore, health policymakers can reduce errors and failures by adopting continuing education on medical, ethical, and legal issues.

    Keywords: Medical malpractice, Iran, Health system
  • Mahdi Alemrajabi*, Saeed Moradi, Sepide Jahanian, Behrouz Banivaheb, Nima Hemmati Pages 666-669
    Background

    Abdominoperineal resection (APR) is the standard surgical treatment for low-lying anorectal malignancies. It seems that immediate flap reconstruction has fewer complications compared to primary closure. There are several options for local flap reconstruction of perineal wound closure, and each specific flap method has its own advantages and disadvantages.

    Case presentation

    In this case report, a new method of reconstruction is presented which contains only the inferior part of the rectus abdominis muscle in 2 patients, one with unilateral and the other with bilateral involvement and they both underwent APR. Both patients were referred to the colorectal surgery clinic for APR by an oncologist. Both patients had severe constipation and both reported pain on defecation and rectorrhagia. Patient 1 received a unilateral inferior part of rectus abdominis muscle flap and patient 2 received a bilateral flap.

    Conclusion

    Immediate flap reconstruction after APR has fewer complications than primary closure and the inferior part of rectus abdominis muscle flap seems to be a possible means of reconstruction after APR.

    Keywords: Muscle flaps, Surgical flaps, Abdominoperineal resection, Rectal malignancy, Case-report, Reconstructive surgical procedures
  • Seyed Hossein Mohaqeqi Kamal, Gholamreza Ghaedamini Harouni*, Mehdi Basakha Pages 670-676
    Background

    Human well-being is a core global issue. Thus, achieving and sustaining higher levels of well-being is a challenge for citizens, governments, and international organizations worldwide. The present study aimed at describing the well-being status of residents of Tehran municipal districts. To achieve this, a composite well-being index was constructed for 22 municipal districts of Tehran (Tehran Well-being Index; TWI).

    Methods

    This cross sectional study was conducted from May to October 2017 in Tehran using the data collected in the second round of Urban Health Equity Assessment and Response Tool (Urban HEART) Project of Tehran (2012-2013). The statistical population of this study was 22 municipal districts of Tehran and a sample of 34 700 households (118 000 individuals) selected using multistage cluster sampling. TWI was developed through the Organization for Economic Cooperation and Development (OECD) methodology of constructing composite indicators. Then, 22 municipal districts were categorized based on TWI scores. All data were analyzed using SPSS v.18. In addition, a cartogram was applied using GIS software to classify well-being status among Tehran municipal districts.

    Results

    Factor analysis results showed that the Kaiser-Meyer-Olkin (KMO) value was 0.691 and 2 factors (material well-being and psychological well-being) explained 74.13% of the total variances. Furthermore, the best and worst performances were found in districts 6 and 17, respectively. District 6 had the best and district 17 the worst material well-being status. Also, districts 6 and 19 had the best and worst psychological well-being status, respectively.

    Conclusion

    In general, the well-being status of the municipal districts of Tehran can be divided into 5 main categories: (a) prosperous (districts 1, 2, 3, 5, and 6); (b) fairly prosperous (districts 4, 21, and 22); (C) moderately prosperous (districts 7, 8, and 13); (d) less prosperous (9, 10, 11, 14, and 12); and (e) deprived zone (districts 12, 15, 16, 17, 18 and 19).

    Keywords: Social welfare, Urban spatial distribution, Social class, Index, Socioeconomic factors
  • Mohammad Zajaria Pezeshki, Mahasti Alizadeh, Akbar Nikpajouh, Ali Ebadi, Soheila Nouhi, Maryam Soleimanpour* Pages 677-681
    Background

    Considering the importance of assessing the program of health promotion hospitals (HPH) for elucidating the compliance with the standards, the present study aimed to evaluate the health promotion standards in governmental and non-governmental hospitals of East-Azerbaijan.

    Methods

    In the present cross-sectional study, all hospitals in East-Azerbaijan province in 2018 were recruited. The Persian validated World Health Organization (WHO) a self-assessment questionnaire was sent to the director of each hospital and invited to corporate with the study. Self-assessment questionnaire consists of 40 measurable elements that assess management policy, patient’s assessment, patient information and intervention, promoting health work placed and continuity and cooperation. Independent sample t-test was conducted to compare the mean score of each standard across hospitals type, location, and size. A significance level of 0.05 was used.

    Results

    Hospitals total HPH score was 56.06±21.27 (out of 100). Among five standards, Standard 3 had the highest score (66.85±18.80), and Standard 4 had the lowest score (47.79±19.12). The capital cities’ hospitals had a significantly higher score in Standard 5 (p=0.02). Non-governmental hospitals had a significantly higher score in standard 4 (p=0.02). There were no significant differences in all five standards of HPH between hospitals with ≤200 and >200 beds (p>0.05).

    Conclusion

    The hospitals in East-Azerbaijan-Iran had moderate compliance with HPH program, and they need to improve their performance especially in the field of providing healthy workplace and offering proper education and health-promoting services to patients after discharge.

    Keywords: Health promotion standards, Hospital, East Azerbaijan
  • Maryam Safaei, Ali Akhondpoor Manteghi, Najmeh Shahini, Amir Hooshang Mohammadpour* Pages 682-686
    Background

    Schizophrenia is associated with increased cardiovascular morbidity. Asymmetric dimethylarginine (ADMA) has been suggested as a cardiovascular biomarker. Treatment with atypical antipsychotics can increase some traditional risk factors of coronary artery disease. In addition to traditional risk factors, this study is carried out as a comparison of serum levels of ADMA and non-traditional factors among patients who take two types of atypical antipsychotics.

    Methods

    In this clinical study, 57 schizophrenic patients with multiple episodes and 20 healthy voluntaries that fulfilled inclusion and exclusion criteria were entered into the study. The patients were divided into 3 groups (18 patients received risperidone alone, 20 patients received clozapine alone and 19 patients did not receive any drug). Plasma concentrations of ADMA, high-sensitivity C-reactive protein (hs-CRP) and homocysteine were measured through enzyme-linked immunosorbent assay (ELISA), and traditional risk factors of metabolic syndrome were measured.

    Results

    Mean age of participants was 46.08±12.54 years. Moreover, the traditional (High-density lipoprotein (HDL), total cholesterol, waistline, and Body Mass Index (BMI)) and non-traditional factors (Homocysteine, hs-CRP) and ADMA were higher in patients with schizophrenia compared to healthy group (p≤ 0.05). Also, in the clozapine group, all mentioned non-traditional factors and ADMA were significantly higher than other groups (p≤ 0.05).

    Conclusion

    In the clozapine group, levels of non-traditional factors and ADMA were significantly higher which indicates these patients are at risk of cardiovascular disease.

    Keywords: Asymmetric dimethylarginine, Atypical antipsychotics, Metabolic syndrome, Schizophrenia
  • Maryam Kashanian*, Shohreh Bahasadri, Ashraf Nejatdehcordi, Narges Sheikhansari, Noushin Eshraghi Pages 687-692
    Background

    Different methods of cervical ripening and induction of labor have been used in the cases of unfavorable cervix with different levels of success, but no method has been found to be the best option. The purpose of the present study was to find the effects and side effects of three different methods of cervical ripening and induction of labor. These three methods were oral titrated misoprostol, constant dose of oral misoprostol and Foley catheter with extra-amniotic saline infusion.

    Methods

    This clinical trial was performed on women with unfavorable cervix who had been admitted in Akbarabadi Teaching Hospital for induction of labor and had bishop score of less than six; between March 2014- March 2015. The eligible women were assigned into three groups. In titrated oral misoprostol group (n=33), titrated solution of misoprostol, and in oral misoprostol group (n=33), 50µg oral misoprostol every four hours and in Foley catheter group (n=50), Foley catheter with extra-amniotic saline infusion were administered. The main outcome was the number of vaginal deliveries during the first 24 hours. In addition, number of cesarean deliveries and adverse effects were compared between the three groups. The obtained data were analyzed using SPSS 18 software. Data analysis was performed according to the intention to treat principle. Chi-square test, Fisher Exact test, Student t-test, and Mann-Whitney U test, were used for comparing data. P-value≤0.05 was considered statistically significant.

    Results

      The three groups did not have any significant difference according to maternal age, gestational age at the time of admission, gravidity, parity, and primary Bishop Score. There was no significant difference between the three groups for the main outcome, which was vaginal delivery during the first 24 hours (p=0.887). There was no significant difference between the three groups according to hypertonicity, uterine hyperstimulation, meconium passage, non-reassuring fetal heart rate, neonatal Apgar score in minutes one and 5, and mean duration of beginning the intervention up to delivery. However, uterine tachysystole and NICU admission were more in the group to whom the titrated solution of misoprostol was administered (p=0.002 and p=0.037 respectively). The number of cesarean deliveries due to failure to progress was higher in the EASI group. However, EASI group showed the least number of none-reassuring fetal heart rate between the three groups. Meconium passage was more in the titrated misoprostol group, but the difference was not significant.

    Conclusion

    All three methods are appropriate methods for induction of labor in the cases of unfavorable cervix; and choosing each method depends on the expertise of labor staff, accessibility to the medications, cost, and taking care for monitoring the patients and adverse effects.

    Keywords: Cervical ripening, extra-amniotic saline infusion (EASI), Foley catheter, Induction of labor, Misoprostol, Prostaglandin E1, Meconium, Tachysystol
  • Maedeh Raznahan, Mohammad Hassan Emamian, Fateme Alipour, Hassan Hashemi, Hojjat Zeraati, Akbar Fotouhi* Pages 693-701
    Background

    Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middle-aged population in 2009 and 2014.

    Methods

    Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05.

    Results

    The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821-0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods.

    Conclusion

    The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.

    Keywords: Horizontal inequity index, Concentration index, Cataract surgery utilization, Middle-aged population, Iran
  • Reza Rezaee, Khalil Alimohammadzadeh*, Seyed Mojtaba Hosseini Pages 702-709
    Background

    Inequality in the distribution of medical equipment and facilities has mainly been observed in health centers and, particularly, in governmental hospitals in each country. This study aimed to assess inequality in the distribution of burn facilities in Iran, including burn beds and specialist physicians needed for burn patients in 2017.

    Methods

    This was a descriptive-analytic study, in which statistical records of the Ministry of Health and Medical Education for 2017 and the Population and Housing Report of 2016 of the Statistical Centre of Iran were used. The main variables studied were number of burn beds and number of general surgeons and plastic surgeons in medical universities in the provinces of Iran. Inequality in the distribution of these variables was evaluated using the Gini coefficient and the Lorenz curve. Excel 2010 software was used for data analysis.

    Results

    In 55% of the provinces, the number of beds per capita for 100 000 population was lower than the average of Iran (1.26 beds of burn ward), and in 45% of the provinces, it was higher than the average of Iran in terms of this index. The results showed that burn beds were distributed unevenly in medical universities (G=0.42). However, the provincial distribution of these beds had a favorable condition (G=0.21). Also, the numerical value of the Gini coefficient showed the alert status in the distribution of specialist physicians based on the university distribution (G=0.51).

    Conclusion

    Although solving the problems related to equality in the distribution of health resources is not an easy task, assessing this issue has a great impact on improving the policymaking procedures and allocating the health system resources. For the first time, this study presented some policies to avoid centralization and prevent some metropolitan cities from turning into cities with limited burn facilities through a comprehensive reviewing of the distribution of the main sources needed by the Iranian burn patients.

    Keywords: Inequality in health, Burn facilities, Hospital, Gini coefficient, Lorenz curve
  • Mandana Haghshenas, Ruohollah Seddigh, Nasibeh Hashemkhani, Amir Abbas Keshavarz Akhlaghi, Ahmad Mousavi, Shiva Soraya* Pages 710-714
    Background

    The present study was conducted to compare occupational burnout scores and determine their correlation with different dimensions of Temperament and Character Inventory (TCI) questionnaire among psychiatry, internal medicine, and surgery residents during the academic year 2013-14.

    Methods

    In this cross sectional analytical study, 201 residents were recruited. Colinger's 125-item TCI and Maslach's Burnout Inventory were completed by residents. The mean severity of burnout and the mean scores in the subgroups of temperament and character were compared between the 3 groups of residents, and the correlations were calculated. Data were analyzed using SPSS software version 16. Also, A 2-sided p value of less than 0.05 was considered significant.

    Results

    A significant positive correlation was found between severity of burnout and harm avoidance in internal medicine residents (r=0.7, p<0.001). Also, a significant correlation was found between severity of burnout and self-directedness in surgery residents (r=0.5, p=0.003), self-transcendence in internal medicine residents (r=0.04, p=0.009), and persistence in internal medicine (r=0.17, p=0.003) and surgery residents (r=0.10, p=0.004). A significant correlation was found between frequency of burnout and harm avoidance in internal medicine residents (r=0.6, p=0.001), self-directedness in surgery residents (r=0.9, p<0.001), persistence in surgery (r=0.14, p<0.001) and psychiatry residents (r=0.19, p<0.001), and finally self-transcendence in internal medicine residents (r=0.6, p<0.001).

    Conclusion

    Dimensions of character were different among surgery, internal medicine, and psychiatry residents. Likewise, the severity of burnout was different among them according to personality traits. Occupational burnout appears to be less if personality traits match the chosen specialty.

    Keywords: Occupational burnout, Personality, Psychiatry, Internal, Surgery
  • Mohsen Asadi Lari, Leila Moosavi Jahromi, Ali Montazeri, Nazila Rezaee, Ali Asghar Haeri Mehrizi, Mehran Shams Beyranvand, Mohammad Reza Vaez Mahdavi, Abbas Abbasi Ghahramanloo, Maryam Khazaee Pool, Ali Ghanbari, Ali Gholami* Pages 715-721
    Background

    Food insecurity as a major public health problem has associations with a wide range of adverse consequences on health and quality of life. The aim of this study is to determine the prevalence of food insecurity among Iranian households, its key socio-economic risk factors and population attributable risk via a large-scale cross-sectional study in the capital of Iran.

    Methods

    This cross-sectional study was performed among 30,809 households with complete questionnaires of food security, during 2011. The univariate test was used to investigate the association between economic status and covariates with household food insecurity. Multiple logistic regression model was used to assess the independent effect of economic status on household food insecurity.

    Results

    Totally, 37.8% (95% CI: 37.25, 38.34%) of the households were food insecure. There were significant associations between economic status and household food insecurity after adjustment for other variables (p-value<0.001). The extent of household food insecurity that could be attributed to the economic status in the 1st and 2nd quintiles (poorest and poor households), compared with the 5th quintile (richest households), was estimated to be 48.43% and 60.12%, respectively.

    Conclusion

    Food insecurity is relatively prevalent among households in Tehran. Economic status was identified as the most significant determinant of household food security, as 62.7% of poorest households were food insecure. Therefore, there is a crucial need to address food insecurity as a priority in food policies.

    Keywords: Food insecurity, Risk factor, Population attributable risk, Socio-economic status
  • Parisa Mehdizadeh, Hossein Daniyali, Mohammad Meskarpour Amiri, Nooredin Dopeykar*, Hadi Youzi Pages 722-726
    Background

    Despite a lot of studies carried out on catastrophic and impoverishing health expenditures, exposure to these expenditures have not been studied among health staffs and their families yet. So that our study has analyzed exposure to CHE (Catastrophic Health Expenditures) and factors affecting them among the health staffs affiliated to army medical universities in Tehran.

    Methods

    This study was a descriptive-analytical and cross-sectional study implemented in 2016. Among all health staffs of a university of medical sciences, the full details of 240 households (838 individuals) were collected by using a stratified random sampling method. The data gathering and analyzing process have been done based on WHO standard guideline. Finally, the odds ratio of CHE determinants is reported using logistic regression by backward elimination method and chi-square test.

    Results

    The results of this study showed that 7.5% (CI: 7.3-7.7) of health staff households (54 individuals) are faced with CHE. The odds of exposure to CHE for households with 3 members and less, households with lower education level and households with two or more outpatient visits were significantly more than others (p<0.05). Households who have used dental services during the past year were 8.77 times (p<0.001) more at risk of CHE. Also, households with 3 members and less, households with lower education level and households with two or more outpatient visits were 8.59, 7.96, and 3.39 times more at risk of such payments, respectively.

    Conclusion

    CHE is a common financing dilemma even among health staffs.  Families who have more referring to health centers and less education level and also dental service users are more at risk of exposure. Health policy-makers should pay more attention to such vulnerable and high-risk groups. Finally, our study results recommended the increase of dental insurance coverage as an effective strategy to reduce exposure to CHE.

    Keywords: Catastrophic health expenditures, Impoverishing health costs, Health personnel
  • Nasibeh Hashemkhani, Ruohollah Seddigh, Amir Abbas Keshavarz Akhlaghi, Ahmad Mousavi, Shiva Soraya* Pages 727-731
    Background

    This study was conducted to compare temperament and character among psychiatry residents, internal medicine, and surgery residents in hospitals affiliated to Iran University of Medical Sciences in the academic year 2013–2014.

    Methods

    This cross sectional analytical study was conducted on 201 residents using the non-probability method of convenience sampling. Cloninger’s 125-item Temperament and Character Inventory (TCI) and Maslach’s Burnout Inventory (MBI) were distributed among all the residents in their morning session. Once the questionnaires were completed and submitted, the data were analyzed in SPSS 16. The frequency of different personality traits was analyzed among the selected residents. 

    Results

    A total of 49.8% of the respondents were female (n=100) and 50.2% were male (n=101). The results of data analysis showed more novelty seeking, reward dependence, and harm avoidance and less persistence (33.93, p=0.006; 9.00, p=0.056; 32.55, p=0.021; and 2.48, p=0.028, respectively) in psychiatry residents than in surgery residents (31.97, 7.87, 30.74, and 3.12 respectively). Reward dependence was more frequent in internal medicine residents than in surgery residents (9.44 and 7.87 respectively, p=0.002). The self-directedness score was lower in psychiatry residents than in internal medicine residents (p=0.761) and higher than in surgery residents (17.96, 18.30, and 17.57 respectively, p=0.824). The cooperativeness and self-transcendence scores were higher in psychiatry residents than in internal medicine (p=0.943, p=0.199, respectively) and surgery residents (p=0.105, p=0.069 respectively).

    Conclusion

    The different dimensions of personality varied between the surgery, internal medicine, and psychiatry residents. Particularly, this study did not show statistically significant differences in dimensions of character (cooperativeness, self-directedness, and self-transcendence) among surgery, internal medicine, and psychiatry residents. The selection of medical specialties based on character traits significantly contributes to more effective treatment of patients and higher satisfaction of the residents.

    Keywords: Character, Medical resident, Psychiatrist, Internist, Surgeon
  • Behzad Karami Matin, Ali Kazemi Karyani, Satar Rezaei, Moslem Soofi, Shahin Soltani* Pages 732-735
  • Marzie Faraji, Mona Ebrahimipour*, Nahid Jalilevand Pages 736-740
    Background

    Preterm children are at risk of deficits in language, including grammatical skills. The main purpose of this survey was to investigate whether Persian-speaking children born preterm differ in their morphosyntax ability compared to full-term children.

    Methods

    Morphosyntactic performance was assessed in 86 Persian-speaking children (43 healthy preterm and 43 full-term children) aged 4 and 5 years using the Persian Developing Sentence Scoring (PDSS).  Participants were matched for age, gender, and gestational age. 

    Results

    The healthy preterm children who participated in this study were significantly outperformed by the full-term children in the morphosyntactic evaluation (p<0.05). Furthermore, their grammatical skills, based on PDSS, were not as developed as 4 to 5-year-old full-term children. Gender, in general, and gestational age had no effect on the PDSS scores of preterm children (p>0.05).

    Conclusion

    Preterm children, regardless of gestational age, are at risk of morphosyntax impairments, which may not be recovered during the normal development. Therefore, grammatical evaluation and treatment seem to be necessary for these children.

    Keywords: Preterm children, Morphosyntax ability, NICU, PDSS, Language delay, Syntax
  • Masomeh Rostami Moez, Mehdi Kangavari, Gholamheidar Teimori, Maryam Afshari*, Marya Ebrahimi Khah, Khadijeh Bande Elahi Pages 741-750
    Background

    Children under five years old are the most vulnerable in home-injuries. More than half of the accident happens at home. Intervention programs are effective ways to reduce the risk of injuries. The use of cultural strategies has been recommended for effective interventions. The aim of this study was to evaluate cultural adaptability in interventional studies which were performed to prevent injuries caused by domestic accidents in children under five years old in all countries.

    Methods

    This systematic review has been conducted from June to July 2016. Iran Medex, Magiran, SID from Persian databases and Scopus, Web of Science, Science direct, Pub Med, Biomed central from English databases were employed. Available cultural adaptation guidelines were used to compare the cultural adaptation strategies. A search of studies had been conducted from the creation of databases until July 2016.

    Results

    Overall, 15 studies were entered into the analyses. The interventional approach in 11 studies was an educational approach. Consequently, 8 studies from 11 reported that they had significantly achieved all expected outcomes. Three studies had used behavioral change models or theories to achieve the desired changes. Seven studies had considered socio-cultural strategy in their interventions, and six studies had reported achieving outcomes. Only seven studies acquired a minimum score of cultural adaptation.

    Conclusion

    In this systematic review, an educational intervention was effective in preventing child injuries. If cultural strategies are taken into consideration in interventions, they will have a change in behavior in this regard. Also, theoretical frameworks and models can be effective.

    Keywords: Cultural, Child, Safety, Wounds, Injuries
  • Behzad Karami Matin, Mohammad Kamali, Heather J Williamson, Fardin Moradi, Shahin Solatni* Pages 751-756
    Background

    In developing countries, people with disabilities (PWD) are more likely to have unequitable access to health care services than their counterparts without disabilities. Access to health care is a multidimensional concept and PWD experience various barriers to use health care.  This quantitative study explored the predictors and determents of access to health care for PWD in an Iranian context.

    Methods

    Data were collected from a cross sectional study conducted in Tehran in 2017. A total of 403 adults with physical and/or intellectual disabilities were selected using census method. The data on PWD were collected from 14 rehabilitation centers affiliated to Welfare Organization and Red Crescent Organization. The self–report World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to collect data on disability status. T test, ANOVA, and multiple linear regressions were used to determine factors influencing access to health care for PWD. Significance level was set at 5%. Also, SPSS software version 20.0 was used for data analysis.

    Results

    The mean of access to health care among people with intellectual disabilities (mean: 61.77, 95% confidence interval (CI):59.20, 64.35) was significantly lower than their counterparts with physical disabilities (Mean: 67.97, 95% CI: 65.26, 70.69). The results of multiple linear regression analysis showed that in the affordability dimension, type of disability, marital status, and supplemental health insurance could predict access to health services for PWD. In availability dimension, only location predicted the outcome variable significantly. Also, location and type of disability were considered to be potential predictors of access to health services in acceptability dimension.

    Conclusion

    The results indicate that various factors can limit access to health services for PWD. To achieve universal health coverage, vulnerable groups and their needs should be identified to increase equitable access to health care services. Also, the health care system should pay more attention to demographic differences when planning and providing affordable and acceptable health care for PWD. Finally, the role of the government as the heath stewardship is vital to promote health care access for PWD in Iran.

    Keywords: Health disparities, Access to health care, Disability, Rehabilitation, Iran
  • Fateme Zahedi Abghari, Fatemeh Bayat, Masoumeh Razipour, Morteza Karimipoor, Maryam Taghavi Basmenj, Sirous Zeinali, Elham Davoudi Dehaghani* Pages 757-761
    Background

    Niemann-Pick diseases are rare inherited lipid storage disorders caused by mutations in the SMPD1, NPC1, and NPC2 genes. The aim of this study was to assess the mutation spectrum of a cohort of Iranian Niemann-Pick patients.

    Methods

    A consanguineous couple with a child suspected of having Niemann-Pick disease type A (died at age 2) was screened for gene mutations in the SMPD1 gene. Sanger sequencing was performed for all exons and exon-intron boundary regions. A literature review on SMPD1, NPC1, and NPC2 genes mutations in Iran was conducted using published original papers on this subject.

    Results

    A novel frameshift c.762delG (p.Leu256fs*) at a heterozygous state was identified in the parents. According to the review study, identified mutations in 39 Iranian patients were concentrated in exon 2 of the SMPD1 gene and exons 8 and 9 of the NPC1 gene.

    Conclusion

    Niemann-Pick diseases genes mutation analysis (SMPD1, NPC1, and NPC2) in Iran shows the genetic heterogeneity of these diseases in this country. More studies with larger sample sizes should be conducted to further examine genetic changes associated with Niemann-Pick diseases in Iran.

    Keywords: Niemann-Pick disease type A, Type B, Type C NPD, SMPD1, NPC1, NPC2
  • Mohammad Reza Aghajankhah Tamijani, Negar Moghaddam, Hassan Moladoust* Pages 762-767
    Background

    The prevalence of detected abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) has been different in previous studies based on the study population, and no data are available on AAA in the population of north of Iran. The aim of this study was to investigate the prevalence of AAA in individuals aged 50 and over in the north of Iran who were a candidate for TTE.

    Methods

    This cross sectional study was conducted on all individuals aged 50 and over who referred to our cardiovascular center for TTE evaluation from October 2016 to October 2017. The maximum diameter of the whole abdominal aorta was accepted as abdominal aortic size and a diameter ≥ 30 mm as AAA. All statistical analyses were conducted using SPSS Version 22.0. Also, Mann-Whitney and chi-squared tests were used to compare variables. A p<0.05 was considered significant.

    Results

    In total, 1411 patients underwent TTE in this study and abdominal aorta was visualized in 1329 patients (93.9%) successfully. The prevalence of AAA was 0.5% (7 patients, 95% CI: 0.496-0.503) during the study period. Patients with AAA were significantly older (p=0.002), with a mean age of 74.4±7.7 years, and 85.7% (6 patients) had hypertension, which was significantly higher (p=0.022) than patients without AAA.

    Conclusion

    This study showed that the AAA prevalence during standard TTE in the northern population of Iran aged 50 and over was 0.5%, which was lower than a previous study in Tehran that found AAA on 3.8% of screened patients. Patients with AAA in this population were significantly older and more hypertensive.

    Keywords: Abdominal aortic aneurysm, Aneurysm, Aorta, Echocardiography, Transthoracic
  • Masoumeh Baghersalimi, Rozita Fathi*, Sohrab Kazemi Pages 768-777
    Background

    Altered circulating amino acids levels have been observed in metabolic disorders, like obesity, type-2 diabetes, and other insulin-resistant states. This study aimed to investigate the effect of 8-week walking on plasma amino acids (PAAs) in obese girls.

    Methods

    This clinical trial study (IRCT20180928041160N1) was conducted on 32 early/mid pubertal obese girls which they divided into interval-walking (IWG, n=12), continuous-walking (CWG, n=11) and control (CG, n=9) groups. The walking program (3-sessions/week for 8-weeks) consists of 30-min walking with 70-85%HRmax and 60-75%HRmax, respectively in the IWG (2-min walking and 1-min active rest) and CWG. The concentration of PAAs was measured at baseline and 72-hours after the last session in fasting state, using high-performance liquid chromatography. A repeated measures ANCOVA (group (3) * time (2)) with post hoc Bonferroni was used to analyze the data.

    Results

    More the PAAs were not affected by interval or continuous walking training. A significant increase in lysine (p=0.003, 95%CI 24.08, 108.97) was observed only in the CG, and there was a significant difference between the CG and CWG (p=0.032). Global arginine bioavailability (GABA) significantly decreased in the CG (P<0.001, 95%CI -0.65, -0.21) and the IWG (p=0.004, 95%CI -0.60, -0.21). A significant increase in weight (p=0.043, 95%CI 0.27, 1.46), insulin (p=0.046, 95%CI -0.91, 9.01), and HOMA-IR (p=0.007, 95%CI 0.26, 2.63) were found only in the CG, and both insulin and HOMA-IR tended to decline in the CWG.

    Conclusion

    Except for lysine and GABA, all groups roughly showed similar changes in more amino acids. Continuous-walking could improve the plasma level of lysine and GABA, which along with an improvement of fasting insulin levels and HOMA-IR.

    Keywords: Obesity, Child, Puberty, Walking, Amino acids
  • Tina Beyranvand, Aidin Aryankhesal*, Asgar Aghaei Hashjin Pages 778-787
    Background

    There is a growing global movement toward quality and safety in healthcare and quality improvement (QI) in general surgery. The fundamentals of QI begin with an understanding of the underlying theoretical framework. This study aims to provide an overview of the existing QI models and frameworks for general surgery

    Methods

    In this systematic review, published literature from January 2007 until September 2018 were retrieved from PubMed, Scopus, Web of Science and Embase databases, and Google Scholar using the MeSH terms related to QI and surgery. In total, 25 full-text articles were finally included, and data extraction was based on research objectives. 

    Results

    Nine models were identified for QI in general surgery. These models were categorized into two main groups: (i) conceptual models or frameworks designed for QI in industry and applied in surgery, and (ii) those designed specifically for QI in surgery. Identified QI models were more used for improving postoperative processes and pre-hospital trauma care, identifying causes of prolonged periods of stay and lowering LOS index, improving surgical antimicrobial prophylaxis and antibiotics administrating during surgery process, reducing and controlling infections, reducing complications, reducing mortality and morbidity, reducing waiting times and start time delays, reducing variability and improving surgical clinic experience, reducing costs, improving operating room efficiency by removing processes that add no value, and lowering per-capita costs

    Conclusion

    According to the findings of this study, there are different models and frameworks with different aspects and dimensions for QI in surgery, which is recommended to use either of these models alone or with each other for specific circumstances. The use of these models in surgery is increasing, and it is recommended that these models could be used according to their functions in cases such as reducing the unnecessary use of resources, increasing the satisfaction of patients and their families with health care and improving the efficiency, safety and quality of healthcare in the surgical departments.

    Keywords: Quality improvement, Improvement model, surgery, hospital, Systematic review
  • Abolfazl Mohammadbeigi, Seyed Mohsen Zahraei, Azam Sabouri, Azadeh Asgarian, Sima Afrashteh, Hossein Ansari* Pages 788-793
    Background

    During the past years, due to the increase in immunization coverage and promotion of surveillance data, the incidence of measles decreased. This study aimed to determine the measles incidence risk, to conduct spatial mapping of annual measles incidence, and to assess the transition threat in different districts of Iran.

    Methods

     A historical cohort study with retrospective data was conducted. The measles surveillance data containing 14 294 cases suspected of having measles in Iran were analyzed during 2014-2016. WHO Measles Programmatic Risk Assessment Tool was applied to calculate and map the incidence of measles in each district, to determine the annual incidence rate, and to conduct spatial threat assessment risk. Threat assessment was measured based on factors influencing the exposure and transmission of measles virus in the population. The annual measles incidence rate and spatial mapping of incidence in each Iranian district was conducted by Measles Programmatic Risk Assessment Tool. Data were analyzed by descriptive statistics in Excel 2013 and Arc GIS 10.3. 

    Results

    Of 14 294 suspected cases, 0.6% (CI 95%: 0.599-0.619) were identified as clinically compatible measles, 0.280 (CI 95%: 0.275-0.284) as confirmed rubella, 0.52% (CI 95%: 0.516-0.533) as epi-linked measles, 4.6% (CI 95%: 0.450-0.464) as lab-confirmed measles, and 94% (CI 95%: 93.93-94.11) were discarded. The annual incidence rate in cases per 100 000 populations increased from 0.0726, (CI 95%; 0.0714-0.0738) in 2014 to 0.1154 (CI 95%; 0.1135-0.1173) in 2016, and the 3-year incidence rate during the study period was 1.032 (CI 95%; 1.017-1.047) and the annual average was 0.3442 (CI 95%; 0.3387-0.3496).

    Conclusion

     The average annual incidence rate of measles in Iran was low, but after a 11-fold increase in the number of measles cases in 2015, the number of measles cases decreased to more than 7-times in 2016. However, maintaning a high immunization coverage of measles and timely vaccination can be effective in reaching the goal of measles elimination.

    Keywords: Incidence rate, Iran, Measles, Surveillance, Spatial mapping
  • Mohammad Reza Azizi, Homa Mohammadsadeghi, Kaveh Alavi, Maryam Rasoulian, Nazila Karimzad, Mehrdad Eftekhar Ardebili Pages 794-798
    Background

    Borderline Evaluation of Severity over Time (BEST) is one of the self-reported tools for evaluation of the severity and track the response of treatment of borderline personality disorder. The present study evaluated the validity and reliability of Persian Translation of the Borderline Evaluation of Severity over Time (BEST) Questionnaire and to compare it with a semi-structured clinical interview for DSM-IV axis II (SCID-II).

    Methods

    The questionnaire was translated into Persian and then, the content and face validities of the questionnaire were determined. The translated BEST questionnaire and SCID-II were conducted on 33 outpatients and 32 hospitalized patients with diagnosis of borderline personality disorder and 30 patients’ companions. Forty-five patients completed the questionnaire again in an interval between 7 to 45 days. The data were analyzed using exploratory factor analysis, paired sample t-test, and the Pearson correlation coefficient and Cronbach’s α coefficient.

    Results

    This study evaluates the content validity, face validity, and criterion validity and reliability of the Persian version of the BEST Questionnaire. The mean scores of the BEST questionnaire were 45.6, 39.2, and 24.3 in in-patients, outpatients, and controls, respectively (p=0.001). The mean scores of the BEST questionnaire were 43.7 in the first evaluation, and 41.4 in the second one (r=0.619, p<0.001). Cronbach’s α coefficient was 0.761, and it reached to 0.898 after omitting items 13 to 15. The questionnaire had a two-factor structure, including internal turmoil and the disturbance in interpersonal relationships.

    Conclusion

    The Persian version of the BEST Questionnaire has a high face and content validity, high criterion validity, moderate to high reliability, and an acceptable two-factor structure.

    Keywords: Borderline personality disorder (BPD), Borderline Evaluation of Severity over Time (BEST), Structured Clinical Interview for DSM-IV (SCID-II), Validity, Reliability