فهرست مطالب

Medical Journal Of the Islamic Republic of Iran - Volume:29 Issue:1, 2015
  • Volume:29 Issue:1, 2015
  • تاریخ انتشار: 1394/02/20
  • تعداد عناوین: 151
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  • Monireh Mohsenzadegan, Nader Tajik, Zahra Madjd, Mehdi Shekarabi, Mohammad M. Farajollahi * Pages 1-7
    Background
    Prostate cancer is one of the leading causes of cancer deaths among men. New gene expressed in prostate (NGEP), is a prostate-specific gene expressed only in normal prostate and prostate cancer tissue. Because of its selective expression in prostate cancer cell surface, NGEP is a potential immunotherapeutic target. To target the NGEP in prostate cancer, it is essential to investigate its expression in prostate cancer cells.
    Methods
    In the present study, we investigated NGEP expression in LNCaP and DU145 cells by real time and RT-PCR, flow cytometric and immunocytochemical analyses.
    Results
    Real time and RT-PCR analyses of NGEP expression showed that NGEP was expressed in the LNCaP cells but not in DU145 cells. The detection of NGEP protein by flow cytometric and immunocytochemistry analyses indicated that NGEP protein was weakly expressed only in LNCaP cell membrane.
    Conclusion
    Our results demonstrate that LNCaP cell line is more suitable than DU145 for NGEP expression studies; however, its low-level expression is a limiting issue. NGEP expression may be increased by androgen supplementation of LNCaP cell culture medium.
    Keywords: DU145 cell line, LNCaP cell line, NGEP, Prostate cancer.
  • Bahman Cheraghian, Saharnaz Nedjat, Mohammad Ali Mansournia, Reza Majdzadeh, Kazem Mohammad, Mohammad Reza Vaez, Mahdavi, Soghrat Faghihzadeh, Ali Asgharhaeri Mehrizi, Mohsen Asadi, Lari * Pages 8-15
    Background
    Myocardial Infarction (MI) is a main cause of death and disability worldwide, which involves a number of genetic, physiopathologic and socio-economic determinants. The aim of this study was to assess the patterns of association between education, wealth and some other risk factors with non-fatal MI in Tehran population.
    Methods
    Data derived from a second round of large cross-sectional study, Urban HEART-2, conducted in Tehran in 2011. Out of 118542 participants, all 249 self-reported incident cases of non-fatal MI were selected as the case group. A number of 996, matched on age and sex, were selected as controls. Principle component analysis (PCA) was used to calculate wealth index and logistic regression model to assess relations between the study variables.
    Results
    Mean (SD) age of participants was 60.25 (12.26) years. A total of 870 (69.9%) of the study subjects were men. Education, wealth status, family violence, hypertension and diabetes were observed as independent predictors of non-fatal MI. Overall, as the level of education increased, the odds of non-fatal MI decreased (p<0.001). We observed an almost J-shaped association between wealth status and non-fatal MI. No significant associations were found between marital status, BMI and current smoking with non-fatal MI (p<0.05).
    Conclusion
    We found different patterns of association between education and wealth with nonfatal MI among Tehran adults. Lower risk of non-fatal MI is linked to high educated groups whereas economically moderate group has the lowest risk of non-fatal MI occurrence.
    Keywords: Myocardial infarction, Education, Wealth, Case, control, Iran
  • Azadeh Sayarifard, Laleh Ghadirian *, Ahmad Mohit, Mehrdad Eftekhar, Mahnaz Badpa, Fatemeh Rajabi Pages 16-24
    Background
    Mental health literacy is an individual’s knowledge and belief about mental disorders which aid their recognition, management and prevention. The aim of this study was to investigate mental health literacy among students of Tehran University of Medical Sciences.
    Methods
    In this cross-sectional study, data were collected by the anonymous self-administered questionnaires and finally 324 students participated in the study. Random cluster sampling was used. Questions were in different areas of the mental health literacy for depression include recognition of disorder, intended actions to seek help and perceived barriers, beliefs about interventions, prevention, stigmatization and impact of media. T-test was used for statistical analysis.
    Results
    The mean (±SD) age was 23.5±2.8. The participants were 188 (58.1%) females and 136 (41.9%) males. In response to the recognition of the disorder 115 (35.6%) students mentioned the correct answer. In help-seeking area, 208 (64.3%) gave positive answer. The majority of affected students sought for help from their friends and parents. Stigma was the greatest barrier for seeking help. Television and Internet were the most common sources of information related to mental health.
    Conclusion
    Generally students’ mental health literacy on depression was low in some areas. Appropriate educational programs specifically for reducing mental disorders stigma seems necessary. Organizing networks of co-helper students for mental health could be considered.
    Keywords: Mental health literacy, Medical science's students, Knowledge
  • Tayebeh Pourghaznein, Hakimeh Sabeghi *, Keyvan Shariatinejad Pages 25-31
    Background
    Nursing education can maintain its dynamic quality when it moves toward innovation and modern methods of teaching and learning. Therefore, teachers are required to employ up to date methods in their teaching plans. This study evaluated the effects of e-learning, lectures, and role playing on nursing students’ learning, retention, and satisfaction.
    Methods
    Sixty nursing students were selected as an experiment and control groups during two consecutive semesters. The educational content was presented as e-learning and role playing during one semester (experiment group) and as lectures in the next semester (control group). A questionnaire containing three parts was used to assess demographics, learning and satisfaction statuses. The questionnaire also included a final open-ended question to evaluate the students’ ideas about the whole course.
    Results
    The mean scores of posttest were 16.13 ± 1.37 using role playing, 15.50 ± 1.44 using e-learning and 16.45 ± 1.23 using lectures. The differences between the mean scores of posttest and pretest were 12.84 ± 1.43, 12.56 ± 1.57, and 13.73 ± 1.53 in the mentioned methods, respectively. Lectures resulted in significantly better learning compared to role playing and e-learning. In contrast, retention rates were significantly lower using lectures than using role playing and e-learning. Students’ satisfaction from e-learning was significantly lower than lecturing and role playing.
    Conclusion
    Due to the lower rates of retention following lectures, the teachers are recommended to use student-centered approaches in their lectures. Since students’ satisfaction with e-learning was lower than the other methods, further studies are suggested to explore the problems of e-learning in Iran.
    Keywords: E, learning, lecture, role play, nursing students
  • Mansour Ebrahimi *, Amin Ahmadi, Saeed Yaghfoori, Maryam Rassouli, Mohammad Azizzadeh Pages 32-34
  • Maryam Sadat Parsa, Ghassem Mohammadkhani *, Fahimeh Hajabolhassani, Shohreh Jalaee, Hassanali Zakeri Pages 35-41
    Background
    Multiple sclerosis (MS) is a chronic neurological disease that affects brain and spinal cord. The infratentorial region contains the cerebellum and brainstem. Vestibular evoked myogenic potentials (VEMPs) are short-latency myogenic responses. Cervical vestibular evoked myogenic potential (cVEMP) is a manifestation of vestibulocolic reflex and ocular vestibular evoked myogenic potential (oVEMP) contributes to the linear vestibular–ocular reflex. The aim of this study was to evaluate cVEMP and oVEMP in MS patients with and without infratentorial plaques and compare the findings with normal controls.
    Methods
    In this cross-sectional study, latency and amplitude of cVEMP and oVEMP were recorded in 15 healthy females with mean age of 31.13±9.27 years, 17 female MS patients with infratentorial plaque(s) and mean age of 29.88±8.93 years, and 17 female MS patients without infratentorial plaque(s) and mean age of 30.58±8.02 years. All patients underwent a complete clinical neurological evaluation and brain MRI scanning. Simple random sampling method was used in this study and data were analyzed using one way ANOVA through SPSS v22.
    Results
    The latency of N1-P1 and P13 in MS participants with and without infratentorial plaques were significantly prolonged compared to normal controls (p<0.001). Additionally latency of P13-N23-N1 and P1 in MS patients with infratentorial plaques were significantly prolonged compared to patients without infratentorial plaques subjects (p<0.001).
    Conclusion
    Abnormality of both cVEMP and oVEMP in MS patient with infratentorial plaque are more than that of MS patient without infratentorial plaque. Recording both ocular and cervical VEMPs are appropriate electrophysiologic methods assessing the function of both ascending and descending central vestibular pathways.
    Keywords: Multiple sclerosis, Cervical, ocular, Vestibular evoked myogenic potential, Infratentorial plaque
  • Ali Karimi, Masoumeh Moezzi *, Reza Imani Pages 42-48
    Background
    Hepatitis B Virus (HBV) causes acute and chronic liver disease worldwide. HBV has eight genotypes (A to H) which is the reflection of its genome with their characteristic geographical distribution. Each genotype could have different pathogenic and therapeutic characteristics. There have been few records on HBV genotyping in general population from our region. This study aimed to determine hepatitis B genotypes using sequencing in the general population of Shahrekord, a Southwestern region of Iran.
    Methods
    A total of 3000 serum samples (cluster sampling method) were enrolled from general population tested for HBsAg using ELISA. Using appropriate extraction kit, HBV DNA was extracted from HBsAg positive samples and each was subjected to nested PCR for detection of HBV DNA. Finally, using sequencing, the samples were used for HBV genotyping. Data were analyzed by SPSS 19 using descriptive statistics, chi square, and Fisher’s exact test. P-value < 0.05 was considered as the level of significance.
    Results
    Out of 3000 serum samples, 40 (1.3%) were positive for HBsAg. HBV DNA was detected in 10 out of 40 (25%) of the samples studied. Genotype D was the predominant HBV type found in all of these 10 HBV positive samples.
    Conclusion
    Genotype D is probably the predominant HBV type in our region.
    Keywords: Chronic hepatitis B, nested polymerase chain reaction, genotyping
  • Farbod Ebadifard Azar, Ali Sarabi Asiabar * Pages 49-53
    Background
    Effective leadership is essential to passing through obstacles facing the health field. The current health care system in Iran has major problems and gaps in the field of effective leadership. The aim of this study was to evaluate hospital managers’ leadership style through self-assessment and to determine the correlation between leadership styles with healthcare executives’ leadership readiness and leadership effectiveness.
    Methods
    In this cross-sectional study a self-administered questionnaire completed by all internal healthcare executives of all teaching and non-teaching hospitals affiliated to Iran University of Medical Sciences. Questionnaire was composed to determine demographic information, leadership style questions, leadership effectiveness and leadership readiness. Descriptive statistics and Pearson correlation coefficient were used for data analysis.
    Results
    According to the findings, the dominant style of healthcare executives was transformational leadership style (with a score of 4.34). The leadership effectiveness was estimated at about 4.36 that shows the appropriate level of leadership effectiveness. There was a significant correlation (correlation coefficient of 0.244) between leadership readiness and transformational leadership style (p<0.05). Also, there was a significant correlation between leadership effectiveness with transformational (0.051) and transactional (0.216) styles.
    Conclusion
    There was a correlation between leadership readiness and leadership effectiveness with leadership styles. Application of this research will be crucial to universities and healthcare executives. This study suggests that strengthening the scientific basis is essential for leadership readiness and leadership effectiveness in healthcare system.
    Keywords: Leadership, Effectiveness, Readiness, Iran University of Medical Sciences
  • Maryam Amini, Maryam Khosravi *, Hamid Reza Baradaran, Rasha Atlasi Pages 54-61
    Background
    Hyperhomocysteinemia is a risk factor for cardiovascular disease particularly in patients with end stage renal disease (ESRD). Vitamin B12 supplementation on its own still remains as a controversial issue for clinicians in decreasing the level of homcysteine in this group of patients.
    Methods
    Using all randomized controlled trials (RCTs), clinical trials and pre-post-trial studies found during January 1999 to March 2014, we conducted a systematic review which assessed the effects of vitamin B12 in decreasing homocysteine levels in patients with ESRD.
    Results
    The findings of this study revealed that, overall, the greatest effect of B12 supplementation on decreasing homocysteine levels in patients with ESRDs occurred when it was combined with folate supplementation. It was also demonstrated that injection treatments might be more beneficial than oral intake treatments.
    Conclusion
    More rigorous studies are needed to draw a firm conclusion about B12 therapy and the level of homocyteine in patients with ESRD.
    Keywords: Homocysteine, Kidney Failure, Vitamin B12, Hemodialysis, Kidney, Amino Acids, Renal Failure, Review
  • Parisa Goodarzi *, Hamid Reza Aghayan, Bagher Larijani, Masoud Soleimani, Ahmad, Reza Dehpour, Mehrnaz Sahebjam, Firoozeh Ghaderi, Babak Arjmand Pages 62-71
    Parkinson’s disease (PD) is the second most common neurodegenerative brain disorder which is around 1.5 times more common in men than in women. Currently, drug medications, surgery, and lifestyle changes are common approaches to PD, while all of them focused on reducing the symptoms. Therefore, regenerative medicine based on stem cell (SC) therapies has raised a promising hope. Various types of SCs have been used in basic and experimental studies relevant to PD, including embryonic pluripotential stem cells, mesenchymal (MSCs) and induced pluripotent SCs (iPSCs). MSCs have several advantages over other counterparts. They are easily accessible which can be obtained from various tissues such as bone marrow, adipose tissue, peripheral blood, etc. with avoiding ethical problems. Therefore, MSCs is attractive clinically because there are no related ethical and immunological concerns. Further studies are needed to answer some crucial questions about the different issues in SC therapy. Accordingly, SC-based therapy for PD also needed more complementary evaluation in both basic and clinical study areas.
    Keywords: Cellular therapy, Neurodegenerative diseases, Parkinson's disease, Stem cell
  • Mehdi Moghtadaei, Javad Moghimi *, Gholamreza Shahhoseini Pages 72-76
    Background
    Proper rotation of components in total knee arthroplasty (TKA) will largely affect the postoperative outcome. Ethnical variation may affect rotational profile. We aimed to evaluate distal femur rotation in Iranian population using transepicondylar axes.
    Methods
    From a total of 450 knee CT scans and via consecutive sampling, 150 qualified subjects with normal lower extremities alignment were selected comprising 96 (64%) males and 54 (36%) females aging 17-80 years. The posterior condylar angle and condylar twist angles were defined as angles between either surgical epicondylar axis (line connecting lateral epicondylar prominence and the medial sulcus) or clinical epicondylar axis (line connecting most prominent points of both epicondyle) and posterior conylar line. Data were compared among genders.
    Results
    Average age of our samples was 43 years (ranging 11-80). Mean (±sd) values for posterior condylar angle and condylar twist angles were 2.35º(±1.34) and 5.77º(±1.70), respectively. The former variable was not discernible in twenty of our subjects because of obscure medial sulcus. Our findings were totally appeared similar to studies from other ethnicities and the observed minor differences may have originated from amount of osteoarthritis and malalignment.
    Conclusion
    Overall, Iranian distal femur rotational profile was similar to other reports. Some minor observed differences may be partially due to samples’ age and different amount of knee osteoarthritis. It is proposed to rely on several methods for determining rotational profile while performing TKA. Moreover, preoperative computed tomography should be fully scrutinized especially in severely osteoarthitic knees.
    Keywords: Femur, Rotation, computed tomography, Iranian
  • Kamran Mousavi Hosseini, Saleh Nasiri * Pages 77-82
    Background
    Factor VII concentrates are used in patients with congenital or acquired factor VII deficiency or treatment of hemophilia patients with inhibitors. In this research, immunoaffinity chromatography was used to purify factor VII from prothrombin complex (Prothrombin-Proconvertin-Stuart Factor-Antihemophilic Factor B or PPSB) which contains coagulation factors II, VII, IX and X. The aim of this study was to improve purity, safety and tolerability as a highly purified factor VII concentrate.
    Methods
    PPSB was prepared using DEAE-Sephadex and was used as the starting material for purification of coagulation factor VII. Prothrombin complex was treated by solvent/detergent at 24°C for 6 h with constant stirring. The mixture of PPSB in the PBS buffer was filtered and then chromatographed using CNBr-activated Sepharose 4B coupled with specific antibody. Factors II, IX, VII, X and VIIa were assayed on the fractions. Fractions of 48-50 were pooled and lyophilized as a factor VII concentrate. Agarose gel electrophoresis was performed and Tween 80 was measured in the factor VII concentrate.
    Results
    Specific activity of factor VII concentrate increased from 0.16 to 55.6 with a purification-fold of 347.5 and the amount of activated factor VII (FVIIa) was found higher than PPSB (4.4-fold). Results of electrophoresis on agarose gel indicated higher purity of Factor VII compared to PPSB; these finding revealed that factor VII migrated as alpha-2 proteins. In order to improve viral safety, solvent-detergent treatment was applied prior to further purification and nearly complete elimination of tween 80 (2 μg/ml).
    Conclusion
    It was concluded that immuonoaffinity chromatography using CNBr-activated Sepharose 4B can be a suitable choice for large-scale production of factor VII concentrate with higher purity, safety and activated factor VII.
    Keywords: Factor VII, Activated factor VII, chromatography, Sepharose.
  • Mohammad Sadegh Fazeli, Mohammad Reza Keramati * Pages 83-104
    Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointestinal tract or even the colon. In this article, we will review the current updates on rectal cancer including epidemiology, risk factors, clinical presentations, screening, and staging. Diagnostic methods and latest treatment modalities and approaches will also be discussed in detail.
    Keywords: Rectal cancer, Treatment, Review, Screening, Diagnosis, Staging, Treatment
  • Hosein Ali Danesh, Mahdy Saboury *, Ameneh Sabzi, Moosa Saboury, Maryamsadat Jafary, Shahriar Saboury Pages 105-109
    Background
    Fourniers gangrene caused by synergic aerobic and anaerobic organism is a life threatening disorder.
    Methods
    The medical records of 8 among 839 patients admitted to imam ali general hospital Zahedan university of Medical Sciences with fourniers gangrene during the 10 months period between 2012 and 2013 were reviewed.
    Results
    The most common etiology and presentation were abscess and perianal pain respectively. Mixed bacterial flora was common finding in patient. Single debridement was carried out in 2 patients and repeated procedure was needed in 6.
    Conclusion
    This disease is characterized with high mortality of up to 75% but in our study the rate was 37.5%. In other studies diabetes mellitus was found to be the common condition related to fourniers gangrene but in our study the common etiology was perianal abscess. Fourniers gangrene should be rule out in any patient with perianal pain and flulike, swelling skin.
    Keywords: Fourniers gangrene, Mortality, Debridement
  • Shoaleh Bigdeli, Vahid Pakpour, Maryam Aalaa, Robabeh Shekarabi, Mahnaz Sanjari, Hamid Haghani, Neda Mehrdad * Pages 110-117
    Background
    Educational clinical environment has an important role in nursing student's learning. Any difference between actual and expected clinical environment will decrease nursing students’ interest in clinical environments and has a negative correlation with their clinical performance.
    Methods
    This descriptive cross-sectional study is an attempt to compare nursing studentsperception of the actual and expected status of clinical environments in medical-surgical wards. Participants of the study were 127 bachelor nursing students of Iran University of Medical Sciences in the internship period. Data gathering instruments were a demographic questionnaire (including sex, age, and grade point average), and the Clinical Learning Environment Inventory (CLEI) originally developed by Professor Chan (2001), in which its modified Farsi version (Actual and Preferred forms) consisting 42 items, 6 scales and 7 items per scale was used. Descriptive and inferential statistics (t-test, paired t-test, ANOVA) were used for data analysis through SPSS version 16.
    Results
    The results indicated that there were significant differences between the preferred and actual form in all six scales. In other word, comparing with the actual form, the mean scores of all items in the preferred form were higher. The maximum mean difference was in innovation and the highest mean difference was in involvement scale.
    Conclusion
    It is concluded that nursing students do not have a positive perception of their actual clinical teaching environment and this perception is significantly different from their perception of their expected environment.
    Keywords: Clinical learning environment, Nursing education, Nursing student
  • Effat Merghati, Khoei, Shahnaz Rimaz *, Jeffrey E. Korte, Sudie E. Back, Kathleen T. Brady, Masoumeh Abad, Neda Shamsalizadeh Pages 118-126
    Background
    Intimate partner violence (IPV) and risky sexual behaviors are serious and overlapping public health problems that disproportionately affect drug-involved women. Despite the fact that drug-using women experience extensive IPV, to date, no studies have investigated the association of IPV and risky sexual behaviors among drug-using women in Iran.
    Methods
    Drug-using women (N =120) were recruited from a rehabilitation center in Tehran from March to October, 2009. The Revised Conflict Tactics Scale (CTS2), a standardized questionnaire, was used to collect data regarding violence. We used t-test and logistic regression models to explore the relationship between IPV domains and specific sexual risk behavior outcomes using SPSS 21.
    Results
    The means (sd) for CTS2 domains were as follows: negotiation 4.29 (1.55), psychological violence 2.55 (1.51), sexual violence 0.37 (1.00), physical abuse 1.17 (1.49), injury 2.18 (1.97), and the mean total score was 1.69 (0.96). We found significantly higher injury scores, but lower sexual abuse scores among women with sexually-transmitted infection (STI) compared to women without STI (p-values 0.030 and <0.0001, respectively). In addition, we found that psychological abuse was positively associated with STI (p-value 0.03) and increased condom use (p = 0.010), possibly mediated through an increased likelihood of having multiple partners.
    Conclusion
    The findings revealed that in Iran drug-involved women experience high rates of IPV and that IPV is associated with increased risky sexual behavior. Implication: Preventive interventions for violence that are integrated within drug treatment programs, as well as harm reduction programs are highly recommended.
    Keywords: Intimate Partner Violence, Drug, use, Iranian women
  • Soheila Rahmani, Siavash Talepasand * Pages 127-138
    Background
    Cancer is not merely an event with a certain end, but it is a permanent and vague situation that is determined by delayed effects due to the disease, its treatment and its related psychological issues. The aim of this study was to examine the effectiveness of the mindfulness-based stress reduction program and conscious yoga on the mental fatigue severity and life quality of women with breast cancer.
    Methods
    This was a quasi-experimental study with a pre-test, post-test and control group. In this study, 24 patients with the diagnosis of breast cancer were selected among the patients who referred to the Division of Oncology and Radiotherapy of Imam Hossein hospital in Tehran using available sampling method, and were randomly assigned into the experimental and control groups. All the participants completed the Fatigue Severity Scale, Global Life Quality of Cancer Patient and Specific Life Quality of Cancer Patient questionnaires. Data were analyzed by multivariate repeated measurement variance analysis model.
    Results
    Findings revealed that the mindfulness-based stress reduction treatment significantly improved the overall quality of life, role, cognitive, emotion, social functions and pain and fatigue symptoms in global life quality in the experimental group. It also significantly improved the body image, future functions and therapy side effects in specific life quality of the experimental group compared to the control group. In addition, fatigue severity caused by cancer was reduced significantly.
    Conclusion
    The results showed that the mindfulness - based stress reduction treatment can be effective in improving global and specific life quality and fatigue severity in women with breast cancer.
    Keywords: Mindfulness, Yoga, Fatigue, Life Quality, Breast Cancer
  • Pooya Baradaran Motie, Ali Zare, Mirzaie *, Nasrin Shayanfar, Maryam Kadivar Pages 139-146
    Background
    Routine repeat testing of critical laboratory values is very common these days to increase their accuracy and to avoid reporting false or infeasible results. We figure that repeat testing of critical laboratory values has any benefits or not.
    Methods
    We examined 2233 repeated critical laboratory values in 13 different hematology and chemistry tests including: hemoglobin, white blood cell, platelet, international normalized ratio, partial thromboplastin time, glucose, potassium, sodium, phosphorus, magnesium, calcium, total bilirubin and direct bilirubin. The absolute difference and the percentage of change between the two tests for each critical value were calculated and then compared with the College of American Pathologists/Clinical Laboratory Improvement Amendments allowable error.
    Results
    Repeat testing yielded results that were within the allowable error on 2213 of 2233 specimens (99.1%). There was only one outlier (0.2%) in the white blood cell test category, 9 (2.9%) in the platelet test category, 5 (4%) in the partial thromboplastin time test category, 5 (4.8%) in the international normalized ratio test category and none in other test categories.
    Conclusion
    Routine, repeat testing of critical hemoglobin, white blood cell, platelet, international normalized ratio, partial thromboplastin time, glucose, potassium, sodium, phosphorus, magnesium, calcium, total bilirubin and direct bilirubin results does not have any benefits to increase their accuracy.
    Keywords: Critical values, Laboratory, Accuracy, Allowable error
  • Shandiz Moslehi, Pezhman Atefi Manesh, Ali Sarabi Asiabar * Pages 147-151
    Background
    Recently, quality is a serious concern in development of organizations. There are various indicators to assess quality and the purpose of this study was to identify the main indicators for quality measurement of Iranian health centers.
    Methods
    This qualitative study was conducted in three stages: first, review of the literature was performed to identify different indicators for quality measurement in health centers; second, a two-round Delphi process was used with participation of 18 experts in both rounds; third, Analytical Hierarchy Process (AHP) method was applied to give weights to each indicator.
    Results
    Twenty-seven indicators were identified from the literature review stage. The Delphi method reduced the list to 4 indicators. Developing a quality plan in the health center had the highest weight (38%) and percentage of followed complaints the lowest (12%). The consistency rate was 7.2% indicating appropriateness of the data.
    Conclusion
    This list of indicators can be used as a template for measuring quality of health centers in Iran and possibly in other developing countries.
    Keywords: Quality Measurement, Indicators, Health Cent
  • Aliasghar Ahmad Kiadaliri *, Mehdi Jafari, Mohammad, Reza Vaez Mahdavi, Soghrat Faghihzadeh, Naser Kalantari, Mohsen Asadi, Lari Pages 152-160
    Background
    To estimate and compare prevalence of overweight and obesity among adult people across the 22 districts of Tehran in 2011. Method s: This was a cross-sectional study using data on 47,406 women and 47,525 men aged≥ 15 years from a large population-based survey (Urban HEART-2). Age-standardized prevalence (ASP) of overweight (25≤BMI<30) and obesity (BMI≥30) were estimated for the Tehran’s districts. Pearson Chi2 tests and logistic regression were used to examine any significant differences in prevalence of these disorders across sociodemographic groups.
    Results
    ASPs of overweight were 36.5% and 32.0 % among men and women, respectively (p<0.001). These figures for obesity were 10.7% and 15.3% among men and women, respectively (p<0.001). Crude prevalence of overweight and obesity rose with age up to the age of 54 years and decreased thereafter. Across education groups, the lowest prevalence of overweight/obesity was seen among most educated people. The results showed that being young, single and student were associated with lower odds of overweight/obesity.
    Conclusion
    This study showed a high prevalence of overweight and obesity among adult in Tehran. There were significant associations between sociodemographic characteristics and prevalence of overweight/obesity among adults in Tehran. The results of this study might be used in identifying high risk groups of overweight and obesity in Tehran.
    Keywords: Overweight, Obesity, Prevalence, Tehran
  • Mitra Khalaf Beigi, Farahnaz Mohammadi Shahbolaghi *, Mehdi Rassafiani, Hojjat, Allah Haghgoo, Hamid Taherkhani Pages 161-168
    Background
    Work is the key component for most people in regard to financial, social and wellbeing matters. Employment is an important factor underpinning mental health disorders. However, unemployment remains an unsolved issue worldwide. Numerous studies have focused on employment outcomes in people with severe mental illness (SMI) but, only a few have explored their perspective on employment. Therefore, this study aimed to clarify the meaning of work among clients with SMI in Iran.
    Methods
    A qualitative research approach was used to conduct this research. Ten participants who were consumers of mental health services took part in this study. Data were analyzed by inductive content analysis approach.
    Results
    Four themes emerged from data including: acquiring identity, work as a drive, passing the time and financial independence.
    Conclusion
    Meaning of work in studied people with SMI was probably similar to the general population. The different finding in this study refers to the dominancy of family relationships and spiritual believes which could cover some problems and in turn affect the meaning of work. Highlighting these meanings could direct mental health professionals to better planning for their clients have better understanding of their clients’ work future and in turn provide more precise plan for them.
    Keywords: Severe mental illness, Vocation, Work, Meaning
  • Mehdi Nikbakht Dastjerdi, Mohammad Momeni, Reza Bidaki, Mehdi Khaleghinia, Masoud Karimi, Googheri, Mohammad Kazemi Arababadi, Ahmad Shabanizadeh * Pages 169-173
    Background
    Toll- like receptors (TLRs) play an important role in the recognition of DAMPs and PAMPs and induction ofinflammation. Previous studies demonstrated that depression and anxiety can influence the expression levels of immune related molecules. Our previous study revealed that mRNA levels of IRAK4, TRAF3 and IRF7 were significantly decreased in chronic HBV infected (CHB) patients when compared to healthy controls. Therefore, the aim of this study was to evaluate the effects of depression and anxiety on the expression levels of these molecules in CHB patients.
    Methods
    Sixty CHB patients participated in this studyand filled out the standard questionnaires; and the expression of IRAK4, TRAF3 and IRF7 were examined using Real-Time PCR techniques.
    Results
    The results of this study demonstrated that expression of IRAK4, TRAF3 and IRF7 did not differ between patients with various stages of depression and anxiety (all p>0.05).
    Conclusion
    According to the results, it seems that declined expression of IRAK4, TRAF3 and IRF7 inCHB patients were not related to depression and anxiety, and other factors including genetic and immunoregulatory effects of HBV may be responsible for the declined expression of these molecules.
    Keywords: Depression, Anxiety, Chronic HBV infection, IRAK4, TRAF3, IRF7
  • Parsa Yousefi Chaijan, Mojtaba Sharafkhah *, Bahman Salehi, Mohammad Rafiei Pages 174-180
    Background
    Attention Deficit Hyperactivity Disorder (ADHD) is the most common childhood neurological disorder. This disorder is more prevalent in some chronic diseases. The aim of this study was to investigate ADHD in children with early stages of chronic kidney disease (CKD) and to compare it with healthy children.
    Methods
    Seventy five 5-16-year-old children with early stages of CKD (stage 1, 2 and 3) and 75 healthy children without CKD were included in this case – control study as case and control groups, respectively. The participants were selected from those children who were referred to the pediatric clinic of Amir Kabir Hospital of Arak (Iran) in the form of simple probability and based on inclusion and exclusion criteria. ADHD was diagnosed using Conner's Parent Rating Scale – 48 (CPRS-48) and DSM-IV criteria and was confirmed by a psychologist consultant. Data were analyzed by Binomial test in SPSS18.
    Results
    ADHD inattentive type was observed in 8 cases (10.6%) with CKD and 2 controls (2.6%) (p= 0.109). Moreover, in the case and control groups, 7 (9.3%) and 6 (8%) children were affected by ADHD hyperactive-impulsive type (p= 0.997), and 9 (12%) and 12 (16%) children were affected by ADHD mixed type (p= 0.664), respectively.
    Conclusion
    No differences were found between the prevalence of ADHD in the children with early stages of CKD and the control group. However, due to the importance of the relationships between different types of psychiatric disorders and CKD and lack of enough evidence concerning the relationship between ADHD and different stages of CKD in children, conducting further studies in this field is recommended.
    Keywords: Attention Deficit Hyperactivity Disorder, Children, Chronic Kidney Disease
  • Fatemeh Ghaffari, Nahid Dehghan, Nayeri *, Mahboubeh Shali Pages 181-191
    Background
    Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it.
    Methods
    This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis.
    Results
    The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats.
    Conclusion
    Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students.
    Keywords: Humour, Nursing Care, Interaction, Communication, Qualitative Study
  • Elahe Tavassoli, Mahnoush Reisi, Seyed Homamodin Javadzade, Zabihollah Gharlipour, Hamid Reza Gilasi, Asghar Ashrafi Hafez * Pages 192-198
    Background
    Cardiovascular diseases refer to a group of diseases that affect the cardiovascular system; principally cardiac diseases, vascular diseases of the brain and kidney and peripheral arterial diseases which are caused by various factors. Considering the importance of nutrition education, especially the intake of fruits and vegetables, this study was performed to determine the effect of health education, Based on the Health Belief Model, on the improvement of intake of fruits and vegetables aiming at preventing cardiovascular diseases among high school girls in the city of Shahr-e-Kord, Iran.
    Methods
    This was a quasi-experimental intervention study, in which 120 female students of high schools in Isfahan were selected through convenient sampling and were divided into two groups of experimental (60) and control (60).The instruments for data collection were the Health Belief Model and FFQ questionnaires. The HBM questionnaire was completed three times (before, immediately and two months after the intervention) and the FFQ questionnaire was completed two times (before and two months after the intervention) by the students. After the pre-test, six educational sessions were provided for the experimental group. Finally, data were collected and analyzed by SPSS 16(t-test, paired t-test and repeated measure ANOVA).
    Results
    There were no differences between the two groups in terms of demographic variables. Before the intervention, there were not any significant differences between the scores of different structures of this model between the two groups (p>0.05); however, after the intervention, significant differences were found between the experimental and control groups in the levels of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy and performance (p<0.001).
    Conclusion
    According to the results, the intervention had a positive impact on the improvement of intake of fruits and vegetables among the students.
    Keywords: Education, Health Belief Model, Heart Diseases, Intake of Fruits, Vegetables.
  • Farzaneh Yazdani, Malahat Akbarfahimi *, Afsoon Hassani Mehraban, Shohreh Jalaei, Mohammad Torabi, Nami Pages 199-209
    Background
    Visualattention is known as acritical base for learning.Thepurpose of the present study was to design, develop and evaluate the test-retest and internal consistency reliability as well as face, content and convergent validity of thecomputer- based selective visual attention test (SeVAT) for healthy first-grade school children.
    Methods
    In thefirst phase of this study,the computer-based SeVATwas developedin two versionsof original and parallel.Ten experts in occupational therapy helpedto measure the content validity using the CVR and CVI methods.Face validity was measured through opinions collected from 10 first-grade children. The convergent validity of the test was examined using the Spearman correlation between the SeVAT and Stroop test. In addition, test-retest reliability was determined by measuring the intra-class correlation (ICC) between the original and parallel versions of theSeVAT in a single session. The internal consistency was calculated by Cronbach's alpha coefficients. Sixty first grade children (30 girls/30boys) participated in this study.
    Results
    The developed test was found to have good content and face validity. The SeVAT showed an excellent test-retest reliability (ICC= 0.778, p<0.001) and internal consistency (Cronbach's Alpha of original and parallel tests were 0.857 and 0.831, respectively). SeVAT and Stroop test demonstrated a positive correlation upon the convergent validity testing.
    Conclusion
    Our results suggested an acceptable reliability and validity for the computer-based SeVAT in the assessment of selective attention in children. Further research may warrant the differential validity of such a test in other age groups and neuro-cognitively disordered populations.
    Keywords: Children, Computer, based, Test, Reliability, Validity, Attention
  • Sule Yi, Ldi, Rim. *, Naci Topalo?, Lu, Mustafa Tekin, Adem KUCUk, Havva Erdem, Mesut Erba?, Ahmet Yi, Ldi, Ri, M Pages 210-215
    Background
    Proanthocyanidin is a potent bioactive antioxidant naturally occurring in grape seed and acts as reactive oxygen species (ROS) scavenger. The aim of this study was to investigate the effects of proanthocyanidinin in experimental ovarian torsion injury.
    Methods
    Twenty four rats were randomly divided into three groups (n=8). Group 1: the laparotomy group, group 2: ovarian torsion group, and group 3: intervention group administered proanthocyanidinin of 50 mg/kg before bilateral ovarian ischemia and reperfusion. Histologic examination and scoring was done at the end of the experiment. Statistical analyses were performed using the SPSS v. 19.
    Results
    Ovarian histopathologic findings of all three groups were significantly different in terms of hemorrhage (p<0.001), edema (p=0.001) and vascular dilatation (p< 0.001). Pathologic changes induced by I/R were reduced in ovaries of rats administered proanthocyanidin, in particular, hemorrhage, edema and vascular dilatation.
    Conclusion
    Proanthocyanidin, known as free radical scavenger and antioxidant, is protective against tissue damage induced by ischemia and/or ischemia/reperfusion in rat ovaries.
    Keywords: Proanthocyanidinin, Fertility, Ischemia Reperfusion, Ovarian torsion
  • Parisa Nejati, Azizeh Farzinmehr *, Maziar Moradi, Lakeh Pages 216-224
    Background
    Knee osteoarthritis (OA) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair, standing, walking and climbing stairs. Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocols in combination to conventional conservative therapy for knee OA.
    Methods
    It was a single blind RCT study with a 12-months follow-up. Totally, 56 patients with knee OA were assigned into 2 random groups. The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs (NSAIDs) and 10 sessions acupuncture and physiotherapy modalities. Non-exercise group received similar treatments except exercise program. The changes in patients’ pain and functional status were evaluated by visual analog scale (VAS), knee and osteoarthritis outcome score (KOOS) questionnaire and functional tests (4 steps, 5 sit up, and 6 min walk test) before and after treatment (1 and 3 months after intervention), and 1 year later at the follow-up.
    Results
    The results showed that the patients with knee OA in exercise group had significant improvement in pain, disability, walking, stair climbing, and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group. At third follow up (1 year later) there was significant difference between groups in VAS and in three items of KOOS questionnaire in functional status.
    Conclusion
    Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy, acupuncture, and modalities for knee OA.
    Keywords: Knee osteoarthritis, Strengthening exercises, Stretching exercises, Acupuncture, Functional status
  • Homa Rasoolijazi, Mehdi Mehdizadeh, Mansoureh Soleimani, Farnaz Nikbakhte, Mohsen Eslami Farsani, Shima Ababzadeh * Pages 225-235
    Background
    The Rosemary extract (RE) possesses various antioxidant, cytoprotective and cognition-improving bioactivities. In this study, we postulated which doses of RE have a more effect on the hippocampus of middle-aged rats.
    Methods
    In this experimental study, thirty-two middle-aged male Wistar rats were fed by different doses (50,100 and 200 mg/kg/day) of RE (containing 40% carnosic acid) or distilled water for 12 weeks. The effects of different RE doses on learning and spatial memory scores, hippocampal neuronal survival, antioxidant enzymes and lipid peroxidation amount were evaluated by one and two way analysis of variance (ANOVA).
    Results
    It seemed that RE (100mg/kg) could recover the spatial memory retrieval score (p< 0.05). The amount of activity of SOD, GPx and CAT enzymes in the hippocampus of animals of the RE (100mg/kg) group showed a significant increase compared to the normal group (p< 0.01), (p< 0.01) and (p< 0.05), respectively. Also, the amount of activity of GPx in the RE (50 mg/kg) group of animals showed a significant increase compared to the normal group (p< 0.05). No significant difference was found between the groups in the MDA level.
    Conclusion
    The results revealed that rosemary extract (40% carnosic acid) may improve the memory score and oxidative stress activity in middle aged rats in a dose dependent manner, especially in 100mg/kg.
    Keywords: Rosemary Extract, Morris Water Maze, Antioxidant Enzyme, Hippocampus, Rat
  • Afsaneh Nikjooy, Nader Maroufi *, Ismaeil Ebrahimi Takamjani, Homayoun Hadizdeh Kharazi, Bahar Mahjoubi, Rasoul Azizi, Hamid Haghani Pages 236-247
    Background
    Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation.
    Methods
    In this clinical trial study, among patients referring to the Colorectal Clinic of HazratRasoul Hospital, 22 subjects were randomly assigned into two equal groups (n=11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients’ symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent _t-test and Mann-Whitney test.
    Results
    Paradox index (p< 0.001), perineal descent index (p< 0.001), depression (p< 0.1), physical function (p<0.001), vitality (p< 0.001) and role emotion (p< 0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapySDT group.
    Conclusion
    Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient’s quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy.
    Keywords: Biofeedback Therapy, MR Defecography, Functional Constipation, Dyssynergic Defecation
  • Mohammadreza Mobinizadeh, Jalal Arabloo, Pejman Hamouzadeh, Ali Akbari Sari * Pages 248-256
    Background
    Catheter ablation is widely used for treatment of atrial fibrillation. The use of fluoroscopic and non-fluoroscopic mapping systems in catheter ablation is common. This study conducted to investigate the safety and effectiveness of Navx non-fluoroscopic mapping system.
    Methods
    In this study, the appropriate electronic databases including Cochrane Library and Ovid Medline searched until August 2013 using free text and MeSH. Systematic reviews, health technology assessment reports in which systematic review was conducted and controlled trials with the sample size of 100 patients and more were included into the study. Results of included studies were analyzed qualitatively.
    Results
    Seven papers were included in this study. According to these studies, non-fluoroscopic guidance systems may reduce the exposure to radiation compared to fluoroscopic system. NavX system has minimum exposure time. Non-fluoroscopic guidance systems are safer than fluoroscopic guidance system. NavX system reduces the procedure and fluoroscopy time. There was no significant difference between two systems, NavX and Carto, based on their safety and effectiveness.
    Conclusion
    EnsiteNavX system is relatively safer and more effective than fluoroscopic guidance systems for treating the cardiac arrhythmia.
    Keywords: Catheter Ablation, Cardiac Arrhythmia, Systematic Review
  • Mashallah Aghilinejad, Elahe Kabir, Mokamelkhah *, Yasser Labbafinejad, Amir Bahrami, Ahmadi, Hamid Reza Hosseini Pages 257-262
    Background
    Ergonomic training had been implemented for prevention or reduction of neck and shoulder complaints among workers. The purpose of the present study was to assess the role of ergonomic training intervention on decreasing the prevalence of neck and shoulder complaints among workers of an automobile factory.
    Methods
    Within the present randomized clinical trial, the role of three ergonomic training methods on the prevalence of neck and shoulders pain among 503 workers of an automobile factory (Response rate: 94.23%) was assessed. The eligible workers were randomly allocated into the following three interventional (pamphlet, lecture, workshop) groups and one control group. The Nordic questionnaire was used to assess the prevalence of neck and shoulder complaints. We followed and assessed the prevalence of neck and shoulders complaints among the study employees before and one year after the intervention. We used chi-square and Mann-Whitney tests to compare the prevalence of neck and shoulder complaints between the trial and control groups. A two-tailed P-value less than or equal to 0.05 was considered statistically significant.
    Results
    The prevalence of neck and shoulders complaints among the study employees at the recent week (p= 0.002) and year (p= 0.02) had been significantly decreased in the study employees after participating in the study workshop. The prevalence of neck and shoulders complaints at the recent week and year did not significantly changed in the study employees after receiving the pamphlet and lecture as ergonomic trainings.
    Conclusion
    Workshop as an ergonomic training method had an effective and powerful role on decreasing the prevalence of neck and shoulders complaints among workers.
    Keywords: Ergonomic Intervention, Prevalence, Neck, Shoulders Pain, Training
  • Kamran Dowlatshahi, Marjan Ajami, Hamidreza Pazoki, Toroudi, Seyed Javad Hajimiresmaiel * Pages 263-272
    Background
    Simvastatin is a widely used medication in cardiac care. Here we evaluate the role of ATP sensitive potassium (KATP) channels in simvastatin induced renal protection after renal ischemia/reperfusion (I/R) injury.
    Methods
    A total of 81 male Wistar rats, were treated with simvastatin (10 and 20mg/kg/day; gavage, one week). Some groups received glibenclamide (KATP channel inhibitor; 5mg/kg) before ischemia (45min) and reperfusion (24h). Finally the kidneys were processed for histological analysis and measurement of biochemical parameters including tissue malondialdehyde (MDA), blood urea nitrogen (BUN), fractional excretion of sodium (FENa), creatinine clearance rate (CCr) and Bcl2-associated X protein (Bax) expression.
    Results
    IR significantly increased serum Cr (p< 0.01) and BUN levels (p< 0.01), elevated FENa (p<0.01) and tissue MDA (p<0.01), and decreased CCr (p< 0.01) and induced histological damage. Bax pro-apoptotic protein was upregulated in renal tissue after I/R injury and downregulated in simvastatin pretreated group. Simvastatin at doses of 10 and 20mg/kg/day significantly reduced serum Cr and BUN levels (p< 0.05 vs. IR group), tissue MDA contents and FENa (p< 0.05 vs. I/R) and increased CCr (p< 0.05 vs. IR). Renal tissue injury was improved only in simvastatin 20mg/kg/day group (p< 0.05). Glibenclamide significantly abolished protective effects of simvastatin and increased serum Cr and BUN and FENa and decreased CCr (p< 0.05). It also abolished the effects of simvastatin on tissue injury and MDA contents and downregulated the Bax protein after IR injury (p< 0.05).
    Conclusion
    Opening of KATP channels is essential for simvastatin-induced renal protection against I/R injury.
    Keywords: Creatinine Clearance, KATP channels, Renal ischemia, reperfusion, Simvastatin, Glibenclamide
  • Amir, Hamzeh Pordal, Seyed Javad Hajmiresmail, Mohammad Assadpoor, Piranfar, Mehdi Hedayati, Marjan Ajami * Pages 273-278
    Background
    Considering the increasing incidence of coronary artery stenosis and its related complications, the importance of its etiology and inconsistent reports we aimed to determine the relationship between oxysterol, serum levels and severity of coronary atherosclerosis and effect of statins on oxysterol.
    Methods
    A total of 85 patients referred to Taleghani Hospital, Tehran, Iran during 2011-2012 with coronary artery stenosis more than 75%, as determined by angiography, participated in the current study. Their demographic information and history of smoking and taking atorvastatin was carefully recorded. Two milliliters of venous blood was obtained from each patient. The serum oxysterol level of samples was measured using the enzyme-linked immunosorbent assay (ELISA) method. Statistical analysis was performed using SPSS v.19.
    Results
    Eighty five patients completed the study. Mean age of patients was 64.4 years; 51 (60%) were male; 55 (68%) had acute coronary syndrome and 30 (32%) had chronic stable angina. Mean±SD of plasma level of oxysterol was 24.8±0.2 pmol/ml. The normal range of oxysterol level was 13pmol/ml. Mean±SD of plasma oxysterol level in patients under statin therapy was 24.4±2.1 pmol/ml. In patients without receiving statins, plasma oxysterol level was 26.38±1.6pmol/ml.
    Conclusion
    Findings of the present study indicated significant correlation between serum oxysterol and severity of coronary artery stenosis. It also demonstrated that receiving atorvastatin is associated with significant reduction of plasma oxysterol level.
    Keywords: Coronary stenosis, Atorvastatin, Hydroxymethylglutaryl, CoA Reductase Inhibitors, An, ticholesteremic agents
  • Zahra Nadia Sharifi, Shabnam Movassaghi, Farzaneh Mohamadzadeh, Sara Soleimani Asl, Bagher Pourheydar, Mehdi Mehdizadeh* Pages 279-287
    Background
    It is well known that the hippocampus, the CA1 Pyramidal cells in particular, is selectively vulnerable during global cerebral ischemia. Recently, it is observed that pentoxifylline has a neuroprotective effect. This study explored the pharmacological relationship between ischemiainduced cell death of the hippocampus and the efficacy of a vasodilator agent (pentoxifylline) in the prevention of delayed neuronal death.
    Methods
    This experimental study was performed on 4 groups: control, ischemia, experimental (200mg/kg pentoxifylline injection one hour prior to and one hour following ischemia) and vehicle (normal saline). Transient global ischemia was induced by bilateral common carotid arteries occlusion. To investigate the apoptotic bodies and caspase-3 activities as a central role in the execution phase of apoptosis, the brains were prepared for the TUNEL technique.
    Results
    Pentoxifylline administration limited apoptosis and caspase-3 activities in rats’ hippocampi. Our data showed no significant difference between the number of apoptotic bodies in the CA1 region of the hippocampus in the control and pentoxifylline -treated groups (p= 0.994). The results of one- way ANOVA revealed that that ischemia significantly increased caspase-3 levels in the hippocampus (p< 0.05); however, the level of caspase-3 in pentoxifylline -treated rats was less than the ischemic group.
    Conclusion
    These results suggest that the neuroprotective effect of pentoxifylline (20 mg/kg) may be accompanied by a reduction in ischemic damage within the CA1 region of the hippocampus in rats subjected to transient global cerebral ischemia.
    Keywords: Cerebral ischemia, Reperfusion, Pentoxifylline, Hippocampus
  • Mohammad Taher, Zahra Safavi Bayat *, Kianoush Niromand Zandi, Erfan Ghasemi, Hamid Abredari, Mahmood Karimy, Ahmad Reza Abedi Pages 288-291
    Background
    Epidemiological changes leading to chronic diseases are becoming more important day by day. Hypertension is also known as a chronic disease. Worldwide prevalence of hypertension have caused serious complications. The disease has become a health problem in all communities. This research aims at analyze the correlation between compliance with the treatment regimen and health locus of control in hypertension patients.
    Methods
    In this study, 130 patients diagnosed with high blood pressure have been included using convenience sampling. Information has been gathered including demographic data, compliance with the treatment regimen and health locus of control. The patient's blood pressure was measured twice and the mean was compared with the first blood pressure recorded in medical records. Data were analyzed using SPSS 17.
    Results
    The results showed that there is a direct correlation between the adherence to the treatment regimen with internal health locus of control. In patients with internal health locus of control, better compliance with treatment regimen was detected.
    Conclusion
    Health locus of control is associated with treatment regimen. Considering health locus control can help nurses and managers in their health programs and also can motivate patients to participate in their self-care and improve patients care quality.
    Keywords: hypertension, treatment, health, locus
  • Marjan Mokhtare, Vahid Hosseini *, Hafez Tirgar Fakheri, Iradj Maleki, Tarang Taghvaei, Seyed Mohammad Valizadeh, Hossein Sardarian, Shahram Agah, Alireza Khalilian Pages 292-302
    Background
    The effectiveness of classic standard triple therapy regimen of helicobacter pylori (H. pylori) eradication has decreased to unacceptably low levels, largely related to development of resistance to metronidazole and clarithromycin. Thus successful eradication of H. pylori infections remains challenging. Therefore alternative treatments with superior effectiveness and safety should be designed and appropriately tested in all areas depending on the native resistance patterns. Furazolidone has been used successfully in eradication regimens previously and regimens containing furazolidone may be an ideal regimen.
    Methods
    H. pylori infected patients with proven gastric or duodenal ulcers and /or gastric or duodenal erosions at Imam Khomeini Hospital in Sari/Northern Iran, were randomly allocated into three groups: group A (OABF) with furazolidone (F) (200 mg bid.), group B (OABM-F) metronidazole (M) (500 mg bid.) for the first five days, followed by furazolidone (F) (200 mg bid.) for the second five days and group C (OAF) with furazolidone (F) (200 mg tid.). Omeprazole (O) (20 mg bid.) and amoxicillin (A) (1000 mg bid.) were given in all groups; bismuth (B) (240 mg bid.) was prescribed in groups A & B. Duration of all eradication regimens were ten days. Eight weeks after treatment, a 14C-urea breath test was performed for evaluation of H. pylori eradication.
    Results
    A total of 372 patients were enrolled in three groups randomly (124 patients in each group); 120 (97%) patients in group A (OABF), 120 (97%) in group B (OABM-F) and 116 (93%) in group C (OAF) completed the study. The intention-to-treat eradication rates were 83.7% (95% CI= 77.3–90.4), 79.8% (95% CI=72.6–87), and 84.6% (95% CI= 78.2–91.1) and per-protocol eradication rates were 86.6% (95% CI= 80.5–92.8), 82.5% (95% CI= 75.6–89.4), and 90.5% (95% CI= 85.1–95.9) for groups OABF, OABM-F, and OAF, respectively. No statistical significant differences were found in case of severe drug adverse effects between the above mentioned three groups (p>0.05). The most common side effects, namely nausea and fever, occurred in all groups, but more frequently in group C (OAF) (p<0.05).
    Conclusion
    In developing countries such as Iran, furazolidone-based regimens can substitute clarithromycin-based regimens for H. pylori eradication because of a very low level of resistance, low cost and high effectiveness. Considering per-protocol eradication rate of ten days OAF regimen, and the acceptable limit of ninety percent, we recommend this regimen in developing countries such as Iran to be substituted of classic standard triple therapy. In order to minimize rare serious adverse effects, one week high dose OAF regimen should be taken into consideration in other studies.
    Keywords: Helicobacter pylori, Furazolidone, Bismuth, Treatment effectiveness
  • Seyed Kazem Malakouti, Arash Mirabzadeh, Marzieh Nojomi, Ali Ahmadi Tonkaboni, Faranak Nadarkhani, Mosleh Mirzaie, Narges Chimeh * Pages 303-311
    Background
    Implementing community-based psychiatric services is one of the priorities of the WHO/EMRO mental health programs. This study presents an aftercare service, as a community based-service, for patients with severe mental illness (SMIs).
    Methods
    In this randomized controlled clinical trial design, 176 patients, who attended selective hospitals with SMI, were allocated into three groups: clinical case managers provided by general practitioners, nurses and the control group (usual treatment). The clients and their caregivers received monthly home visits (education and treatment supervision). The effectiveness of the intervention was measured by indicators of psychopathology such as scores of YOUNG, caregivers’ knowledge and satisfaction with the services. Health-related quality of life (SF-36) was considered as the primary outcome variable. Data were collected at baseline and at 12 months follow-up. Direct and indirect medical costs were obtained through a periodic completion of questionnaires and interviews by caregivers. Cost effectiveness ratio was estimated as cost per QALY gained in each group. SPSS 16.0 was used in this survey and statistical methods were chi-square, ANOVA, Scheffe as post-Hoc test and paired sample t-test with 95% confidence interval and 0.05 significance level.
    Results
    The results of our study revealed that the score of YOUNG, caregivers’ knowledge and satisfaction with service were improved in both intervention groups after 12 months. Improvement in health-related quality of life was observed in the general practitioner and nurse group. The incremental cost effectiveness ratio was 5740807 IRR and 5048459 IRR per QALYs gained in the general practitioner and nurse groups, respectively.
    Conclusion
    The model of aftercare services provided by trained nurses is the most cost- effective and feasible model for Iran’s socio-economic conditions with low resource allocations.
    Keywords: Severe Mental Illness, Aftercare, Service, Mental Health, Community.
  • Zahra Shabani, Maryam Esghaei, Hossein Keyvani, Fateme Shabani, Fateme Sarmadi, Hamidreza Mollaie, Seyed Hamidreza Monavari * Pages 312-317
    Background
    Infection with parvovirus B19 may cause fetal losses including spontaneous abortion, intrauterine fetal death and non-immune hydropsfetalis. The aim of this study is to determine the frequency of parvovirus B19 in formalin fixed placental tissues in lost fetuses using real-time PCR method.
    Methods
    In this cross-sectional study, 100 formalin fixed placental tissues with unknown cause of fetal death were determined using real-time PCR method after DNA extraction.
    Results
    Six out of 100 cases (6%) were positive for parvovirus B19 using real-time PCR. Gestational age of all positive cases was less than 20 weeks with a mean of 12.3 weeks. Three cases have a history of abortion and all of positive cases were collected in spring. Mean age of positive cases were 28 years.
    Conclusion
    Parvovirus B19 during pregnancy can infect red precursor cells and induces apoptosis or lyses these cells that resulting in anemia and congestive heart failure leading to fetal death. Management of parvovirus B19 infection in pregnant women is important because immediate diagnosis and transfusion in hydropsic fetuses can decrease the risk of fetal death.
    Keywords: Human Parvovirus B19, Placenta, Fetal death
  • Payman Salamati, Reza Rostami, Soheil Saadat, Taher Taheri, Maryam Tajabadi *, Ghazale Ranjbari, Zohreh Sadat Naji, Saba Jafarpour, Vafa Rahimi, Movaghar Pages 318-324
    Background
    Patients with spinal cord injury (SCI) have a lower health related quality of life (HRQOL) compared to both healthy controls and the normal population. The aim of this study was to compare HRQOL between two groups of veteran and non-veteran SCI patients.
    Methods
    All male paraplegic non-veterans who had sustained complete SCI before 1988 and were residents of Tehran province (Iran), and a similar group of SCI veterans who consecutively participated in a health screening program were enrolled in this study. Patients fewer than 35 and older than 65 years of age were not included in this study. The participants were interviewed based on the Persian version of SF-36 questionnaire by two psychologists. Eight sub-scales and two physical and mental component summaries of the instrument were assessed. We used chi-square, odds ratio, Mann-Whitney U, independent t-test and linear regression for analysis.
    Results
    Overall, 25 veterans and 22 non-veterans were enrolled in the study. The mean age, time since injury and the presence of comorbid illnesses were not significantly different between the two groups (P>0.05). A greater number of veterans were married (p= 0.003) and employed (p= 0.047). On average, veterans had more years of formal education than non-veterans (p= 0.001). The mean (SD) bodily pain sub-scale was 72.73(31.253) for non-veterans and 49.7(28.287) for veterans (p=0.011). Absence of comorbid illnesses was associated with a better physical component summary (p<0.001). Employment was associated with a better mental component summary (p= 0.022).
    Conclusion
    We did not find any differences in HRQOL between the two groups except for the bodily pain sub-scale. Further studies with larger sample sizes are recommended.
    Keywords: Quality of Life, Spinal Cord Injuries, Veterans, Iran
  • Azita Goshtasebi *, Ziba Mazari, Samira Behboudi Gandevani, Mohsen Naseri Pages 325-332
    Background
    Heavy menstrual bleeding of endometrial origin (HMB) is a major healthcare problem in premenopausal women and affects several aspects of women’s health and quality of life (QoL). The aim of this study was to compare the efficacy of Persian Golnar (PG) and tranexamic acid (TA) on heavy menstrual bleeding of endometrial origin (HMB) and patients’ QoL.
    Methods
    A double-blind randomized controlled trial with parallel design and block randomization technique was conducted. A total of 94 women with HMB were randomly assigned to take either PG or TA for 5 days from day 1 of menses for three consecutive menstrual cycles. Blood loss was measured by the pictorial blood loss assessment chart (PBAC). Hematological assessments were made before the intervention and after treatment. QoL as a secondary outcome was evaluated using SF-36 and the menorrhagia questionnaire (MQ). Statistical analysis was performed using t-test, paired t-test, χ2 test, Mann–Whitney test, and Wilcoxon signed-rank test.
    Results
    In each group, 38 women (80.8%) completed the 3-month follow-up. Both PG and TA reduced blood loss. PBAC mean (SD) score was reduced from 304.92 (176.17) and 304.44 (192.72) to 164.60 (100.24) and 143.13 (96.07) after the third treatment cycle, respectively (p<0.001). Furthermore, mean hemoglobin, Hb (SD) concentrations in the PG and TA groups increased significantly from 12.06(0.86) and 11.53(0.86)mg/dl to 13.02 (0.82) and 12.72 (0.88)mg/dl (p< 0.001). QoL was significantly improved in both groups (p< 0.001). However, there were no significant differences between the groups after the intervention.
    Conclusion
    The results of the present study demonstrate the efficacy of PG in treating HMB in terms of clinical and QoL indicators.
    Keywords: Menstrual disturbance, Bleeding, Iran, Punica granatum, Tranexamic acid
  • Vahid Changizi*, Mohammad Hossein Alizadeh, Akbar Mousavi Pages 333-339
    Background
    CT scan and nuclear medicine exams deliver a great part of medical exposures. This study examined professional radiation hazards in CT scan and nuclear medicine workers.
    Methods
    In a cross sectional study 30 occupationally exposed workers and 7 controls (all from personnel of a laboratory) were selected. Physical dosimetry was performed for exposed workers. Blood samples were obtained from the experimental and control groups. Three culture mediums for each one were prepared in due to routine chromosome analysis using G-banding and solid stain.
    Results
    There were significant increased incidence of chromatid gap (ctg) and chromatid break (ctb) with mean±SD frequencies of 3±0.84 and 3.1±1.40 per 100 cells respectively in the nuclear medicine workers versus controls with mean±SD frequencies of 1.9±0.69 and 1.3±0.84 for ctg and ctb, respectively. Chromosome gaps (chrg) were higher significantly in the nuclear medicine population (2.47±0.91) than in controls (1.4±0.9) (p< 0.05). In CT scan group the ctg and ctb were increased with a mean±SD frequency of 2.7±0.79 and 2.6±0.91 per 100 cells respectively compared with control group. The mean±SD frequencies of the chrb were 2.0±0.75 and 0.86±0.690 per 100 cells for exposed workers and control group, respectively.
    Conclusion
    This study showed chromosome aberrations in peripheral lymphocytes using solid stain method are reasonable biomarker reflecting personnel radiation damage.
    Keywords: CT scan, Nuclear physics, Chromosome aberration, G, banding, Solid stain
  • Afsaneh Tehranian*, Leila Bayani, Somayesadat Heidary, Hadis Rastad, Akram Rahimi, Ladan Hosseini Pages 340-344
    Background
    AUB is a common cause of women’s referring to gynecologists. Although hysteroscopy is known as the gold standard technique for diagnosing the cause of AUB, sonohysterography is less invasive, and it is performed by general gynecologists. The purpose of this study was to evaluate the diagnostic performance of sonohysterography compared to the results of the endometrial biopsy, guided by hysteroscopy in premenopausal women with AUB.
    Methods
    This cross- sectional Study was conducted at the gynecological clinic of Roointan -Arash women''s Hospital from February 2011 to February 2012. The study participants were 90 premenopausal female patients, who visited the clinic for AUB, for whom, hormonal, iatrogenic and systemic causes were ruled out. They underwent sonohysterography and hysteroscopy and endometrial biopsy. The results of sonohysterography and pathological reports of endometrial biopsy were compared, and the diagnostic accuracy of sonohysterography for normal endometrium, endometrial polyps, sub mucosal fibroids and endometrial hyperplasia was evaluated.
    Results
    The diagnostic accuracy of sonohysterography was found to be 89.1% for the normal endometrium, 90% for endometrial polyps, 99% for sub mucosal fibroids and 94.4% for endometrial hyperplasia.
    Conclusion
    Sonohysterography is an accurate, non-invasive and cost-effective method for diagnosing AUB causes compared to hysteroscopy and endometrial biopsy. Therefore, as an initial diagnostic step, it can replace the alternative and less accurate methods such as transvaginal ultrasound, blind endometrial curettage or more costly and invasive methods such as hysteroscopy requiring anesthesia.
    Keywords: Sonohysterography, Hysteroscopy, Endometrial Biopsy, Abnormal Uterine Bleeding, Premenopausal
  • Mostafa Armanfar*, Afshar Jafari, Gholam Reza Dehghan, Leila Abdizadeh Pages 345-352
    Background
    Heavy exercise cause muscle damage associated with production of inflammatory agents. The purpose of present study was to determine the effect of acute and 14-day Coenzyme Q10 supplementation on inflammatory, blood lactate and muscle damage in male middle distance runners.
    Methods
    Eighteen male middle-distance runners in a randomized and quasi experimental study were allocated into two equal groups: supplement group (n=9, Coenzyme Q10: mg/kg/day) and placebo group (n= 9, Dextrose: 5mg/kg/day). After acute (1day) and 14-day supplementation, all subjects were participated in a training like running (competitive 3000 meters). Blood samples were obtained in the four phases: one hour before and 18-24 hours after two running protocols. Lactate, serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP) and creatine kinase (CK) were analyzed. Repeated ANOVA and Bonferuni as a post hoc tests were used to determine the changes in four stages. Differences between groups were determined by t-test.
    Results
    The results showed that acute and short-term Coenzyme Q10 supplementation had not significant effect on basal parameters. The acute coenzyme Q10 supplementation attenuated only the exercise-induced increase in response of the plasma CRP. The short-term (14-day) coenzyme Q10 supplementation attenuated the exercise-induced increase in response of the lactate, serum interleukin- 6, tumor necrosis factor-alpha, and CRP in male middle-distance runners. However, the acute and short-term coenzyme Q10 supplementation had not any significant effect on the exerciseinduced increase response of total serum creatine kinase.
    Conclusion
    Based on the present results, it can be concluded that the 14-day coenzyme Q10 supplementation (5mg.kg-1.day-1) is more effective than the acute supplementation to overcome the exercise-induced adverse responses in some oxidative, inflammatory and biochemical parameters. Therefore, short-term coenzyme Q10 supplementation is recommended to reduce exercise-induced adverse consequences.
    Keywords: Runners, Coenzyme Q10, Inflammatory, Lactate, Muscle damage
  • Fatemeh Sari Aslani, Bita Geramizadeh, Amir Reza Dehghanian Pages 353-358
    Background
    Melanoma causes the greatest morbidity and mortality of all skin cancers. Mucosal melanoma is a rare but highly aggressive neoplasm. According to previous studies the prevalence of KIT mutations in acral lentiginous and mucosal melanomas is relatively low (less than 15 20%), but it can have profound therapeutic implications for localized high risk or metastatic diseases. Our goal was to evaluate c-Kit expression in different types of primary and metastatic melanoma to discriminate potential candidates for targeted therapy.
    Methods
    We designed a cross-sectional study and selected 50 cases of malignant melanoma (primary, metastatic cutaneous, and mucosal) from the affiliated hospitals of Shiraz University of Medical Sciences in the period of 2008 to 2012. Immunohistochemistry for KIT expression was performed. Multistage sampling method was selected for sampling and chi-square test was used for statistical analysis.
    Results
    In our study, male to female ratio was 1.77. The male sex was correlated with higher tumor stage (p< 0.05). 62% (n= 31) of cases showed at least 5% of KIT-positive cells, consist of 18% (n= 9) with 5–50%, 16% (n= 8) with 51–95%, and 28% (n= 14) of cases showed more than 95% of cells expressing KIT. But in 38% (n= 19) of cases KIT expression was less than 5% of positive cells. Tumor stage was positively correlated with tumor cell immunoreactivity and intensity (p< 0.05). Metastatic melanoma showed lower percentage (43%) of positivity. Intensity of staining and percentage of positive cells were positively correlated (p< 0.001).
    Conclusion
    In primary melanomas, significant KIT expression was found by immunohistochemistry, which may be useful to screen the patients for advising to KIT mutation analysis and targeted therapy.
    Keywords: Melanoma, Proto, Oncogene Proteins c, kit
  • Afsaneh Rezazadeh, Mahnaz Solhi, Kamal Azam Pages 359-365
    Background
    Adolescence is a sensitive period of acquiring normal and abnormal habits for all of life. The study investigates determinants of responsibility for health, spiritual health and interpersonal relations and predictive factors based on the theory of planned behavior in high school girl students in Tabriz.
    Methods
    In this Cross-sectional study, 340 students were selected thorough multi-stage sampling. An author-made questionnaire based on standard questionnaires of Health Promotion and Lifestyle II (HPLPII), spiritual health standards (Palutzian & Ellison) and components of the theory of planned behavior (attitudes, subjective norms, perceived behavioral control, and behavioral intention) was used for data collection. The questionnaire was validated in a pilot study. Data were analyzed using SPSS v.15 and descriptive and analytical tests (Chi-square test, Pearson correlation co efficient and liner regression test in backward method).
    Results
    Students’ responsibility for health, spiritual health, interpersonal relationships, and concepts of theory of planned behavior was moderate. We found a significant positive correlation (p<0/001) among all concepts of theory of planned behavior. Attitude and perceived behavioral control predicted 35% of intention of behavioral change (p<0.001). Attitude, subjective norms, and perceived behavioral control predicted 74% of behavioral change in accountability for health (p<0.0001), 56% for behavioral change in spiritual health (p<0.0001) and 63% for behavioral change in interpersonal relationship (p<0.0001).
    Conclusion
    Status of responsibility for health, spiritual health and interpersonal relationships of students was moderate. Hence, behavioral intention and its determinants such as perceived behavioral control should be noted in promoting intervention programs.
    Keywords: Accountability in the health, Spiritual health, Interpersonal relationship, Theory of planned behavior, Girl students
  • Bahram Sangelaji, Fatemeh Estebsari, Seyed Massood Nabavi, Ensiyeh Jamshidi, Damineh Morsali, Maryam Dastoorpoor* Pages 366-374
    Background
    The positive impacts of exercise therapy on patients’ cognitive problems still remain unknown. This study was a pilot intervention to examine the effects of combined exercise on the cognitive problems of patients with multiple sclerosis (MS) in Iranian MS Society over 201 to 2013.
    Methods
    This quasi-experimental research was carried out in the form of a pretest/posttest study. Forty two patients with MS were selected from those visiting the rehabilitation center of Iranian MS Society, using non-probability convenience sampling. The Expanded Disability Status Scale (EDSS) of each patient was recorded before the intervention and Brief Repeatable Battery of Neuropsychological (BRB-N) test was administered before and after the intervention. The data were analyzed using the analytical tests such as Wilcoxon test.
    Results
    Of 21 participants, 17 subjects (82%, n=14) female with mean (±SD) age of 37 (±9.98) years and mean (±SD) EDSS of 2.35 (±0.90) completed all stages of the study. Changes in long-term storage and permanent long-term retrieval of information after the intervention were statistically significant (p<0.001). In addition, the change in the average of total delay after the intervention was also significant by 1.11 (p<0.001).
    Conclusion
    Our study confirmed the possibility of change in the cognitive abilities of MS patients through physical interventions. This finding emphasizes the necessity of more clinical examinations and increases the hopes for new rehabilitation methods for the disorder.
    Keywords: Exercise Therapy, Cognitive Functions, Multiple Sclerosis
  • Kamran Yazdani, Afarin Rahimi, Movaghar, Saharnaz Nedjat, Leila Ghalichi, Malahat Khalili* Pages 375-384
    Background
    Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced.
    Methods
    This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers.
    Results
    The medians of the numbers of papers and books during a 5-year period were 150. 5 and 2. 5 respectively. The median of the «articles per researcher» was 19. 1. Based on multiple linear regression, younger age centers (p=0. 001), having a separate budget line (p=0. 016), and number of research personnel (p<0. 001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0. 004).
    Conclusion
    The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers.
    Keywords: Scientometrics, Research centers, Scientific output, Tehran University of Medical Sciences
  • Elham Talachian, Ali Bidari*, Samileh Noorbakhsh, Azardokht Tabatabaei, Fereshteh Salari Pages 385-391
    Background
    Diarrhea is a leading cause of mortality and morbidity during the early life period especially in developing countries. Micronutrients deficiencies have been proposed either as a risk factor or a consequence of diarrhea. Association studies highlight the relation of vitamins and minerals’ deficiencies with acute diarrhea. In this regard we aimed to evaluate the status of vitamins A and D, and zinc serum levels in children with acute diarrhea.
    Methods
    In this cross sectional study performed in a referral teaching hospital, we measured and compared baseline vitamin A, 25-hydroxy vitamin D (25(OH)D), and zinc serum levels in 2 children admitted with acute diarrhea and 25 other children who were admitted for undergoing elective surgeries.
    Results
    25-(OH)D levels were significantly lower in the diarrhea group (p=0.03). We were unable to demonstrate a significant difference in the levels of vitamin A and zinc between the case and control groups (p= 0.14 and p=0.07, respectively).
    Conclusion
    We observed lower serum 25(OH)D levels in children with acute diarrhea. Whether this finding indicates a premorbid risk factor or simply a consequence of diarrhea needs further studies. Regardless of the cause and effect relationship, supplementation with vitamin D in acute diarrhea remains as a plausible consideration.
    Keywords: Acute diarrhea, Micronutrients deficiencies, Vitamin A, Vitamin D, Zinc, Children
  • Seyed Kazem Malakouti, Marzieh Nojomi, Hamid Reza Ahmadkhaniha, Mohammad Hosseini, Maryam Yekeh Fallah, Mosleh Mirzaei Khoshalani* Pages 392-406
    Background
    Suicide prevention is one of the priorities in policies of Iranian Ministry of Health and Medical Education (MHME). The suicide prevention program had two main parts of identifying and treatment of the depressed and suicide high risk individuals by Primary Health Care (PHC) network. The main aim of this study was to evaluate the results of integration of the program into PHC network in two cities with moderate to high rate of suicide with diverse socio-cultural backgrounds.
    Methods
    This work as a field trial study was conducted in Nahavand and Savojbolagh from April 2010 to March 2011 (12 months). A screening tool was designed. Required capacities such as treatment, referral and registration system were provided six months before the main study. The intervention phase (for one year) including the treatment process and five consultation sessions was conducted to identify depressed people and individuals with high risk of suicide. The data were analyzed by Chi square test.
    Results
    After one year of intervention, the rate of committing suicide became 4.98 and 3.36 per one hundred thousand population in Nahavand and Savojbolagh, respectively (16 and 1.6 per 100,000 in the year of before intervention respectively, 2009-2010). The female: male ratio of committing suicide was 2:1 in Nahavand and 1:1 in Savojbolagh. The most common method of committing suicide was drug intoxication in both cities. The identified cases by health workers at rural setting were 33 to 44 per 1000, in which 1.3 cases per 1000 population had been approved by general physicians.
    Conclusion
    This study approved the feasibility and efficacy of integration of suicide prevention program into PHC. The increased rate of suicide in Savojbolagh could be related to low rate of screening and lack of treatment facilities (hospitalization and electroconvulsive therapy (ECT), and part-time psychiatrist. Increasing the PHC capacities could improve the health network efficiency to identify and manage depressed and at risk of suicide individuals. Screening tool/s and method have to be improved to provide better results.
    Keywords: Suicide, Suicide prevention, Primary Health Care (PHC), Field trial
  • Sedighe Moradi*, Mohammad Reza Shafieepour, Maryam Mortazavi, Farhad Pishgar Pages 407-410
    Background
    Gestational diabetes mellitus (GDM) is common during pregnancy. This survey was designed based on the frequency of GDM among an urban population according to the American Diabetes Association (ADA) and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.
    Methods
    We included all pregnant women who were admitted to a gynecology clinic from September 2012 until May 2013. The fasting blood sugar (FBS) was measured. Those having FBS≥ 126 mg/dl were excluded from the study. All women underwent a standard OGTT (oral glucose tolerance test) by ingesting 75g of glucose in the 24th to 32nd week of their pregnancy.
    Results
    Two hundred ninety pregnant women with a mean±SD age of 27.72±5.091 years were included in the study. The mean±SD FBS, blood glucose one hour and two hours after ingesting 75g of glucose were 82.48±9.41, 146.86±34.22 and 114.21±27.79 mg/ dl, respectively. Based on the criteria of the ADA, 9.3% (n= 27) of the admitted patients suffered from GDM. For the IADPSG and the WHO, those numbers were 31% (n= 90) and 15.2% (n= 44), respectively.
    Conclusion
    The prevalence of GDM was 1.5-times and 3 times higher when the IADPSG based data were compared to those of the WHO or the ADA.
    Keywords: Gestational Diabetes Mellitus, ADA, HAPO, IADPSG
  • Shirin Djalalinia, Fahimeh Ramezani Tehrani, Hossein Malekafzali, Zeynab Hashemi, Niloofar Peykari* Pages 411-418
    Background
    Reproductive health problems affect youths in all countries. There is an urgent need to enhance youths reproductive health services to provide a healthy life for this group. In this regard, the present study aimed to evaluate the Reproductive Health Peer Education Program based on the opinion of university students.
    Methods
    This interventional study was conducted in Qazvin University of Medical Sciences through the peer education method. The participants of this study were 24 peer educators who received training in a 40 hour peer educator training course. The peer education program was implemented in the university. In order to evaluate this community- based intervention, 329 students were selected through the stratified sampling method and their opinion was assessed. Descriptive statistical methods were used by SPSS software for data analysis.
    Results
    The results of the study revealed that peer education was accepted by 64.7% (n= 213) of the students, according to their opinion. The educational priorities of the students were as follows: pre-marriage counseling (78%, n= 166); STI/AIDS (17%, n= 36); and contraception (5, n= 11). The peer education program was recognized as the most required reproductive health service in the university by 55.3% (n= 118) of the students. They believed that the most important duties of the peer educators were: education (33.5%, n= 71); counseling (30.4%, n= 65); referring to a counseling center (21.6%, n= 46) and referring to a therapeutic center (14.5%, n= 31). Also, the students stated that confidentiality (53%, n= 113), suitable communication (26%, n= 55) and sufficient knowledge (21%, n= 45) were desired characteristics for the peer educators.
    Conclusion
    According to the students'' opinion, peer education could provide suitable reproductive health services and could also be beneficial for reproductive health promotion and might reinforce positive behaviors in youths. Reproductive health peer- counseling is a sensitive process, and it is best to be conducted under the supervision of specialists.
    Keywords: Reproductive Health, Peer Education, Youth
  • Nahideh Gharehaghaji, Mahmood Nazarpoor*, Hodaiseh Saharkhiz Pages 419-427
    Background
    Ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles are used as blood pool contrast agent for magnetic resonance angiography and perfusion imaging. Our aim in this study was to investigate the effect of the two coating types of iron oxide nanoparticles on the relationship between nanoparticles concentration and signal intensity (SI) in T1-weighted MR images.
    Methods
    Different concentrations of the polyethylene glycol (PEG), and carboxydextran-coated iron oxide nanoparticles were imaged using inversion recovery Turbo-FLASH (Turbo fast low-angle shot) pulse sequence with inversion times (TIs) of 300-900 ms (interval of 100 ms). The maximum non-linear and linear relationship between the corrected SI (after non-uniformity correction) and the concentration of the two coated nanoparticles were calculated in T1-weighted images.
    Results
    The maximum non-linear relationship between the corrected SI and the concentration of the PEG, and carboxydextran-coated nanoparticles were obtained at concentrations of 400 and 200 μmol Fe/L at a TI of 900 ms, respectively. In addition, the maximum linear relationship between the corrected SI and the concentration of the PEG, and carboxydextran-coated nanoparticles (R2=0.99) appeared at 228.184 and 205.654 μmolFe/L with a TI of 300 ms, respectively.
    Conclusion
    The maximum non-linear corrected SI of the carboxydextran-coated nanoparticles was slightly higher than that of the PEG-coated nanoparticles at similar TIs. However, the PEG coated nanoparticles were better than the carboxydextran-coated nanoparticles as a T1 contrast agent for perfusion measurements.
    Keywords: MRI, T1, weighted image, Iron oxide nanoparticles, Coating, Inversion recovery
  • Mohammad Ali Zamani, Mehran Movahhedi, Seyyed Mohammad, Kazem Nourbakhsh, Forouzan Ganji, Mahmoud Rafieian, Kopaei, Mahmoud Mobasheri, Abolfazl Khoshdel, Shahram Etemadifar, Majid Shirani, Zahra Keivani Hafshejani* Pages 428-432
    Background
    Complications of Ventolin as the most common drug used for bronchiolitis are widely known. The present study was conducted to determine the efficacy of hypertonic saline 3%, compared with Ventolin, for treatment of acute bronchiolitis in children.
    Methods
    This double-blinded clinical trial study was conducted in Hajar Hospital, Shahrekord, Iran, from 2011 to 2012. A total of 70 patients under the age of two years with bronchiolitis were divided into two groups of 35 each. Ventolin nebulizer and hypertonic saline 3% nebulizer three times per day were administered in the first (Ventolin) and second (Hypersaline) group, respectively. The length of recovery was compared between the two groups. The data were analyzed by SPSS software (version 22) using chi-square, t-test, paired t-test, and Mann-Whitney.
    Results
    The mean±SD length of recovery was 4.14±0.9 and 3.06±0.6 in the Ventolin and hypersaline groups, respectively. The mean duration of recovery was significantly lower in the hypersaline group (p<0.001).
    Conclusion
    Hypertonic saline 3% nebulizer has more pleasant therapeutic effects on acute bronchiolitis than Ventolin. Therefore, use of hypertonic saline 3% nebulizer is recommended for the treatment of acute bronchiolitis in children under two years old.
    Keywords: Hypertonic saline solution, Pediatric, Bronchiolitis, Ventolin, albuterol
  • Samira Rabiei, Rahebeh Shakerhosseini*, Navid Saadat Pages 433-440
    Background
    Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metabolic syndrome, is not only the result of changes in genetic, diet or physical activity, but also an imbalance of micro flora may play an important role. Therefore, alteration of micro flora using pre/probiotic is considered as a new strategy for treatment of metabolic disorders.
    Methods
    The current study is a triple blind randomized controlled trial. 46 patients from both sexes, who fulfilled inclusion criteria, randomly categorized into intervention or placebo group. The intervention and placebo groups consumed 2 probiotic capsules or 2 placebo capsules during 3 months, respectively. Both groups received a weight loss diet, according to their adjusted ideal body weight. Anthropometric, body composition, blood pressure and nutritional measurements were done in the beginning, at 6th week, and at the end of the study. T-test and paired-t test were used for statistical analysis.
    Results
    40 patients completed the study. BMI, WC, HC, fat mass, lean mass and blood pressure were reduced in all participants (p< 0.05). Systolic blood pressure in symbiotic group was less than placebo group, significantly (p< 0.05). The trend of weight loss in symbiotic group continued at least for 12 weeks while it was stopped at week 6 in placebo group.
    Conclusion
    Symbiotic supplement with the weight loss diet had synergistic effects on improvement in systolic blood pressure and anthropometric measurements. Based on our findings, symbiotic can postpone plateau phase of weight loss and it may prevent resistance to further weight loss.
    Keywords: Metabolic syndrome, Gut micro flora, Symbiotic, Body composition
  • Payman Salamati, Ali Moradi, Hamid Soori*, Mousa Amiri, Majid Soltani Pages 441-449
    Background
    Evaluation of intra-city roads in terms of environmental factors of motor vehicle injuries can help us to better identify these factors and the share of each of the factors in injuries. Therefore, this study was conducted to determine the high injury areas and the risk factors of motor vehicle crashes resulting in injury and death in Tehran, the capital city of Iran, from November 2011 through February 2012.
    Methods
    In this cross sectional study, the locations of the motor vehicle injuries resulting in injuries and deaths were obtained from police stations in Tehran. The coordinates of the injuries locations were extracted and entered into the Arc-GIS software to overlay the different layers of geographical data and extract the risk map.
    Results
    A total of 4257 motor vehicle injuries were evaluated in this study. Forty-two injuries (1%) resulted in death and 4215 injuries (99%) resulted in injury. The traffic districts 5 and 21 had the highest frequency of injuries resulting in death. The type of the motor vehicle resulting in injury or death was motorcycle in 2330 injuries (54.73%).
    Conclusion
    The frequency of traffic injuries is more in the west and northwest areas of Tehran, and it is caused more by motorcycles in terms of traffic and motor injuries resulting in injury and death. It is useful to conduct more studies to better identify these factors considering their importance in traffic injuries.
    Keywords: Injuries, Traffic, Geographic Information Systems, Motor Vehicles, Iran
  • Poupak Rahimzadeh, Seyed Hamid Reza Faiz*, Mahzad Alimian, Ali Mohammadian Erdi Pages 450-456
    Background
    Controlling the hemodynamic situation of patients who have spinal operation is of prime importance, and maintaining the heart rate and blood pressure in normal or low- normal levels in these patients can reduce their bleeding loss. One of the commonly used drugs for this purpose is remifentanil. Another sedative-hypnotic-analgesic drug, with acceptable effects is dexmedetomidine. The aim of this study was to compare the effect of dexmedetomidine with remifentanil in spinal operation.
    Methods
    In a double blind randomized clinical trial, using random sampling method, 60 patients with the age range of 15-65 years who were candidates for posterior spinal fusion operation were included. Induction of anesthesia was performed, and both groups received isoflurane 1 during the surgery. Remifentanil was injected via infusion pump in one group. The patients in the trial group received dexmedetomidine. As trial outcomes, heart rate and blood pressure were measured before, after induction and during the operation. Pain score, sedation score and the need to analgesic therapy were recorded in the recovery room and the ward. Independent sample t-test and chi square were used for statistical analysis.
    Results
    Dexmedetomidine had a significant lowering impact on intraoperative blood pressure and heart rate compared to remifentanil (p<0.001). The mean of sedation scores after extubation in patients who received dexmedetomidine was significantly higher than the sedation scores in patients who received remifentanil (p<0.001). The mean of post-extubation and recovery pain score in patients taking remifentanil was significantly higher than patients taking dexmedetomidine (p 0.05).
    Conclusion
    Dexmedetomidine in patients with spinal operation is associated with lower postoperative pain score and intraoperative bleeding. Hemodynamic effects are significantly better in patients received dexmedetomidine.
    Keywords: Dexmedetomidine, Hemodynamic, Spinal fusion, Remifentanil
  • Nahid Heydari, Fahimeh Hajiabolhassani *, Jamileh Fatahi, Shafieh Movaseghi, Shohreh Jalaie Pages 457-462
    Background
    Rheumatoid arthritis (RA) is an autoimmune systemic disease. Most common autoimmune diseases are multisystem disorders that may also present with otological manifestations, and autoimmune inner ear disease accompanied by vestibular dysfunction. This study aimed to compare the vestibular function between RA patients and normal subjects using cervical vestibular evoked myogenic potentials (cVEMPs).
    Methods
    In this cross- sectional study, 25patients with RA (19 female and 6 male: mean (±SD) age, 40.00 (±7.92) years) and 20 healthy subjects (15 female and 5 male: mean (±SD) age, 35.35 (±10.48) years) underwent cVEMPs, using 500 Hz-tone bursts at 95 dB nHL intensity level. Data were analyzed using independent sample t-test through SPSS software v. 16.
    Results
    The mean peak latency of p13 was significantly higher in RA patients (p<0.001). The mean peak latency of n23 was significantly higher in patients in the left ear (p=0.03). Vestibular evoked myogenic potential (VEMP) responses were present in all (100%) of the participants. There were no significant differences in mean peak to peak amplitude and amplitude ratio between the two groups.
    Conclusion
    According to the prolonged latency of VEMP responses in RA patients, lesions in the retrolabyrinthine, especially in the vestibulospinal tract are suspected.
    Keywords: Rheumatoid arthritis, Vestibular evoked myogenic potentials, Saccule, Sternocleidomastoid
  • Zoleikha Mahmudi, Iman Tahamtan, Shahram Sedghi*, Masoud Roudbari Pages 463-479
    Background
    We conducted a comprehensive bibliometrics analysis to calculate the H, G, M, A and R indicators for all Iranian biomedical research centers (IBRCs) from the output of ISI Web of Science (WoS) and Scopus between 1991 and 2010. We compared the research performance of the research centers according to these indicators.
    Methods
    This was a cross-sectional and descriptive-analytical study, conducted on 104 Iranian biomedical research centers between August and September 2011. We collected our data through Scopus and WoS. Pearson correlation coefficient between the scientometrics indicators was calculated using SPSS, version 16.
    Results
    The mean values of all indicators were higher in Scopus than in WoS. Drug Applied Research Center of Tabriz University of Medical Sciences had the highest number of publications in both WoS and Scopus databases. This research center along with Royan Institute received the highest number of citations in both Scopus and WoS, respectively. The highest correlation was seen between G and R (.998) in WoS and between G and R (.990) in Scopus. Furthermore, the highest overlap of the 10 top IBRCs was between G and H in WoS (100%) and between G-R (90%) and H-R (90%) in Scopus.
    Conclusion
    Research centers affiliated to the top ranked Iranian medical universities obtained a better position with respect to the studied scientometrics indicators. All aforementioned indicators are important for ranking bibliometrics studies as they refer to different attributes of scientific output and citation aspects.
    Keywords: Scientometrics, H, index, G, index, A, index, R, index, M, index, Biomedical Centers, Research Centers, Iran
  • Farzaneh Agha, Hosseini*, Iraj Mirzaii, Dizgah Pages 480-485
    Background
    Oral lichen planus (OLP) has been classified as a pre-malignant condition. Matrix metalloproteinase-13 (MMP-13) or collagenase-3 may play a key role in cancer development. The aim of this study was to compare serum and saliva MMP-13 between patients with oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC).
    Methods
    This cross sectional study was performed on 30 patients with OLP (8 reticular and 22 erosive forms) and 20 patients with OSCC (6 in low stage and 14 in advanced stage) who were selected randomly. The study was conducted at the Cancer Department, Clinic of Oral Medicine, Tehran University of Medical Sciences. The serum and saliva MMP-13 were assayed by ELISA method. Statistical analysis of the Student’s t-test, ANOVA and Pearson correlation coefficient was performed.
    Results
    There were no significant differences in mean saliva and serum levels of MMP-13 between patients with OSCC and OLP and their subgroups. Serum MMP-13 correlated significantly with unstimulated (r = 0.307, p= 0.048), but not with stimulated, saliva MMP-13.
    Conclusion
    Serum and saliva MMP-13 levels appear to be statistically similar in OLP and OSCC.
    Keywords: MMP, 13, Oral lichen planus, Squamous cell carcinoma, Saliva
  • Morteza Khavanin Zadeh*, Saman Mohammadipour, Zahra Omrani Pages 486-490
    Background
    Arteriovenous Fistula (AVF) is the ideal method of vascular access for patients on maintenance hemodialysis (HD). Therefore it is an important part of treatment in HD. There are several observations that indicate the role of inflammation in failure of AVF. The aim of this study was to evaluate the hematologic and inflammatory biomarkers in early AVF failure.
    Methods
    This case-control study included 110 ESRD patients, whom were undergone AVF creation, divided in two groups. About 700 radius-cephalic AVF were created during these two years. We found 55 cases with AVF failure. In this study, we compared those 55 failures with 5 functional AVF which were selected using randomized sampling from the rest of patients according to age, gender, and AVF location. Levels of serum C-reactive protein (CRP) were checked in both groups to evaluate the relation between AVF failure and CRP level before surgery.
    Results
    The mean±SD age of the patients was 49.7±17.28 years. CRP was positive in 34 patients (61.8%) with unsuccessful fistula function, while only 4 (7.3%) of those with successful AVF had positive CRP and the rest had negative CRP. The difference between the two groups of patients was strongly significant (p<0.001). Statistically, there was not any significant difference between the average of age (p: 0.580) of patients in the control and experimental groups. However, the gender (p: 0.832) discrepancies was not meaningful between the groups.
    Conclusion
    AVF thrombosis is one of the main complications after AVF creation. Therefore, it is recommended to check CRP before AVF surgery to prevent possible failure of the fistula function.
    Keywords: Vascular Access, Arteriovenous Fistula, CRP, Failure
  • Hesam Seyedin, Salime Goharinezhad*, Soodabeh Vatankhah, Mohammad Azmal Pages 491-497
    Background
    Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients'' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran.
    Methods
    This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating.
    Results
    The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628).
    Conclusion
    Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals.
    Keywords: Patient Education Process, Head Nurse, Teaching Hospitals
  • Omid Pournik, Leila Ghalichi*, Alireza Tehraniyazdi, Seyed Mohammad Tabatabaee, Mostafa Ghaffari, Eva Vingard Pages 498-502
    Background
    The effect of psychosocial work environment on personal and organizational aspects of employees is well-known; and it is of fundamental importance to have valid tools to evaluate them. This study aims to evaluate the reliability and validity of the Persian version of Copenhagen Psychosocial Questionnaire (COPSOQ).
    Methods
    The questionnaire was translated into Persian and then back translated into English by two translators separately. The wording of the final Persian version was established by comparing the translated versions with the original questionnaire. One hundred three health care workers completed the questionnaire. Chronbach’s alpha was calculated, and factor analysis was performed.
    Results
    Factor analysis revealed acceptable validity for the five contexts of the questionnaire. Cronbach’s alpha ranged from 0.73 to 0.82 in different contexts.
    Conclusion
    This study revealed that the Persian version of COPSOQ is a reliable and valid instrument for measuring psychosocial factors at work.
    Keywords: Occupational Health, Validity, Reliability, Iran, Psychosocial Work Environment
  • Elham Boushehri, Kamran Soltani Arabshahi, Alireza Monajemi* Pages 503-512
    Exploration into the concept of «medical expert» dates back to more than 50 years ago, yet yielding three leading theories in the area of clinical reasoning, namely, knowledge structure, hypotheticdeductive, and dual process. Each theory defines “medical expert” in a dissimilar way. Therefore, the methods of assessment through which the experts are identified have been changed during the time. In this paper, we tried to categorize and introduce some widely used tests for identification of experts within the framework of existing main theories. Implementation of the proposed categorization for providing future assessment tools is discussed.
    Keywords: Clinical reasoning, Assessment, Analytical approach, Non, analytical approach, Experts
  • Hooman Angoorani, Ali Mazaherinezhad*, Omid Marjomaki, Shima Younespour Pages 513-521
    Background
    Osteoarthritis is a disabling musculoskeletal disease with no definite treatment. This study compared the effect of Platelet-rich plasma (PRP) and Transcutaneous Electrical Nerve Stimulation (TENS) plus exercise in the treatment of patients with knee joint osteoarthritis.
    Methods
    54 eligible patients with knee osteoarthritis were randomly allocated into two groups. (IRCT2012110611382N) Group A (27 patients) received 2 injections of PRP (4 weeks apart) and group B (27 patients) received 10 sessions of TENS as well as exercise during the study period. Clinical outcome was evaluated using the Knee injury and Osteoarthritis Outcome Scores (KOOS) questionnaire before the treatment, 4 weeks, and 8 weeks after that the treatment. Pain was also assessed using a visual analog scale (VAS). Time to an intolerable knee pain during treadmill workout was also evaluated using an objective test.
    Results
    In the PRP group, the mean KOOS symptom score improved significantly from baseline to the end of study, while the change was not significant over this period for the group B. In both groups, significant reductions were observed in VAS scores from baseline till the end of study. The mean time to feel intolerable knee pain during treadmill work out of PRP group increased significantly from baseline to week 4, but no significant changes were found in this parameter over the time of study in the group B.
    Conclusion
    Intraarticular injection of PRP is an effective, safe method for short-term treatment of patients with knee joint osteoarthritis.
    Keywords: Platelet, rich Plasma, PRP, Knee Osteoarthritis, Exercise
  • Fatemeh Homaei Shandiz, Mona Najaf Najafi, Zahra Abbasi Shaye, Mahta Salehi, Maryam Salehi Pages 522-530
    Background
    Women with the medical history of breast cancer constitute the biggest group of patients who survived cancer. Despite the high rate of mastectomy after breast cancer in Iran; only limited patients elect reconstruction surgery. The aim of our study was to evaluate the rate of tendency to breast reconstruction (BR) surgery among women with breast cancer who had mastectomy but not undergone reconstruction.
    Methods
    This cross sectional study was conducted in Mashhad, north east of Iran during 2013. A total of 108 patients with mastectomy due to breast cancer were selected through convenience sampling and completed the questionnaire. Demographic data collected and 21 items of questionnaire were compared between patients with and without tendency to BR. Data were analyzed using Chi square, t tests and logistic regression.
    Results
    In this study 62 (57.4%) patients had a tendency to BR and 46 (42.6%) had not. The mean (±SD) age of patients in first group was 43.3±8.03 and 49.6±9.9 in the second group (p<0.001). Frequency of agreement about impact of BR on appearance and beauty, mood, family living conditions and their opinion (p<0.001), lack of sufficient information (p=0.01), physician's opinion (p<0.001) and priority of cancer breast treatment (p=0.02) were significantly different between the two groups.
    Conclusion
    More than half of the patients had a tendency to BR although they did not go under the surgery yet. Identification of factors that can increase the tendency and factors that help to change the intention to action are important and should be investigate in future research.
    Keywords: Tendency, Mastectomy, Breast cancer, Breast reconstruction
  • Mehdi Moghtadaei, Javad Moghimi *, Hossein Farahini, Ali Jahansouz Pages 531-537
    Background
    Total knee arthroplasty is a complex procedure aiming to relieve pain and improve function. It is critical to select prosthesis that best cover the bone surfaces. Ethnicity may affect fitness of the components mainly designed for Caucasian populations. This study aimed to evaluate morphometric features of proximal tibia in Iranian population.
    Methods
    During 2013, 150 consecutive patients (96 males and 54 females) form orthopedics department of Rasoul-Akram hospital with knee CT scan were randomly enrolled. We entered cases with apparent normal extremity alignment and bone maturity. Cases with history of fracture or conditions affecting knee profile were excluded. Standard cuts were simulated on CT scan. Anteroposterior (AP), mediolateral (ML) and aspect ratio (ML/AP) were measured for general morphology. Medial and lateral AP distance of tibia and their distance to tibial center were measured for checking symmetry.
    Results
    Mean age was 43.0± 10.4 years (rang 11-80). Males showed significantly larger values in ML dimension and aspect ratio than females under a given AP value (p<0.001). However, the aspect ratio was suggestive of similar configuration of proximal tibia profiles among genders. Totally, close correlations were observed among simulated cuts and size-matched tibial components of the prostheses. However, better coverage was provided by some brands via designing interchangeable components for a given dimension. Medial and lateral condyles of tibia were almost symmetrical.
    Conclusion
    Our findings indicated that some alterations in the shape of the components are needed to provide optimal coverage in Iranian population. We propose symmetrical configuration in designing tibial components as well.
    Keywords: Proximal tibia, morphometry, Total knee arthroplasty, computed tomography, Iranian.
  • Kieran Walsh Pages 538-540
    Healthcare professional education is the undergraduate, postgraduate and continuing professional development for doctors, nurses and allied healthcare professionals. Labour economics is the relationship between workers and employers, and the resultant effect on employment and wages. Healthcare professional education ultimately produces a workforce, and that workforce is governed by the rules of labour economics like any other workforce. Despite all of these largely incontrovertible facts, there has been remarkably little interest in the relationship between healthcare professional education and labour economics. This short article attempts to redress this shortcoming by describing some of the factors that can affect healthcare professional education and labour economics, and aims to mention some of the methods in which these two disciplines can interact with each other.
    Keywords: Labour Economics, Healthcare Professional Education, Cost
  • Ali Gholami, Zohre Foroozanfar * Pages 541-547
    Background
    An important issue the world faces today is ensuring that households living in different countries have access to enough food to maintain a healthy life. Food insecurity is prevalent in both developed and developing countries. The objective of this study was to assess the household food security status and related factors among different rural districts of Neyshabur (A city in northeast of Iran).
    Methods
    Of 5000 selected rural households 4647 were studied in this cross-sectional study. A validated short questionnaire (with six questions) was used to measure food security. Chi-square test and logistic regression were used for data analysis through SPSS software.
    Results
    In total, 2747 households (59.1%) were identified as food secure. The highest prevalence of food security was observed in Central district (62.3%) and the lowest was in Miyanjolgeh district (52.9%). Backward multiple logistic regression revealed that car ownership, presence of chronic disease in household and household income (per month) were significantly associated with food security in all of surveyed districts (p< 0.05).
    Conclusion
    According to results of this study, lower than 60% of Neyshabur rural households were food secure and economic variables were the most important factors. Therefore, a special attention should be paid to this health problem in these regions.
    Keywords: Food security, Food insecurity, Household, Iran
  • Meghdad Pirsaheb, Mojtaba Limoee *, Farideh Namdari, Razieh Khamutian Pages 548-557
    Background
    Chlorinated pesticides have been used in pest control for several decades in the world. These compounds are still applied in many regions, and their continuous usage has resulted in their bioaccumulation and residue in the food chain. These residues could transfer to food products and accumulate in fat tissues. Undoubtedly, the breast milk could be a significant biomarker for estimation of these residues in the human body. This study was conducted to review and compile the results of the studies undertaken in the world which surveyed the organochlorine pesticides residue in breast milk.
    Methods
    A total of 710 national and international articles and texts related to the focused subject were extracted from the virtual databases using the following key words: Chlorinated pesticides, residue and breast milk. Thirty articles published between 1980 and 2013 were selected and reviewed.
    Results
    The majority of the reviewed articles indicated the presence of two or more organochlorine pesticides in the collected samples of breast milk. Based on the reviewed studies, dichlorodiphenyltrichloroethane (DDT) had the highest level of concentration in the collected samples of breast milk. Moreover, there was a statistically significant positive correlation between mother’s age, her multiparty and concentration of chlorinated pesticides in breast milk.
    Conclusion
    The organochlorine pesticides are still applied in some developing countries including some regions of Iran. Thus, it seems essential to inform the community about the adverse effects of this class of pesticides; and most importantly the governments should also ban the use of such compounds.
    Keywords: Chlorinated Pesticides, Residue, Breast Milk.
  • Razieh Khamutian, Farid Najafi *, Mohammad Soltanian, Mohammad Javad Shokoohizadeh, Saeedeh Poorhaghighat, Abdollah Dargahi, Kiomars Sharafi, Alireza Afshari Pages 558-565
    Background
    Industrialization and urbanization had a devastating impact on public health and caused an increase in health related morbidity and mortality. In fact, asthma is a chronic condition which is considered as one of the significant challenges of public health. In this study, we investigated the association of air pollution and weather conditions with excess emergency ward admissions of asthmatic patients in Kermanshah hospitals.
    Methods
    This was an ecological study. The total number of hospital admissions to emergency wards from all related and major hospitals of Kermanshah was collected from September 2008 through August 2009. In addition, data on air pollution as well as meteorological data were collected from the Environmental Protection Agency and Meteorological Organization of Kermanshah. To determine the association between the number of hospitalization due to asthma with those parameters, Poisson regression was used.
    Results
    The results of Poisson regression revealed a significant association between carbon monoxide, ozone, nitrogen dioxide and temperature with emergency room visits due to asthma in Kermanshah. No associations were found for sulfur dioxide or for particulate matter.
    Conclusion
    This study provides further evidence for the significant effect of monoxide carbon on asthma; and it suggests that temperature may have a role in the exacerbation of asthma. However, due to the multi-factorial nature of asthma, other factors also play a major role in the development and exacerbation of this illness.
    Keywords: Air Pollution, Asthma, Weather, Iran
  • Zahra Mohammadi, Arash Tehrani Banihashemi *, Homa Asgharifard, Mehran Bahramian, Hamid Reza Baradaran, Mohammad E. Khamseh Pages 566-571
    Background
    Health literacy is the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment. The aim of this study was to identify the effect of various factors on health literacy in patients with diabetes.
    Methods
    This was a cross-sectional observational study of 407 Iranian patients older than 15 years of age with type 1 and 2 diabetes identified from the Diabetes Clinic affiliated to the Institute of Endocrinology and Metabolism (IEM) of Iran University of Medical Sciences. We assessed patient's health literacy using the Persian version of Test of Functional Health Literacy in Adults (TOFHLA) questionnaire.
    Results
    The mean age of the patients was 55.85 years, and 251 (61.7%) of them were female. Females had lower educational level compared to males (p< 0.001). In total, 18.2%, 11.8% and 70.0% of the participants had adequate, marginal and inadequate health literacy scores, respectively. Tukey’s post hoc test revealed that employed patients enjoyed a high health literacy level compared to housekeepers (p< 0.001).
    Conclusion
    Health literacy score in Iranian patients with diabetes seems low. Therefrom effective interventions should be designed and implemented for this group of patients to improve diabetes outcomes.
    Keywords: Health literacy, Diabetic patients, Influencing Factors
  • Maryam Delphi *, Farzaneh Zamiri Abdolahi, Richard Tyler, Mahsa Bakhit, Nader Saki, Ahmad Reza Nazeri Pages 572-579
    Background
    Our hearing ability in space is critical for hearing speech in noisy environment and localization. The Spatial Hearing Questionnaire (SHQ) has been devised to focus only on spatial haring tasks (e.g., lateralization, distance detection and binaural detection). The aim of the present study was to determine the reliability and validity of the Persian translation of the SHQ (Spatial Hearing Questionnaire).
    Methods
    Translation and back-translation, reliability, content and construct validity were investigated. Eighty patients with sensory neural hearing loss (SNHL) (52.50% female and 47.5 % male) with the mean±SD age of 49.02±13.60 years completed SHQ, and they were categorized into mild, moderate, moderate to severe and severe groups based on their hearing threshold. Inclusion criteria in this study were the MMSE questionnaire score of higher than 21, good general health, no history of psychiatric disorders, dizziness or vertigo, dementia or alcohol abuse.
    Results
    The reliability was assessed by Cronbach’s alpha and found to be 0.99. Item-total correlation was between r= 0.84 and 0.92. There was a significant difference between the mean score of P-SHQ in the four groups. Based on the factor analysis, two factors were extracted from the questions in P-SHQ: sound localization; and music and speech understanding in noise and quiet. These factors could explain 82.1% and 9.3% of the total variance, respectively.
    Conclusion
    The present study proved the reliability and validity of the Persian version of SHQ (P-SHQ). This provides a suitable tool for spatial hearing assessment in clinical/research environments.
    Keywords: Spatial Hearing, Questionnaire, Validity, Reliability, Persian Language
  • Pezhman Atefi Manesh, Abbas Saleh Ardestani, Behnaz Kermani, Aziz Rezapoor, Ali Sarabi Asiabar Pages 580-585
    Background
    Several studies suggest the existence of an effective relationship between individuals’characteristics and important factors such as occupational and organizational performance, job satisfaction, organizational commitment, and etc. This study was designed based on the dimensions of personality (introversion /extroversion) of managers of Iran University of Medical Sciences at three levels (executive, middle and senior)with their career success rate.
    Methods
    This was a cross-sectional descriptive study, whose population was all managers of Iran University of Medical Sciences. To collect data, two valid and reliable questionnaires were used. The first questionnaire assessed personality characteristics of each director, and the second measured occupational success. Related tests such as Pearson correlation test and independent comparison (independent t-test) at a significance level of 0.05 were used for data analysis.
    Results
    Findings revealed no significant relationship between variables of introversion and extroversion and occupational success among the senior managers, (p> 0.05). However, there was adirect but incomplete relationship between introversion and extroversion, which correlated with job success among middle and executives managers.
    Conclusion
    It seems that in all three levels of managers, if the managers communicated more with employees and if the subject of communication was more of executive nature, the correlation rate would increase between extroversion and introversion with job success variables. Therefore, it is suggested to give attention to organizational interaction and communication, and contingency variables such as organization condition,structure, formality and complexity.
    Keywords: Introversion, Extroversion, Occupational success, Personality
  • Mansoureh Vahdat, Elaheh Sariri, Zahra Najmi, Alireza Mobasseri, Mahjabin Marashi, Behnaz Mohabbatian, Yousef Moradi * Pages 586-590
    Background
    Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard of evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about accuracy of these tests. The aim of this study was to compare the accuracy of combination of TVS and HSG with hysteroscopy.
    Methods
    Medical records of an infertile women who were undertaken all three diagnostic modalities were reviewed concerning their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
    Results
    Ninety nine infertile women with the mean age of 29.1± 6.47 years, mean duration of marriage of 8.93± 10.28 years, and mean duration of infertility of 5.59± 4.16 years were assessed. The sensitivity, specificity, PPV, and NPV of TVS were 30, 98.5, 90, and 23.6%, respectively. HSG had a sensitivity of 60%, specificity of 95.6%, PPV of 85.8%, and NPV of 15.4%. When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 67, 94.2, 83.3, and 13.3%, respectively.
    Conclusion
    Two dimensional TVS, HSG, and combination of both diagnostic modalities are not accurate enough for assessing uterine malformation in infertile women.
    Keywords: ultrasound, hysterosalpingography, hysteroscopy, Müllerian anomaly, accuracy, infertility
  • Morteza Khavanin Zadeh *, Hamid Nouri, Yousef Moradi, Ladan Reza, Rashin Joodat Pages 591-596
    Background
    Central Venous Catheters (CVCs) are used not only as an access to central venous system, but also for hemodynamic monitoring, parenteral nutrition, chemotherapy and hemodialysis. The use of central venous catheters is associated with some complications notably infections that are troublesome both to patient and physician. We conducted this study to examine catheter fixation with skin fold technique and evaluated risk of catheter infection in this method and compared it to conventional technique.
    Methods
    This study is a controlled clinical trial and cases are all the patients over 18 years, admitted to Hashemi-Nejhad kidney center from 2011 to 2012, who needed an internal jugular venous catheter for hemodialysis. Two hundred and twenty two patients entered the study. Patients were randomly divided to skin fold suturing (127 patients) and standard suturing (95 patients) groups. Chi – square test and logistic regression were used for data analysis. P value less than 0.05 was considered to be significant.
    Results
    The mean age of patients in skin fold suturing and standard suturing groups were 54.5±16.43 and 54.4±14.84 years, respectively. The rate of catheter infection significantly decreased (mean difference=13%) with skin fold technique (3%) in comparison to standard suturing group (p=0.002).
    Conclusion
    The findings of this survey demonstrated that catheter fixation with skin fold could be an appropriate technique in comparison with current conventional method. However, further studies on other possible and unpredictable complications of this technique is required.
    Keywords: Central venous catheter, Skin fold fixation, infection
  • Yousef Moradi, Hamid Reza Baradaran, Maryam Yazdandoost, Shahla Atrak, Maryam Kashanian Pages 597-602
    Background
    Burnout has currently been a major concern among physicians due to exposing to a high level of stress at work. There are several reports to show various level of burnout in residency program because of several predisposing factors. Since residents of obstetrics and gynecology have intense work demands, limited autonomy, a high degree of interference with work at home and little rest, therefore, this systematic review was undertaken to estimate a more precise the prevalence of burnout among residents in obstetrics and gynecology.
    Methods
    International and national electronic databases were searched from 1974 to 2015 including PubMed, Science Direct, Scopus, and Science Information Database. All studies, in which the prevalence of burnout among residents in obstetrics and gynecology, were included in this meta-analysis.
    Results
    Twelve studies involving a total of 2509 participants were included in the meta-analysis. Overall prevalence rate of burnout among gynecologists estimated 44 percent (95% CI: 30 - 57).
    Conclusion
    The findings of this meta-analysis showed that the prevalence of the burnout syndrome during obstetrics and gynecology residency seems high. It is recommended to consider and address this important situation for any future solutions and interventions which will improve the work situation of medical residents.
    Keywords: burnout, gynecologists, Meta, analysis, Cross, sectional, Prevalence
  • Hamid Alizadeh, Farhad Daryanoosh, Maryam Moatari, Khadijeh Hoseinzadeh Pages 603-609
    Background
    Herein, we studied the effects of two different exercise protocols on IL-17 and CRP plasma levels along with the anti-inflammatory effects of fish oil. The purpose of the present study was to investigate the effect of Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) consumption along with two different types of physical activities on IL-17 and CRP plasma levels in trained male mice.
    Methods
    A total of 130 adult male mice of Syrian race with the age of 2 months and the weight of 35±1 grams were selected. At the beginning, 10 mice were killed in order to determine the amounts of pre-test variables. The rest of the mice were randomly divided into 6 groups including control group (n=20), supplement (n=20), aerobic exercise (n=20), anaerobic exercise (n=20), supplement-aerobic exercise (n=20), and supplement-anaerobic exercise (n=20). Blood samples were withdrawn from the tail under intraperitoneal ketamine and xylasineanaesthesia. The anaerobic training program included 8 weeks of running on treadmill, 3 sessions per week; the aerobic training program included 8 weeks of running on treadmill, 5 sessions per week. At the end of the training program, the blood sample from each group was taken in order to measure the CRP and IL-17 levels. The analysis of variance (ANOVA) was used to determine the differences among the groups.
    Results
    The results showed that there was a significant difference in IL-17 and CRP plasma levels between the groups after 8 weeks (P<0.05).
    Conclusion
    Following the two different training programs, both IL-17 and CRP plasma levels increased, although these observed increases were not same for two measured variables. The results might also show that the effect of the supplement depends on the type of training.
    Keywords: Omega, 3, Interleukin, 17, C reactive protein, Physical activity.
  • Mohammad Amin Toodeji, Sadegh Izadi *, Abdolhamid Shariat, Mohammad Hosin Nikoo Pages 610-614
    Background
    Embolus is one of the causes of ischemic stroke that can be due to cardiac sources such as valvular heart diseases and atrial fibrillation and atheroma of the aorta. Transesophageal echocardiography (TEE) is superior in identifying potential cardiac sources of emboli. Due to insufficient data on TEE findings in ischemic stroke in Iran, the present study was done to evaluate TEE in detecting cardiac sources of emboli. The main aim of this study was to describe the cardiogenic sources of emboli using TEE in the ischemic stroke patients.
    Methods
    This is a cross-sectional study conducted during a 13-month period from January 2012 to February 2013 in Shiraz Nemazee teaching hospital. Patients admitted with stroke diagnosis were included; but hemorrhagic stroke cases were excluded. 229 patients with ischemic stroke diagnosis were included and underwent TEE.
    Results
    Causes of cardiac emboli were detected in 65 cases (40.7%) and categorized to high-risk (29.7%) and potential risk (11%). High risk cardiac sources included atrial fibrillation (8.7%), mitral valve disease (MS or MI) 11 cases (4.75%), aortic valve disease (AS or AI) 8 (3.5%), prosthetic valve 3 (1.35%), dilated cardiomyopathy 45 (19.65%) and congestive heart failure with ejection fraction < 30% in 8 cases (3.5%). Potential cardiac sources of emboli comprised 7 cases (3.05%) of septal aneurysm, 4 (1.75%) left ventricular hypokinesia, 13 (5.7%) mitral annular calcification and 9 cases (3.95%) complex atheroma in the ascending aorta or proximal arch.
    Conclusion
    Our study showed that high risk cardiac sources of emboli can be detected using TEE in a considerable percentage of ischemic stroke patients. The most common high risk cardiac etiologies were dilated cardiomyopathy and valvular heart diseases.
    Keywords: Transesophageal, Echocardiography, Stroke, Embolic
  • Zahra Mohammadi, Abbasali Keshtkar, Fateme Fayyazbakhsh, Mehdi Ebrahimi, Mahsa M. Amoli *, Mostafa Ghorbani, Patricia Khashayar, Mahboubeh Dini, Mina Ebrahimi, Rad, Bagher Larijani Pages 615-621
    Background
    Osteoporosis, or porous bone, is a disease characterized by low bone mass density (BMD) and structural deterioration of bone tissue, leading to bone fragility and increased risk of hip, spine, and wrist fractures. There are numerous risk factors for osteoporosis. While many of these factors are non-genetic in nature, there is a definite genetic component responsible for this condition. The main aim of this study was to evaluate the association between VDR (Vitamin D receptor gene) polymorphisms (Fok1) A>G (rs2228570) and bone mineral density in an Iranian defined population.
    Methods
    The study participants comprised of 1032 Iranians recruited from the city of Sanandaj during IMOS (Iranian Multi Center Osteoporosis Study). Bone mineral density measurement was performed in all the participants with and without osteoporosis. All samples were genotyped for VDR genes (Fok1) polymorphism with polymerase chain reaction, using a predesigned TaqMan allele discrimination assay.
    Results
    There was a significant association between Fok1 polymorphism and osteoporosis in post-menopausal women, 0.138(0.025-0.768).
    Conclusion
    It seems that cohort studies, which are more powerful than case-control studies, can be useful in evaluating the roles of genetic variants as risk or protective factors for osteoporosis.
    Keywords: Osteoporosis, Vitamin D Receptor Gene, Fok1, Bone Mineral Density
  • Mostafa Hosseini, Hamid Reza Alizadeh Otaghvar *, Adnan Tizmaghz, Ghazaal Shabestanipour, Soheila Arvaneh Pages 622-626
    Background
    Fine needle aspiration (FNA) has led to a decrease in unnecessary surgeries for thyroid nodules. This study was designed to compare diagnostic value of FNA and frozen section methods in the follicular lesions.
    Methods
    This is a cross-sectional study based on the medical records of 42 patients who were referred to surgery clinic of Rasool-e-Akram hospital in Tehran with complaint of thyroid nodules. All FNAs were diagnosed as follicular lesions in pathologic evaluation. All the patients underwent thyroid surgery and their frozen section results were also assessed. Finally, diagnostic value of the two tests was compared based on final permanent histologic report.
    Results
    Forty two patients with follicular thyroid nodules diagnosed with FNA were included. During the operation, using frozen sections, diagnosis of papillary carcinoma, non-papillary malignancies, benign lesion and intermediate cytology was made in 13 (31%), 3 (7%), 25 (59.5%), 1 (2.5%) patients, respectively. Results of permanent histology showed that follicular adenoma is the most prevalent lesion which appeared in 25 (59.5%) cases. Papillary and follicular carcinomas were detected in 10 (23.8%) and 4 (9.5%) cases, respectively.
    Conclusion
    Results of the study demonstrate a 73% reduction in second surgery in patients with follicular thyroid lesions based on intraoperative frozen section results.
    Keywords: Thyroid nodule, Follicular lesion, Frozen section, FNA
  • Shabnam Niroumand, Mohammad Khajedaluee, Majid Khadem, Rezaiyan, Maryam Abrishami, Mohammadreza Juya, Gholamhasan Khodaee, Maliheh Dadgarmoghaddam * Pages 627-635
    Background
    Cardiovascular disease (CVD) is the cause of one third of deaths worldwide and this will progress because of increasing CVD's risk factors. The most basic task of dealing with the epidemic of CVD is primary prevention of risk factors. As Atherogenic Index of Plasma (AIP) is a strong marker to predict the risk of atherosclerosis and coronary heart disease, we assessed the correlation between AIP and other important factors.
    Methods
    This cross-sectional study was a part of national non-communicable risk factors surveillance system data that has been established since 2004 in Iran. This was done on 1000 people between 2008 and 2010. The study was approved by Ethics Committee of Mashhad University of Medical Science. Chi square, Mann-Whitney U, correlation tests were used in this study. Statistical analysis was performed using SPSS version 11. In all calculations, p <0.05 was considered as statistically significant level.
    Results
    The study population consisted of 500 men and 500 women with mean±SD age 41.9±14.2 years. According to the AIP category, 9.8% (98) were in low risk group, 12.7% (127) were in intermediate risk and 77.5% (775) were in increased risk of CVD. AIP was significantly correlated with waist circumference (r=0.35, p<0.001), BMI (r=0.33, p<0.001) and physical activity (r=-0.09, p<0.01).
    Conclusion
    AIP can be used as a regular monitoring index of CVD in every day practice, especially in persons with other cardiovascular risk factors.
    Keywords: Risk Factor, Cardiovascular Disease, Atherogen
  • Shirin Djalalinia, Niloofar Peykari, Mostafa Qorbani, Bagher Larijani, Farshad Farzadfar * Pages 636-650
    Background
    Socioeconomic status and demographic factors, such as education, occupation, place of residence, gender, age, and marital status have been reported to be associated with obesity. We conducted a systematic review to summarize evidences on associations between socioeconomic factors and obesity/overweight in Iranian population.
    Methods
    We systematically searched international databases; ISI, PubMed/Medline, Scopus, and national databases Iran-medex, Irandoc, and Scientific Information Database (SID). We refined data for associations between socioeconomic factors and obesity/overweight by sex, age, province, and year. There were no limitations for time and languages.
    Results
    Based on our search strategy we found 151 records; of them 139 were from international databases and the remaining 12 were obtained from national databases. After removing duplicates, via the refining steps, only 119 articles were found related to our study domains. Extracted results were attributed to 146596 person/data from included studies. Increased ages, low educational levels, being married, residence in urban area, as well as female sex were clearly associated with obesity.
    Conclusion
    Results could be useful for better health policy and more planned studies in this field. These also could be used for future complementary analyses.
    Keywords: Obesity, Socioeconomic factors, Iran
  • Mashallah Aghilinejad, Negah Tavakolifard, Sayed Aliakbar Mortazavi, Elahe Kabir Mokamelkhah, Akbar Sotudehmanesh, Seyed Alireza Mortazavi * Pages 651-658
    Background
    Low back pain (LBP) is one of the most common problems among the workers of different industries. The role of occupational factors in causing the LBP has been indicated previously. LBP has great socio-economic costs and most of its costs are related to the chronic LBP. The aim of this study was to identify the occupational risk factors that are related to the progression of the LBP from acute to chronic phase.
    Methods
    This cohort study has been conducted on 185 workers with acute LBP. Information related to their occupational exposure at baseline has been measured with a valid questionnaire using the self-report approach. Patients follow up was done monthly for three months after the start of the pain. Those workers whose occupational exposure had not changed during the follow up were divided into two groups of chronic LBP (n = 49) and cured (n = 136) according to the duration of the pain period (more or less than 3 months), and their job exposures were compared.
    Results
    Among the physical and psychosocial risk factors, social support (OR= 0.466, CI= 0.231- 0.940) and job satisfaction (OR= 0.455, CI= 0.232-0.891), and lifting weights more than 15kg (OR=2.482, CI= 1.274-4.834) indicated a significant relationship with the chronicity of the LBP. After putting the variables into the regression model, only lifting>15kg remained statistically significant.
    Conclusion
    According to the observed relationship between these occupational risk factors (social support, job satisfaction, lifting>15kg) and the chronicity of the LBP, there is hope that eliminating these factors in the workers with acute LBP will prevent its progression to the chronic phase.
    Keywords: Low back pain, Occupational factors, Workers, Iranian metal industry, Cohort study
  • Mohammadreza Zakeri, Alireza Olyaeemanesh *, Marziee Zanganeh, Mahmoud Kazemian, Arash Rashidian, Masoud Abouhalaj, Shahram Tofighi Pages 659-666
    Background
    The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds?
    Methods
    The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey; while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data.
    Results
    The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.(exchange rate: 1$=9988 Rial).
    Conclusion
    The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.
    Keywords: Financing, Health System, National Health Account
  • Alireza Akbarzadeh Baghban, Somayeh Ahmadi Gooraji *, Amir Kavousi, Navid Mirzakhani Araghi Pages 667-673
    Background
    Stroke is a prevalent cause of disability in adults. The fall is the most common balance and motor impairments, which affects the quality of life in stroke patients. This study aims to employ random effects hurdle model for evaluating the balance improvement in stroke patients under the occupational therapy.
    Methods
    In this longitudinal study with repeated measurement during one year between 2013 and 2014, the data was collected using non-random sampling method from three occupational therapy clinics. For a total of 38 stroke patients, the number of falls was recorded every two weeks. The random effects hurdle model and random effects zero inflated Poisson (ZIP) model were fitted to the data and were compared together. Data analysis was carried out using SAS Software version 9.2.
    Results
    The results of random effects ZIP model showed that the covariates of sex and age and affected side of stroke and follow up duration had statistically significant effect on balance improvement (p< 0.05). The occupational therapy has been effective on balance improvement more than 40% during one year.
    Conclusion
    The ZIP model with random effects can capture zero inflation and correlation structure in longitudinal count data simultaneously. Older patients, women and patients with left-side impairments were more at risk of fall and balance impairment, so they need more care and therapy.
    Keywords: Stroke, Balance, Occupational therapy
  • Maryam Kashanian, Elaheh Sariri, Mansoureh Vahdat, Maryam Ahmari, Yousef Moradi *, Narges Sheikhansari Pages 674-684
  • Aziz Rezapour, Farbod Ebadifard Azar, Saber Azami Aghdash, Asghar Tanoomand, Seyed Morteza Hosseini Shokouh, Negar Yousefzadeh, Pezhman Atefi Manesh, Ali Sarabi Asiabar * Pages 685-694
    Background
    Households’ financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household’s health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013.
    Methods
    This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11 software. Recall period for the inpatient care was 1 year and for outpatient 1 month.
    Results
    The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households’ financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system.
    Conclusion
    According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health.
    Keywords: Equity, Health care financing, Equity indices, Fairness in financial contribution (FFC), Kakwani index
  • Sara Razmjou, Hamid Reza Baradaran *, Jalil Kouhpayehzadeh, Kamran Soltani, Arabshahi Page 695
    Background
    Clinical supervision is an important factor in the development of competency in residency program. Attending physicians play a key role in supervision of residents. However little is known about how attending physicians and residents perceive the quality of clinical supervision. The aim of this study was to explore the differences between perceived qualities of supervision in these two groups in different wards in teaching hospitals in Tehran, Iran.
    Methods
    A valid questionnaire were completed by 219 attending physicians and residents from surgery, psychiatry, gynecology, pediatrics, internal medicine, orthopedics and radiology wards in two teaching hospital affiliated to Iran University of Medical Sciences. This questionnaire contained 15 items in regards to supervisory roles, rated on a five point Likert scale (1=never, 2=seldom, 3=sometimes, 4=often, 5=always).
    Results
    Out of 219 participants, 90 (41%) were attending physicians and 129 (59%) were residents. The overall mean±SD scores of perceived clinical supervision achieved by attending physicians and residents were respectively, 4.20±0.5 and 3.00±0.7 which was statistically significant (p<0.05). Attending physicians and residents acquired minimum scores (mean=4.06 and 2.7, respectively) regarding expectation from their supervisor to know and do during training period of residency.
    Conclusion
    It seems that the clinical supervisory does not have an efficient performance in teaching hospitals which needs to be more assessed and improved. Therefore it is suggested that policymakers in medical education system pay more attention to this important issue and enhance some faculty development programs for clinical educators in Iran.
    Keywords: Attending physicians, Clinical Supervision, Residents, Teaching Hospital, Iran
  • Rezvan Khorshidi Roozbahani, Mehrnaz Geranmayeh *, Sedigheh Hantoushzadeh, Abbas Mehran Pages 707-711
    Background
    Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. GDM, defined as glucose intolerance, first diagnosed or initiated during pregnancy affects 1-14% of pregnancies based on various studies. Screening and early diagnosis and appropriate glycemic control can improve prenatal outcomes. Telephone follow-up seems to be a reasonable way for pregnant women follow-up. The present study evaluated the effects of telephone follow-up on blood glucose level during pregnancy and postpartum screening.
    Methods
    Eighty mothers with GDM were enrolled in this clinical trial and randomly divided into intervention and control groups. All mothers were asked to check their blood sugar levels fivetimes daily. In intervention group, telephone intervention was performed for 10 weeks. In each follow-up, individuals were followed for insulin injections, diet, clinical tests and reminding the next visit. In control group, three times of telephone call was established to record blood sugar levels. Another telephone call was established at 6 weeks of postpartum in both study groups to evaluate the performance of the screening test for blood sugar.
    Results
    The mean age of mothers was 30.9±5 years in the control and 30.7±5.1 years in the intervention groups In intervention group, mean level of blood glucose, 2 hours after lunch at 28 weeks of pregnancy was significantly lower than the control group (P<0.05). Mean differences in levels of fasting blood glucose between 28 weeks and 32 and between 28 and 36 weeks of pregnancy were significantly higher in the intervention than the control group (P<0.05). Rate of postpartum glucose screening test was significantly higher in the intervention group (P<0.001).
    Conclusion
    The findings of this study demonstrated that telephone follow-up could significantly reduce fasting blood glucose levels in mothers with gestational diabetes and also increased the rate of postpartum screening test.
    Keywords: Gestational diabetes mellitus, Postpartum screening, Telephone, Follow, up
  • Hamid Ravaghi, Massomeh Goshtaei *, Alireza Olyaee Manesh, Nazanin Abolhassani, Jalal Arabloo Pages 713-723
    Background
    In this regard, in Iran a plan was developed and accordingly 52 indicators to measure equity in health were developed and announced by the Ministry of Health in collaboration with other sectors. This study aims to obtain a deeper understanding of the development of health equity indicators and identify their implementation challenges and proposed solutions from the perspective of policy makers and executives responsible for the indicators development and implementation. To reduce the health inequity, it is necessary to measure and monitor these inequalities.
    Methods
    Stakeholders involved in the development and implementation of these health equity indicators (at national and provincial levels), and the review and analysis of relevant documents including meeting minutes, working plans and working progress reports. Data were analyzed using a framework analysis approach.
    Results
    In this qualitative study, data were gathered using semi-structured interviews with 15 the use of health equity indicators and process of indicators development, challenges of development and implementation of the indicators and laying the groundwork for the establishmentof indicators. The findings showed that policy maker's viewpoint on concepts and indicators is different from those of executives and their perceptions have little in common. The establishment ofindicators requires accurate stakeholder's understanding and accurate insight into the issue of equity in health, political will, financing, training and empowerment of organization's employees, legal requirements, and finally a clear action plan.
    Conclusion
    Four main themes were identified, including the concept of equity in health and its importance, and executives. As the attention has been focused recently on the issue, in addition to knowledge improvement, proper solutions with an intersect oral collaboration approach in order to tackle challenges should be considered. The development of the indicators requires a shared understanding among policy makers.
    Keywords: Social determinants of health, Health equity, Policy analysis, Iran.
  • Saber Azami, Aghdash, Farbod Ebadifard Azar *, Aziz Rezapour, Akbar Azami, Vahid Rasi, Khalil Klvany Pages 724-736
    Background
    healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method.Nowadays, for quality improvement, measuring patient safety culture (PSC) in Methods SID and IranMedex using the search terms including patient safety, patient safety culture, patientsafety climate and combined with hospital (such as “hospital survey on patient safety culture”),measurement, assessment, survey and Iran. A total of 11 articles which conducted using HospitalSurvey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimateoverall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) softwarev. 2 was employed.
    Results
    Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, units” dimension received the highest score of PSC (67.4%) and “Non-punitive response to error” the lowest score (32.4%). About 41% of participants in reviewed articles evaluate their hospitals’ performance in PSC as ‘excellent/very good’. Approximately %52.7 of participants did not report any adverse event in the past 12 months.
    Conclusion
    The overall PSC score based on the random model was 50.1%. “Teamwork within hospital Among the 12 dimensions of HSOPSC questionnaire, the “Non-punitive response to error” achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action.The results of this study show that Iranian hospitals’ performances in PSC were poor.
    Keywords: Patient safety, Culture, Quality improvement, HSOPSC questionnaire, Iranian hospitals
  • Aeen Mohammadi, Rita Mojtahedzadeh, Amir Hossein Emami *, Marjaneh Dehpour Pages 738-743
    Background
    Pamphlet is a tool used for distance continuous professional development programs. In this study, we assessed the impact of an educational pamphlet on improving prescription writing errors in general physicians’ performance.
    Methods
    In this randomized controlled interventional study, we prepared a training pamphlet according to the most prevalent prescription writing problems. We randomized 200 participants among general physicians affiliated with Tehran Social Security Insurance Organization, and randomly divided them into intervention and control groups. Participants’ prescriptions (N=34888) were investigated over a month, and then the prepared pamphlet was sent out to the participants in the intervention group. After three months we examined their one-month prescriptions again (N=30296) and investigated the changes in prescription errors.
    Results
    There was no significant difference in the mean number of prescriptions in two groups before and after intervention (p=0.076). Mean number of medicinal items reduced significantly in intervention group. Also mean number of prescriptions including injection drugs (p=0.024), Corticosteroids (p=0.036), Cephalosporin (p=0.017) and non-steroidal anti-inflammatory drugs (p=0.005) reduced significantly. No significant differences were found for other errors.
    Conclusion
    This study showed that use of an appropriate pamphlet has a considerable impact on improving general physicians’ performance and could be applied for continuous professional development.
    Keywords: Educational media, Pamphlet, Continuous medical education, General practitioners
  • Samaneh Rashvand, Mohammad Hossein Somi, Bahram Rashidkhani, Azita Hekmatdoost * Pages 744-751
    Background
    The incidence of ulcerative colitis (UC) is rising in populations with western-style diet, rich in fat and protein, and low in fruits and vegetables. In the present study, we aimed to evaluate the association between dietary protein intakes and the risk of developing incident UC.
    Methods
    Sixty two cases of UC and 124 controls were studied using country-specific food frequency questionnaire (FFQ). Group comparisons by each factor were done using χ2 test, and significance level was set at α= 0.05. Logistic regression adjusted for potential confounding variables was carried out.
    Results
    Univariate analysis suggested positive associations between processed meat, red meat and organ meat with risk of ulcerative colitis. Comparing highest versus lowest categories of consumption, multivariate conditional logistic regression analysis accounting for potential confounding variables indicated that patients who consumed a higher amount of processed meat were at a higher risk for developing UC (P value for trend= 0.02). Similarly, patients who consumed higher amounts of red meat were at a higher risk for UC (P value for trend= 0.01). The highest tertile of intake of organ meat was associated with an increased risk of ulcerative colitis with a statistically significant trend across tertiles (P value for trend= 0.01) when adjusted.
    Conclusion
    In this case-control study we observed that higher consumptions of processed meat, red meat and organ meat were associated with increased risk for UC.
    Keywords: Ulcerative colitis, Diet, Protein
  • Hosein Rafiemanesh, Mojtaba Mehtarpoor, Abdollah Mohammadian, Hafshejani, Hamid Salehiniya *, Mostafa Enayatrad, Salman Khazaei Pages 752-759
    Background
    In Iran, cancer is the third cause of death. The present study aimed at providing the incidence rates (crude and agestandardized) of different types of cancers in Sistan and Baluchestan province (Southeastern of Iran). Cancer is the second leading cause of death in developing countries.
    Methods
    Registry Center of Health Heputy for Sistan and Baluchestan province. Common cancers were defined based on the number of cases and standardized incidence rates. To compute the annual percentage change (APC), joinpoint 4.1.1.1 software was applied.
    Results
    Data were collected retrospectively reviewing all new cancer patients registered in Cancer46.82% occurred in females and 53.18% in males. The most frequent cancer in women was breastcancer followed by esophagus, skin, colorectal and leukemia. The 5 most frequent cancers in menwere stomach, skin, leukemia, esophagus and bladder. Joinpoint analyze showed a significant increasing trend for adjusted standard incidence rate (ASIR) for both sexes (p<0.05).
    Conclusion
    A total of 3535 cases of cancers registered during 2004-2009 were identified. Of these, other provinces in Iran, cancer incidence in Sistan and Baluchistan is less common but trends of cancers are increasing in Sistan and Baluchestan Province. It is necessary to have a comprehensive health policy for prevention and control of this problem.According to The results of the present study and comparison to previous studies for
    Keywords: Cancer, Epidemiology, Incidence, Sistan, Baluchestan, Iran.
  • Masoumeh Ghandi Dezfuli, Malahat Akbarfahimi *, Seyed Massood Nabavi, Afsoon Hassani Mehraban, Ebrahim Jafarzadehpur Pages 760-767
    Background
    Multiple Sclerosis (MS) is the most common disabling neurological disease. Hand dysfunction is one of the main complaints of patients with MS. The present study aimed to compare hand dexterity of MS patients with low Expanded Disability Status Scale (EDSS) scores and healthy adults. It also sought to identify the predictors of disability status of patients with MS based on their manual dexterity and demographic characteristics.
    Methods
    In this cross-sectional study, 60 (16 male/44 female) patients with MS and 60 (19 male/41 female) healthy people, who matched in terms of age and sex, were recruited. Their hand dexterity was evaluated by the Purdue Pegboard Test. The disability status of the MS group was determined by the Expanded Disability Status Scale. The data were analyzed using SPSS15.
    Results
    The hand dexterity in MS group even with low EDSS score (1.5 ± 1.07) was weaker than control group. Moreover, the dexterity of dominant hand and alternating two hands coordination subtests of the PPT was a good discriminator between two groups (p<0.001). The results of linear regression analysis suggested dominant hand dexterity and disease duration as predictors of disability status that predict 60.5 per cent of the variation in EDSS scores in patients with MS (p<0.001).
    Conclusion
    Reduced dominant hand dexterity in patients with MS is a disabling factor. Further research is recommended to determine if early hand rehabilitation can reduce the severity of disability in Patients with MS.
  • Rezaali Bagheri, Zohreh Sohrabi *, Eshagh Moradi Pages 768-776
    Background
    Outstanding leadership is one of the important and vital concepts in management and educational leadership debates especially in educational organizations such as universities. Thus, effective educational leadership and adopting an appropriate tool to assess leadership in education are crucial in these institutions. The present study was conducted to develop an instrument for measuring the leadership style in faculty members.
    Methods
    In this descriptive cross-sectional study, content and face validity of Multifactor Leadership Questionnaire (MLQ) was examined using the opinions of 10 experienced faculty members as a panel of experts. For construct validity, 210 questionnaires were administered to faculty members of Tehran University of Medical Sciences. Confirmatory factor analysis was run using principal component analysis and Varimax rotation method. The reliability of the scale was measured through internal consistency using Cronbach’s alpha formula. Confirmatory factor analysis was used to examine the construct validity of the questionnaire. Data were analyzed using SPSS v.16 and LISREL software.
    Results
    Factor analysis and expert opinion resulted in a questionnaire with 18 items across six subscales including idealized influence, inspirational motivation, intellectual stimulation, individualized consideration, contingent reward, and management by exception. The reliability coefficient of the questionnaire was acceptable (0.90). Confirmatory factor analysis showed that the scale had appropriate goodness of fit.
    Conclusion
    The 18-item Educational Leadership Questionnaire was found to have acceptable validity and reliability for measuring leadership style in the faculty. It is recommended that the questionnaire be administered to a larger sample.
    Keywords: Multifactor Leadership, Validity, Reliability, Faculty
  • Shahram Sedghi, Nida Abdolahi, Ali Azimi, Iman Tahamtan, Leila Abdollahi * Pages 777-783
    Background
    Personal Information Management (PIM) refers to the tools and activities to save and retrieve personal information for future uses. This study examined the PIM activities of faculty members of Iran University of Medical Sciences (IUMS) regarding their preferred PIM tools and four aspects of acquiring, organizing, storing and retrieving personal information.
    Methods
    The qualitative design was based on phenomenology approach and we carried out 37 interviews with clinical and basic sciences faculty members of IUMS in 2014. The participants were selected using a random sampling method. All interviews were recorded by a digital voice recorder, and then transcribed, codified and finally analyzed using NVivo 8 software.
    Results
    The use of PIM electronic tools (e-tools) was below expectation among the studied sample and just 37% had reasonable knowledge of PIM e-tools such as, external hard drivers, flash memories etc. However, all participants used both paper and electronic devices to store and access information. Internal mass memories (in Laptops) and flash memories were the most used e-tools to save information. Most participants used “subject” (41.00%) and “file name” (33.7 %) to save, organize and retrieve their stored information. Most users preferred paper-based rather than electronic tools to keep their personal information.
    Conclusion
    Faculty members had little knowledge about PIM techniques and tools. Those who organized personal information could easier retrieve the stored information for future uses. Enhancing familiarity with PIM tools and training courses of PIM tools and techniques are suggested.
    Keywords: Information Management, Information seeking behavior, Storage, retrieval, Literacy, Faculty, Iran
  • Farshad Najafipour, Pejman Hamouzadeh, Jalal Arabloo, Mohammadreza Mobinizadeh, Amir Norouzi * Pages 784-793
    Background
    Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy.
    Methods
    The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. Results from studies were analyzed and discussed within a descriptive synthesis.
    Results
    Sixteen studies met the inclusion criteria. It seems that outcomes from using intra-operative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer.
    Conclusion
    According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology.
    Keywords: Intra, Operative Radiation Therapy, IORT, Health Technology Assessment, Cancer.
  • Nahid Kianmehr, Ali Bidari, Mani Mofidi, Nasim Bahar * Pages 794-797
    Background
    Osteonecrosis (ON) is known to be one of the most disabling complications following corticosteroid (CS) medications. However, evidence regarding risk of asymptomatic prevalence of ON among different diseases and the impact of variable steroid regimens are conflicting. We aimed to determine the prevalence of ON of femoral head in asymptomatic patients with systemic rheumatic diseases who received high-dose CS and also clarify its relationship with different dosages and regimens.
    Methods
    In this cross-sectional study, 50 consecutive patients receiving high-dose CS for rheumatic diseases who have no pelvic pain were recruited. MRI of both hips was performed on all patients using a 1.5 Tesla to diagnose ON.
    Results
    Of 50 subjects, 18 (36%) developed ON of the femoral head. Groups with and without ON were comparable in terms of sex, age and mean starting CS dose. There was no statistical difference in the type of CS regimen including daily dose, peak dose and cumulative dose between the two groups. However, silent ON was associated with both the cumulative CS dose and the duration of CS therapy.
    Conclusion
    According to high prevalence of ON in our selected patients with no other identifiable risk factor for ON, monitoring of high risk patients with periodic hip MRI would help diagnose necrosis in early stage.
    Keywords: Silent Osteonecrosis, Systemic rheumatic diseases, Corticosteroid
  • Alireza Ahmadvand, Farshad Farzadfar, Hamid Reza Jamshidi, Naser Mohammadi, Kourosh Holakouie, Naieni * Pages 798-807
    Background
    Statins have been effective medications in lowering serum total cholesterol (TC) concentrations across populations over time. The aim of this study was to estimate national and provincial trends in atorvastatin sales in Iran, to systematically quantify its relationship with socio-economic indicators, and changes in TC level.
    Methods
    In this retrospective ecological study, conducted in Iran, we examined trends in atorvastatin sales, the wealth index (WI) as a validly-available socio-economic indicator, and TC level between 2004 and 2011. The main outcome variable was mean atorvastatin sold in defined daily dose per 100,000 people per day (DPD). We analyzed the relationship between WI and DPD and between DPD and mean TC across time and space.
    Results
    At national level, both mean WI and mean DPD showed increasing trend over time, while we observed decreasing trend for TC. Mean WI and DPD in 2011 was nearly 5 and 50 time that of their respective figures in 2004, while the mean TC decreased for nearly 10%. Increases in both WI and DPD had happened in every province, but with different patterns. The maximum and minimum changes in DPD versus WI were seen in Gilan and North Khorasan respectively.
    Conclusion
    A striking increase occurred in the sales for atorvastatin in Iran from 2004-2012 in most provinces examined. The wealthier a province became, the more sales were seen for atorvastatin. TC optimistically decreased from 2005 to 2011 and its decrease was positively correlated with increasing sales for atorvastatin.
    Keywords: Atorvastatin, Socioeconomic status, Hypercholesterolemia, Risk factors, Iran, Epidemiology, Pharmacoepidemiology
  • Khadijeh Hoseinzadeh *, Farhad Daryanoosh, Parvin Javad Baghdasar, Hamid Alizadeh Pages 808-817
    Background
    Inflammation and pain induced by delayed onset muscle soreness (DOMS) as a result of eccentric exercise (EE) or unaccustomed activity cause some difficulties in exercise for athletes. The purpose of this study was to survey the effect of ginger extract on biochemical and functional symptom of delayed onset muscle soreness.
    Methods
    In a quasi-experimental study, 36 healthy female subjects, who were recruited by intra dormitory calls, randomly divided into 3 groups, including: ginger intake 1 hour before exercise (GIBE), ginger intake immediately after exercise (GIAE) and placebo group (PL). Subjects consumed capsules contain 60 mg of ginger extract (equivalent of 2 g dried ginger powder) or placebo before and after exercise. The exercise protocol consisted of a 20 minute step test using a 46cm step at a rate of 15 steps per minute. The blood samples were taken before, 1, 24 and 48 hour after exercise to assay creatine kinase (CK) and interleukin-6 (IL-6). Muscle pain scores, isometric strength and circumference of thigh muscle, and hip range of motion were recorded at mentioned times. The analysis of variance (ANOVA) with repeated measure was used to determine the differences between groups.
    Results
    The results showed a significant reduction of pain in GIBE compared to GIAE after 24 and 48h of EE and GIAE compared to PL (p<0.05). IL-6 changed significantly in GIBE compared to PL (p<0.05) after 1, 24, and 48h after EE. The other factors didn’t change meaningfully.
    Conclusion
    The finding of this study suggests that 2 grams of ginger may have anti-inflammation and analgesic effect on DOMS.
    Keywords: muscle soreness, exercise, Ginger, Interleukin, 6, Creatine kinase (CK).
  • Atossa Mahdavi *, Ali Qashqaei, Ashraf Aleyasin, Marzieh Aghahosseini, Leili Safdarian, Zahra Rezaeean, Parvin Fallahi Pages 818-823
    Background
    Improvement of assisted reproductive technique (ART) results in higher pregnancy rates from positive Beta HCG to take home baby statistics. Despite developments in culture media allowing blastocyst stage transfer, some centers apply second, third and sometimes fourth day post injection for embryo transfer. This study aimed to compare their reproductive outcomes.
    Methods
    This prospective cohort study conducted on 218 infertile couples with at least 4 oocytes retrieved and 2 good quality embryos. They were divided consecutively into 2nd (ET2) or 3rd (ET3) day embryo transfer. Some patients experienced 4rd (ET4) day embryo transfer due to weekend reasons, so we included them in our comparison as well. There were 98, 97 and 23 patients in the aforementioned groups, respectively. Reproductive and pregnancy outcomes were evaluated by Chi square and t-test with the significance level set at α=0.05.
    Results
    Totally, 73 patients (33%) had positive beta HCG and 39.7 percent of them (n=29) experienced pregnancy loss. Positive Beta HCG was detected in 31(31.6%) of ET2 patients, 38 (39.2%) of ET3 patients and 4 (17.4%) of ET4 group. Abortion or pregnancy loss was reported in 9(29%) of ET2 patients, 18 (47.4%) of ET3 patients and 2 (50%) of ET4 group.
    Conclusion
    Our study demonstrated that there may be a higher pregnancy as well as higher abortion in day 3 embryo transfer.
    Keywords: Infertility, Pregnancy, Intracytoplasmic sperm injection, Embryo transfer, assisted reproductive technology
  • Ali A. Asadi, Pooya *, Marziyeh Tajvarpour, Bahareh Vedadinezhad, Mehrdad Emami Pages 824-827
    Background
    This study compares the clinical characteristics of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) with those who have temporal lobe epilepsy (TLE) due to other etiologies.
    Methods
    In this retrospective study all patients with a clinical diagnosis of TLE were recruited in a referral outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 to May 2013. We classified the patients with TLE as having mesial temporal sclerosis if they had clear signs of mesial temporal sclerosis and/or atrophy in their MRI and others who had any other MRI abnormality.
    Results
    A total of 174 patients were studied (including 105 patients with mTLE-HS and 69 patients with TLE due to other etiologies). Frequency of seizure types was not significantly different between these two groups. Earlier age at epilepsy onset (p= 0.005), a past history of febrile seizures (p= 0.010) and presence of affective auras (p= 0.008) were commonly seen in patients with mTLE-HS, while auditory auras (p= 0.020) were more frequent in those with TLE due to other etiologies.
    Conclusion
    The mainstay for making a correct diagnosis, when evaluating a patient with seizure, is having a standardized approach, particularly with regard to taking a detailed clinical history. One may find important clues in the clinical history (e.g., age at disease onset, detailed seizure description and past history) to make a correct diagnosis.
    Keywords: Age, Aura, Febrile seizure, Temporal lobe epilepsy, Hippocampal sclerosis
  • Farzad Ebrahimzadeh, Ebrahim Hajizadeh, Nasim Vahabi, Mohammad Almasian, Katayoon Bakhteyar * Pages 828-838
    Background
    Unwanted pregnancy not intended by at least one of the parents has undesirable consequences for the family and the society. In the present study, three classification models were used and compared to predict unwanted pregnancies in an urban population.
    Methods
    In this cross-sectional study, 887 pregnant mothers referring to health centers in Khorramabad, Iran, in 2012 were selected by the stratified and cluster sampling; relevant variables were measured and for prediction of unwanted pregnancy, logistic regression, discriminant analysis, and probit regression models and SPSS software version 21 were used. To compare these models, indicators such as sensitivity, specificity, the area under the ROC curve, and the percentage of correct predictions were used.
    Results
    The prevalence of unwanted pregnancies was 25.3%. The logistic and probit regression models indicated that parity and pregnancy spacing, contraceptive methods, household income and number of living male children were related to unwanted pregnancy. The performance of the models based on the area under the ROC curve was 0.735, 0.733, and 0.680 for logistic regression, probit regression, and linear discriminant analysis, respectively.
    Conclusion
    Given the relatively high prevalence of unwanted pregnancies in Khorramabad, it seems necessary to revise family planning programs. Despite the similar accuracy of the models, if the researcher is interested in the interpretability of the results, the use of the logistic regression model is recommended.
    Keywords: Unwanted Pregnancy, Logistic regression, Discriminant Analysis, Probit Regression, Khorramabad
  • Aziz Rezapour, Farbod Ebadifard Azar, Negar Yousef Zadeh, Yarallah Roumiani *, Saeed Bagheri Faradonbeh Pages 839-850
    Background
    Assessment of hospitals’ performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran.
    Methods
    This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier4,1 software.
    Results
    According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389.
    Conclusion
    This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved.
    Keywords: Technical efficiency, Resource allocation, Data envelopment analysis, Stochastic frontier analysis
  • Mansoureh A. Farahani, Fatemeh Ghaffari *, Naiemeh Seyed Fatemi Pages 851-861
    Background
    There are widespread misconceptions about the positive effects of opium on coronary artery disease (CAD). Thus, we performed a study to explore the opium addiction process contributing factors among CAD patients using a grounded theory approach.
    Methods
    The sample comprised 30 addicted CAD patients and their family members, physicians, nurses and friends. Purposive and theoretical sampling was employed; semi-structured interviews were conducted. Coding and constant comparative analysis techniques were as proposed by Strauss and Corbin (1998).
    Results
    The core category was ‘Fighting for Survival’, comprising three main themes, namely, ‘the gateway’, ‘blowing into the fire’ and ‘getting stuck in the mud’.
    Conclusion
    Increasing knowledge about the adverse effects of opium on the cardiovascular system would reinforce prevention and rehabilitation measures. Involving patients’ family-members in addiction prevention and rehabilitation programs and referring patients to specialized rehabilitation centres could help patients quit opium. Healthcare providers (HCPs) should notice to the effects of opium consumption among CAD patients; nursing care must be holistic in nature. Although opium is stigmatised in Iran, HCPs must treat addicted CAD patients similar to other patients. Nursing students’ must be aware of the negative effects of illegal drugs on CAD patients and the misconceptions regarding the positive effects thereof. Any misconceptions must be probed and clarified. Rehabilitation centres must be supervised by cardiologists and HCPs.
    Keywords: Coronary artery disease, Opium consumption, Drug abuse, Qualitative research, Iran.
  • Maryam Esfahani *, Yasaman Hashemi, Kaveh Alavi Pages 862-871
    Background
    Beck Scale for Suicidal Ideation (BSSI) is a widely used instrument to assess suicidality. However, there is only limited information about the psychometric characteristics of BSSI in the Persian language. In this study, we investigated the validity, reliability and factor structure of the BSSI in the general population of Tehran.
    Methods
    Initially, 900 questionnaire packages were distributed to the general population of Tehran (response rate: 59 percent), using cluster random sampling method. The questionnaire package consisted of a demographic questionnaire, the Persian translation of the BSSI, Symptom checklist-90-Revised (SCL-90-R), Beck Hopelessness Inventory (BHI) and Philips Social Support Appraisal Scale. Internal consistency and correlations of the BSSI scores with other constructs were investigated. Factor analysis was done using principal component method.
    Results
    The Cronbach's alpha coefficients of the screening part and the whole scale were satisfactory (>0.8). The scores of both the screening part and the total scale in individuals who experienced suicidal attempt were higher than others. Both the screening part and the total scale had a positive correlation with depression and Global Severity Index in SCL-90-R, and a negative correlation with social support. The scores of the screening part had a positive correlation with anxiety, psychoticism, hostility and hopelessness as well. The screening part consisted of a single factor which explains 60% of the total variance.
    Conclusion
    The Persian translation of the BSSI has desirable psychometric properties in research setting. However, the clinical usage of the scale remains to be explored, and the factor structure of the whole questionnaire should be assessed in a clinical sample.
    Keywords: Suicidal Ideations, Psychometrics, Beck Scale for Suicidal Ideation, Factor Analysis
  • Maryam Payan, Nader Tajik *, Mohammad Reza Rouini, Mohammad Hossein Ghahremani Pages 872-980
    Background
    Cytochrome P450 2C19 (CYP2C19) is important in metabolism of wide range of drugs. CYP2C19*17 is a novel variant allele which increases gene transcription and therefore results in ultra-rapid metabolizer phenotype (URM). Distribution of this variant allele has not been well studied worldwide. The aim of present study was to investigate allele and genotype frequencies of CYP2C19*17 in a healthy Iranian population and compare them with other ethnic groups.
    Methods
    One hundred eighty healthy unrelated Iranian volunteer took part in this study and were genotyped for CYP2C19 *2, *3, *17 (-3402) by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and CYP2C19*17 (-806) by a nested-PCR assays. The distribution of CYP2C19*17 polymorphism in Iranian population was then compared with other ethnic groups.
    Results
    The CYP2C19*17 allele frequency was 21.6% in Iranian population. Among studied subjects 5.5% were homozygous for CYP2C19*17 and phenotyped as ultra-rapid metabolizers; 28.8% were genotyped as CYP2C19*1*17 (extensive metabolizers) and 3.3% as CYP2C19*2*17 (intermediate metabolizers).
    Conclusion
    The CYP2C19*17 genetic distribution in Iranian population is similar to Middle East or European countries. The high frequency of CYP2C19*17 in Iranian population highlights the importance of this new variant allele in metabolism of CYP2C19 substrates. Thus, future association studies are required to reveal clinical consequence of this genetic polymorphism in carrier individuals.
    Keywords: CYP2C19, Genotyping, Iranian, Polymorphism, Polymerase chain reaction.
  • Shahnaz Rimaz, Maryam Dastoorpoor *, Samira Vesali, Narges Saiepour, Saharnaz Nedjat, Masoumeh Sadeghi, Effat Merghati Khoei Pages 981-991
    Background
    Although most studies on female-headed families focus on women's access to social support, the associations between social capital and quality of life in these families are unclear in many societies (such as Iran). This study aimed to determine the associations between social capital and quality of life in Iranian female headed families.
    Methods
    This cross-sectional study was performed on 152 female-headed households supported by Tehran Municipality, district 9 from April 2011 to July 2012. Convenience sampling was employed. Data were collected using demographic questionnaire, the Iranian version of World Health Organization Quality of Life, and the Word Bank Social Capital. Descriptive and multiple regression methods were used to analyze the data.
    Results
    The mean±SD age of participants was 50.8±13.8 years. Findings revealed that in quality of life, the domains of environment health and social relation received the lowest (9.87 ± 2.41) and the highest (12.61 ±3.43) scores respectively; and with respect to social capital, membership in groups and social trust had the least (19.61 ± 17.11) and the most (51.04 ± 17.37) scores, respectively. The multiple regression model revealed a significant positive association between total score of the quality of life and the total score for the social capital (p< 0.001).
    Conclusion
    Findings suggest that quality of life of female-headed families and social capital domains are strongly related. This means that by improving the social capital, women’s life can also be improved.
    Keywords: Social Capital, Quality of life, Female, Headed Families (FHF).
  • Hashem Fakhre Yaseri *, Ali Mohammad Fakhre Yaseri, Ali Baradaran Moghaddam, Seyed Kamran Soltani Arabshhi Pages 992-1000
    Background
    Human papilloma virus (HPV) infection is one of the most common sexually transmitted diseases that affects men like women and infected cutaneous and mucosal squamous epithelium. The aim of the present study was to determine the prevalence of HPV in the semen of oligospermic, azoospermic and normal patients.
    Methods
    From June 2012 to June 2013, a total of 90 individuals were enrolled in this cross sectional comparative study. The participants were classified into three groups (oligospermia, azoosprmia and normal). This classification was based on a new WHO reference values for human semen characteristics published on 2010. After extraction of DNA from specimens L1 gene of HPV was amplified by nested polymerase chain reaction (Nested-PCR) and the PCR products of positive specimens were genotyped using INNO-LiPA HPV Genotyping Extra assay.
    Results
    Among 50 confirmed oligospermic male, 15 were HPV DNA positive (30%). In azoospemic group we had 8 HPV DNA positive (40%) and in normal group just 3 of 20(15%) samples were positive. Statistical assessment was done with SPSS v.15. Chi-square test showed no significant relationship between 3 groups results. Based on independent samples t-test, we found statistical significant relationship for sperm count (p<0.05) and sperm motility (slow) (p<0.05) in oligospermic group positive samples compared with negative. In the present study, 13 HPV genotypes were detected among positive samples. HPV genotypes 16, 45 in the high risk group and 6,11,42 in the low risk group were more frequent than the others.
    Conclusion
    The current study shows that HPV infection can affect on sperm count and motility and decrease count of sperm cell and decrease motility capability of these cells.
    Keywords: Papilloma virus, Male infertility, Oligospermia.
  • Sherko Nasseri, Seyed Hamidreza Monavari *, Hossein Keyvani, Bahram Nikkhoo, Rouhollah Vahabpour Roudsari, Mohammad Khazeni Pages 1001-1006
    Background
    Human papilloma virus (HPV) infection is one of the most common sexually transmitted diseases that affects men like women and infected cutaneous and mucosal squamous epithelium. The aim of the present study was to determine the prevalence of HPV in the semen of oligospermic, azoospermic and normal patients.
    Methods
    From June 2012 to June 2013, a total of 90 individuals were enrolled in this cross sectional comparative study. The participants were classified into three groups (oligospermia, azoosprmia and normal). This classification was based on a new WHO reference values for human semen characteristics published on 2010. After extraction of DNA from specimens L1 gene of HPV was amplified by nested polymerase chain reaction (Nested-PCR) and the PCR products of positive specimens were genotyped using INNO-LiPA HPV Genotyping Extra assay.
    Results
    Among 50 confirmed oligospermic male, 15 were HPV DNA positive (30%). In azoospemic group we had 8 HPV DNA positive (40%) and in normal group just 3 of 20(15%) samples were positive. Statistical assessment was done with SPSS v.15. Chi-square test showed no significant relationship between 3 groups results. Based on independent samples t-test, we found statistical significant relationship for sperm count (p<0.05) and sperm motility (slow) (p<0.05) in oligospermic group positive samples compared with negative. In the present study, 13 HPV genotypes were detected among positive samples. HPV genotypes 16, 45 in the high risk group and 6,11,42 in the low risk group were more frequent than the others.
    Conclusion
    The current study shows that HPV infection can affect on sperm count and motility and decrease count of sperm cell and decrease motility capability of these cells.
    Keywords: Papilloma virus, Male infertility, Oligospermia.
  • Malek Ali Mohammadi, Mohammadreza Eshraghian, Mohammad, Reza Zarindast, Abbas Aliaghaei, Hamideh Pishva* Pages 1007-1014
    Background
    Alzheimer disease is the main cause of dementia in middle-aged and elderly people. Considering the improving effects of creatine supplementation on cognitive performance, this study aimed to determine the effects of creatine supplementation on learning, memory, and apoptosis in an experimental model of Alzheimer’s disease.
    Methods
    Thirty-two male Wistar rats each weighing 250±50 grams were divided into four groups. The AdCr+ (Aβ injection, creatine supplementation) and AdCr- groups (Aβ injection, no creatine supplementation) were injected bilaterally with amyloid beta (Aβ) (0.2µg in each CA1 area), and the sham group was injected with normal saline in the same area. After the injection, the AdCr+ group received a diet of 2% creatine for six weeks. The control group underwent no surgical or dietary intervention. After six weeks the Morris Water Maze (MWM) test was administered, to measure learning and memory retrieval. After sacrificing the animals, TUNEL staining for an anti-apoptosis assay was performed for the sham, AdCr+, and AdCr- groups. All groups were compared by independent t-test using SPSS software.
    Results
    Results of MWM show that rats in sham and control groups performed better than those in the AdCr- and AdCr+ groups. Compared to sham group, AdCr+ and AdCr- groups had more TUNEL positive neurons count. Results indicated no differences between the AdCr+ and AdCr- groups in learning, memory retrieval, and percentage of TUNEL positive neurons.
    Conclusion
    After Aβ injection, creatine supplementation had no effect on learning, memory retrieval, or neuron apoptosis in male Wistar rats.
    Keywords: Creatine supplementation, Amyloid beta, Alzheimer disease, Memory, Learning, Apoptosis
  • Ali Yeganeh, Negin Hatami, Mani Mahmoudi, Bahram Boduhi, Mahzad Saidifard, Babak Otoukesh* Pages 1015-1020
    Background
    Infectious diseases are major public health problems, among which blood-borne ones are the most important infections. Patients who undergo orthopedic surgery are at higher risk of transmitting infectious diseases from and to others, due to repeated blood examinations and injection, drains secretion and receiving blood products. Accordingly, in this study we determined prevalence of Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) and human immunodeficiency Virus (HIV) infections in patients who underwent surgery in a general training hospital.
    Methods
    In this cross-sectional study the prevalence of HBV, HCV, and HIV infections was determined among 320 patients under orthopedic trauma surgeries in a general training hospital in Tehran, Iran from 2009 to 2011. Associations of these rates with age, gender, marital status, residence location, substance abuse history, hospital admission history, previous surgery, blood transfusion, dentistry procedures, and previous medical history were also assessed.
    Results
    A total of 320 patients (290 male, 30 female) were studied. Ten patients (3.2%) had at least one of these three infections. Totally 10 patients (3.2%), 2 subjects (0.6%), and 8 patients (2.5%) had HCV, HIV, and HBV infections, respectively. None of the evaluated variables had significant relationship with HCV, HBV, and HIV infections (p> 0.05).
    Conclusion
    According to the obtained results, routine use of diagnostic tests for infectious disease such as HIV and viral hepatitis is recommended and should be considered before orthopedic operations.
    Keywords: Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus, Orthopedic Surgery
  • Fariba Fattahi, Ahmad Geshani *, Zahra Jafari, Shohreh Jalaie, Mona Salman Mahini Pages 1021-1029
    Background
    Chess is a game that involves many aspects of high level cognition such as memory, attention, focus and problem solving. Long term practice of chess can improve cognition performances and behavioral skills. Auditory memory, as a kind of memory, can be influenced by strengthening processes following long term chess playing like other behavioral skills because of common processing pathways in the brain. The purpose of this study was to evaluate the auditory memory function of expert chess players using the Persian version of dichotic auditory-verbal memory test.
    Methods
    The Persian version of dichotic auditory-verbal memory test was performed for 30 expert chess players aged 20-35 years and 30 non chess players who were matched by different conditions; the participants in both groups were randomly selected. The performance of the two groups was compared by independent samples t-test using SPSS version 21.
    Results
    The mean score of dichotic auditory-verbal memory test between the two groups, expert chess players and non-chess players, revealed a significant difference (p≤0.001). The difference between the ears scores for expert chess players (p= 0.023) and non-chess players (p= 0.013) was significant. Gender had no effect on the test results.
    Conclusion
    Auditory memory function in expert chess players was significantly better compared to non-chess players. It seems that increased auditory memory function is related to strengthening cognitive performances due to playing chess for a long time.
    Keywords: Dichotic, Auditory Memory, Chess Players
  • Nahid Dehghan, Nayeri, Fatemeh Ghaffari *, Mahboubeh Shali Pages 1030-1038
    Background
    The main objective of nursing is to provide comprehensive nursing care that is appropriate to patients’ needs. However, the incidence of missed nursing care compromises the provision of comprehensive and safe care and threatens patients’ lives. Thus, this in-depth qualitative study aimed to explore nurses’ experiences of missed care and factors affecting it. The aim of this study was to describe nurses’ experiences of missed care in clinical practice.
    Methods
    In this study, qualitative research methodology, with a content analysis approach was used. The sample included 23 nurses in referral teaching hospitals. Data were collected through focus group discussions, face-to-face and telephonic interviews, using semi-structured questions.
    Results
    Three themes, comprising several sub-themes, emerged, and included contextual conditions, coercion, and deprivation.
    Conclusion
    The results indicated that organizational and personal factors facilitate the incidence of coerced, missed nursing care. High quality of care, the prevention of missed care incidences and patient safety depend on the provision of adequate staff, appropriate equipment and a sense of responsibility for patients’ care needs among nurses.
    Keywords: Missed, Nursing Care, Patient Safety, Qualitative Research
  • Galavizh Ahmadi, Mohsen Asadi, Lari, Saeid Amani, Masoud Solaymani, Dodaran* Pages 1039-1048
    Background
    We explored survival of skin cancer and its determinants in Kurdistan province of Iran.
    Methods
    In a retrospective cohort design, we identified all registered skin cancer patients in Kurdistan Cancer Registry from year 2000 to 2009. Information on time and cause of death were obtained from Registrar’s office and information on type, stage and anatomic locations were extracted from patients’ hospital records. Additional demographic information was collected via a telephone interview. We calculated the 3 and 5 years survival. Survival experiences in different groups were compared using log rank test. Cox proportional hazard model was built and hazard ratios and their 95% confidence intervals were calculated.
    Results
    Of a total of 1353, contact information for 667 patients were available, all of which were followed up. 472 telephone interviews were conducted. Mean follow-up time was 34 months. We identified 78 deaths in this group of patients and 44 of them were because of skin cancer. After controlling for confounding, tumour type, anatomical location, and diseases stage remained significantly associated with survival. Hazard ratios for death because of squamous cell carcinoma was 74.5(95%CI:4.8-1146) and for melanoma was 24.4(95%CI:1.3-485) compared with basal cell carcinomas. Hazard ratio for tumours in stage 4 was 16.7 (95%CI:1.8-156.6) and for stage 3 was 16.8(95%CI:1.07-260) compared with stage 1 and 2.
    Conclusion
    Tumour stage is independently associated with survival. Relatively low survival rates suggest delayed diagnosis. Increasing public awareness through media about the warning signs of skin cancers could increase the chance of survival in these patients.
    Keywords: Skin cancer, Survival analysis, Kaplan Meier, Cox model
  • Ali Jafarian, Fezzeh Elyasinia *, Mohammad Reza Keramati, Farham Ahmadi, Reza Parsaei Pages 1049-1053
    Background
    Peripheral arterial disease is a source of morbidity and mortality. Surgical vascular reconstruction is a treatment option but probability of failure and complications are important concerns. In this study, we evaluated outcome of surgical infrainguinal reconstruction and factors affecting graft patency for a period of one year.
    Methods
    In this cohort study, 85 consecutive patients with chronic ischemia who underwent lower extremity surgical vascular reconstruction (including 52 femoropopliteal and 25 femorofemoral bypass) from March 2007 to Feb 2009 were recruited. Graft patency was evaluated before discharge from hospital and one year after the surgical operation using duplex ultrasonography. Association between possible risk factors and graft patency were evaluated.
    Results
    In general, 71% (37 patients) of femoropopliteal and 52% (13 patients) of femorofemoral reconstructions were patent during the follow up period. Diabetes mellitus, hypertension, smoking, opium use and ischemic heart disease were significantly associated with decreased rate of patency (p<0.05).
    Conclusion
    Assessing risk factors that predict perioperative mortality and graft patency is essential for selecting patients that would benefit from surgery. Omitting surgical reconstruction and endovascular intervention may be preferable especially when multiple risk factors are present or in the absence of critical limb ischemia.
    Keywords: Outcome, Surgical reconstruction, Peripheral vascular disease, Infrainguinal bypass
  • Abbas Habibzadeh, Saeed Pourabdol *, Shahzad Saravani Pages 1054-1061
    Background
    A great deal of attention has been given to the study of learning disorders. Hence, the aim of this research was to study the effect of emotion regulation training in decreasing emotion failures and self-injurious behaviors among students suffering from specific learning disorder.
    Methods
    This was an experimental study with the pre-test, post-test and a control group. Research population included all 5th grade male students suffering from specific learning disorder (case study: 5th grade students in Ardabil in 2015). Research sample included 40 male students suffering from specific learning disorder(SLD) who were selected through multi-step cluster sampling and classified into two groups: Experimental group (n= 20) and control group (n= 20). The following tools were used for data collection: Kay Math mathematic Test, Raven Intelligence Test, Reading Test of Shafiei et al, Falahchay Writing Expression, Emotion Failures Scale, Self-Injurious Behavior Questionnaire and Diagnostic Interview based on DSM-5. Data were analyzed by multivariate of variance analysis (MANOVA) model in the SPSS software version 22.
    Results
    The results of MANOVA revealed that emotion regulation training was effective in decreasing emotion failures in all parameters (difficulty in describing feelings, difficulty in identifying feelings, and externally oriented thinking style) and self-injurious behaviors in students suffering from specific learning disorder (p< 0.001).
    Conclusion
    In this study, it was found that since emotion regulation training can have a remarkable effect on reducing negative emotions and increasing the positive ones; this treatment can play an eminent role in decreasing emotion failures and self-injurious behaviors in such students.
    Keywords: Specific Learning Disorder, Self, Injurious Behaviors, Emotion Failures, Emotion Regulation
  • Maryam Kashanian *, Elaheh Sariri, Mansoureh Vahdat, Maryam Ahmari, Yousef Moradi, Narges Sheikhansari Pages 1062-1067
    Background
    The purpose of the present study was to compare the serum levels of IL6 and CA125 in women with and without endometriosis. They were also compared in mild, moderate and severe cases.
    Methods
    In this case-control study, CA125 and IL6 levels in 76 women with laparoscopic proven endometriosis were compared with 76 women without evidence of endometriosis. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were then calculated for each test.
    Results
    Both groups did not show significant difference in their age, BMI, ESR and gravidity. Mean serum levels of IL-6 and CA125 were significantly higher in the case group (30.4±6.43 vs 13.9±3.17 Pg/ml and 62.6±10.69 vs 16.6±1.79 IU/ml respectively). Considering a cutoff point of 30 Pg/ml for IL-6, sensitivity, specifically, PPV and NPV value of 21.1%, 66.6%, 86.8% and 23.37% were obtained, respectively. Considering a cutoff point of 35 IU/ml for CA125, sensitivity, specifically, PPV and NPV were 44.76%, 94.73%, 89.47% and 63.15%, respectively. Area under the ROC curve was 0.69 for CA125 and 0.54 for IL6, which showed a low value for these tests.
    Conclusion
    Although CA125 and IL-6 were higher than normal controls in endometriosis, area under the ROC curve, did not show significant any diagnostic value for these tests.
    Keywords: Endometriosis, Interleukin 6, CA125, Cytokines
  • Shahla Yazdani, Rahele Rouholahnejad, Nesa Asnafi, Majid Sharbatdaran, Marziihe Zakershob, Zinatossadat Bouzari* Pages 1068-1075
    Background
    Abnormal levels of the markers AFP, hCG, and uE3 could be useful in predicting adverse pregnancy outcomes. This study was designed to determine the correlation between second trimester maternal serum markers and adverse pregnancy outcome (APO).
    Methods
    In this historical cohort study, we randomly followed 231 obstetric patients with quadruple screening test in 14-18 weeks of gestation from March 2012 to March 2013 in a medical laboratory in Babol, Iran. We measured maternal serum levels of alphafetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A. The risk of adverse pregnancy outcomes (APOs) were then compared between patients with negative and positive test results. We used Chi-square and Fisher-exact tests for qualitative variables and t-test for quantitative variables. Demographic differences between the two groups were minimized by applying logistic regression.
    Results
    The risk of having an APO such as pre-eclampsia (p=0.008), fetal growth restriction (p=0.028) and premature rupture of membrane (p=0.040) increased significantly in patients with abnormal markers.
    Conclusion
    Abnormal results of quadruple screening test could be associated with APO in women with normal appearing fetus.
    Keywords: Quadruples, Prenatal Screening, Pregnancy trimester
  • Minoo Kalantari, Mohammad Kamali *, Soodabeh Joolaee, Narges Shafarodi, Mehdi Rassafiani Pages 1076-1082
    Background
    It is the responsibility of each occupational therapist to always act ethically and professionally in a clinical setting. However, there is little information available concerning the factors influencing ethical behavior of occupational therapists at work. Since no study has been conducted in Iran on this topic, this qualitative study aimed to identify the factors influencing ethical behavior of pediatric occupational therapists.
    Methods
    Twelve pediatric occupational therapists participated in this study. The sampling was purposeful, and the interviews continued until reaching data saturation. All interviews were recorded and transcribed. The data were analyzed by qualitative content analysis, and the ethics of qualitative research was considered.
    Results
    The factors influencing ethical behavior were classified into four main categories including organizational factors, therapist related factors, client’s family issues, and social factors.
    Conclusion
    This study identified numerous factors influencing the ethical behavior of pediatric occupational therapists that could be used to train occupational therapists, human resources managers, professional policy makers, and could also be used to conduct future researches, and produce tools.
    Keywords: Ethical Behavior, Occupational Therapy, Content Analysis, Qualitative Research
  • Hamid Abredari, Fariba Bolourchifard *, Maryam Rassouli, Navideh Nasiri, Mohammad Taher, Ahmadreza Abedi Pages 1083-1087
    Background
    Diabetic foot affects more than 25% of diabetic patients and finally up to 20% of cases result in amputation. The most important factor resulting in severe complications or even death is lack of self-care. Health locus of control has been introduced as one of health factors and predicting factors of self-care. This research was performed for analyzing the correlation between self-care behaviors and health locus of control in diabetic foot patients.
    Methods
    In this descriptive study, 120 patients with diabetic foot were chosen using convenience sampling from endocrine clinic and wards of endocrine and vascular surgery of Teleqani Hospital of ShahidBeheshti Medical University. The data were gathered by demographic, self-care behavior, and health locus of control questionnaires. The t-test, analysis of variance (ANOVA) and spearman coefficient were used to analyze the data.
    Results
    Results of this research showed that there is a direct and significant relation between self-care behaviors and internal health locus of control (p<0.001), and also in contrast with chance health locus of control (p<0.001).
    Conclusion
    We have to consider these factors’ role in nursing interventions and patient-care education programs and plans. Probably, interventions and programs that will lead to the strengthening of internal health locus of control improve and strengthen patients’ self-care behaviors and their involvement in treatment.
    Keywords: Diabetic foot, Self, care behaviors, Health locus of control
  • Adel Yazdankhah, Mohammad Tayefeh Norooz, Hadi Ahmadi Amoli, Ali Aminian, Zhamak Khorgami, Paria Khashayar, Patricia Khashayar* Pages 1088-1094
    Background
    Medical professionalism helps physicians adopt a proper and good healing action for the patients based on their particular circumstance. This study was conducted to assess professionalism in surgical residents, using a 360-degree evaluation technique in several teaching hospitals in Tehran, Iran.
    Methods
    This study was conducted on all the second and third year surgery residents from three university teaching hospitals in Tehran. Multi-source feedback questionnaire contained 10 questions on the residents’ professional behavior and was completed by the faculty and staff members (nurses, operation room staff, and medical assistants) as well as other surgery residents, interns and patients to evaluate each resident. Response rates were used to determine feasibility for each of the respondent groups and the mean and standard deviation score for each question was computed to determine the viability of the items. Reliability was assessed using alpha Cronbach coefficient for each respondent group. The correlation between these scores and the residents’ final and OSCE grade was also assessed.
    Results
    The internal consistency reliability for 360-degree rating was 0.889. There was no significant difference in the residents’ score in different hospitals. While male residents obtained higher total score, there was no significant difference between them. The residents, however, obtained lower scores compared to the staff. The highest score was recorded for question 6, suggesting that the residents treated the patients regardless of their socioeconomic status.
    Conclusion
    This study revealed a strong agreement between the results gathered from different respondents, confirming the reliability of the questionnaire and the respondents’ unbiased response. It also revealed that the residents did well in the whole test, showing they were conscientious and learning to become medical professionals.
    Keywords: Multi, Source Feedback, Professionalism, 360, Degree, Assessment
  • Hossein Masoumi Asl *, Mohammad Mehdi Gouya, Mohammad Mehdi Soltan, Dallal, Nooshin Aghili Pages 1095-1100
    Background
    The outbreaks of foodborne diseases is a major health problem and occur daily in all countries, from the most to the least developed. This study is the first report of foodborne outbreaks in Iran that carried out from 2006 to 2011.
    Methods
    A retrospective, longitudinal study carried out using foodborne disease national surveillance system data from 2006-2011, which have been reported by all provincial health centers to the Center for Communicable Disease Control. Collected data were analyzed using SPSS version 18 software.
    Results
    Since 2006 to 2011, a total of 2250 outbreaks were reported in Iran. Analyzed data showed that the outbreak rate has increased from 0.07/100000 in 2006 to 1.38/100000 population in 2011. Khuzestan, Kermanshah and Qazvin were three provinces that reported more outbreaks than nationally expected outbreak incidence rate during 2011. Analysis of epidemiological characteristics of foodborne outbreaks during 2011 indicated that the numbers of outbreaks were highest in warm months, e.g. 17.8% of total outbreaks was just reported in August. Females and age group of 16-30 years old were more affected and 55% of cases occurred in rural area. Among 684 human samples which have been tested, E. coli, Shigella, Hepatitis A and Vibrio cholera were predominant etiologic agents respectively.
    Conclusion
    Increasing the detection rate of foodborne outbreaks imply the expansion of surveillance activities and improved primary health care in Iran in recent years. Foodborne disease surveillance system is a new program in Iran that should be continued and strengthened including diagnostic laboratory capacities.
    Keywords: Foodborne Disease Outbreak, Surveillance, Iran
  • Soheil Shapouri, Vahid Nejati, Mehrdad Eftekhar Ardebili* Pages 1101-1106
    Background
    Researchers have been investigating similarities of and differences between homosexuals and heterosexuals for past few decades. Several studies have shown that in the particular domain (e.g., spatial ability), male homosexuals would resemble female heterosexuals better than male heterosexuals. Executive function, however, has received more attention than social cognition in this line of research.
    Methods
    This study focuses on theory of mind and empathy as two important components of social cognition in male homosexuals (N=14), male heterosexuals (N=15) and female heterosexuals (N=14).
    Results
    Applying Reading the Mind in the Eyes test and the Empathy Quotient, no significant difference between groups was identified.
    Conclusion
    This study suggests that similarities of male homosexuals and female heterosexuals may be confined to executive function and not extended to some social cognition abilities like theory of mind or empathy.
    Keywords: Sexual Orientation, Theory of Mind, Empathy, Sex Differences
  • Vitorino Modesto Santos* Pages 1107-1108
  • Shandiz Moslehi, Pezhman Atefimanesh *, Aliasghar Asgharnejad Farid Pages 1109-1115
    Background
    Schizophrenia is a disorder with psychotic symptoms that severely affects personal performance. Assessing problem- focused strategies and quality of life (QoL) in patients with schizophrenia may help the clinicians to use appropriate interventions. This study was conducted to find the relationship between problem-focused coping strategies and quality of life in schizophrenic patients who referred to the clinic of Iran University of Medical Sciences in 2013.
    Methods
    Non-random sampling was used in two stages (quota and convenience sampling). Data were collected through Demographic Questionnaire, 5-point Likert-type scale World Health Organization Quality of Life and Problem-Focused Strategies Standard Questionnaire. Four dimensions of QoL which were assessed among schizophrenic patients were as follows: Physical health, mental health, social relationships and environmental factors. Pearson correlation coefficient and regression were used for data analysis.
    Results
    The highest mean score (Mean= 2.7) belonged to environmental factors and the lowest score to social relationships (Mean= 2.55). Overall, there was a significant direct relationship between the QoL and problem-focused coping strategies (p= 0.024, r= 0.319).
    Conclusion
    The Schizophrenic patients who used more problem- focused coping strategies had better QoL. Therefore, it is important to take into account problem- focus coping strategies when treating the patients. The application of this research will be crucial to clinicians and healthcare executives.
    Keywords: Problem, Focused Strategies, Quality of Life, Schizophrenia
  • Zahra Hosseini, Zabihollah Gharlipour Gharghani, Anahita Mansoori, Teamur Aghamolaei*, Maryam Mohammadi Nasrabadi Pages 1116-1123
    Background
    Breakfast is the most important daily meal, but neglected more than other meals by children and adolescents. The aim of this study was to evaluate the effectiveness of an educational intervention, based on the Theory of Reasoned Action (TRA) to increase breakfast consumption among school children in Bandar Abbas, Iran.
    Methods
    In this quasi experimental study which was conducted in 2012, 88 students of four secondary schools in Bandar Abbas, south of Iran, were enrolled. Multi-stage cluster sampling was performed with random allocation of interventional and control groups. The study tool was a questionnaire which was filled by the students before and two months after the educational intervention. For data analysis, statistical tests including paired-samples t-test, independent samples t-test, Wilcoxon test, and Mann-Whitney test were used through SPSS v.18 software.
    Results
    The result of the study showed that application of TRA significantly increased scores of behavior of breakfast consumption (p<0.01). After the intervention, a significant increase was revealed in all nutrition intakes, except for fat and sugar (p<0.01).
    Conclusion
    The findings support application of the TRA in improving the intention and behavior of breakfast consumption. Applying this theory for designing interventions to increase breakfast eating is recommended.
    Keywords: Theory of Reasoned Action, Breakfast, Students
  • Mohammad Hossein Badakhsh, Mojtaba Malek, Rokhsareh Aghili, Ameneh Ebrahim Valojerdi, Mohammad Ebrahim Khamseh* Pages 1124-1128
    Background
    This study was to estimate the frequency of prehypertension and to characterize patient awareness and associated cardiovascular risk factors in an urban population in Iran.
    Methods
    During a hypertensive awareness program, a cross-sectional study was conducted on 2036 people. All participants completed a questionnaire about their demographic and anthropometric indices and were asked about symptoms, risk factors and preventive measures of hypertension. Data were compared between prehypertensive and non-hypertensive groups.
    Results
    Prehypertension was detected in 30% (n=611) of the subjects. Previous CHD, diabetes, and hyperlipidemia were more prevalent in low prehypertension group compared to high normal blood pressure. The male sex, increasing age and body weight were positively associated with the rate of prehypertension. Only 8% of participants with prehypertension were aware about the symptoms of hypertension, 12% correctly mentioned at least three risk factors of hypertension, and 48% explained appropriate preventive measures.
    Conclusion
    Prehypertension was prevalent in this population. Age, body weight, male sex, and previous CHD were the major determinants. Furthermore, hypertension awareness was alarmingly poor. Therefore, hypertension prevention programs focused on increasing public awareness are essential.
    Keywords: Blood Pressure, Prehypertension, Awareness, Cardiovascular risks
  • Kieran Walsh* Pages 1129-1130
  • Meysam Behzadifar, Masoud Behzadifar, Ali Sayehmiri, Maryam Behzadifar, Mandana Sarokhani, Kourosh Sayehmiri* Pages 1131-1135
    Background
    Mental disorder is one of the most important diseases of which is predicted to increase from 10.5% to 15% until 2020. This study aimed to determine economic factors influencing mental health using multiple regression models in Ilam province in 2013.
    Methods
    In this cross sectional study, 903 families from different cities of Ilam were selected using multistage cluster sampling. The families were selected from each city separately and each head of family was interviewed. The instruments for data collection included general and economic questionnaires and the General Health Questionnaire (GHQ). The data were analyzed using SPSS software version 21, Eviews, t-test, ANOVA, Pearson's correlation coefficient, single and multiple linear regressions.
    Results
    The mean ± SD mental health score in this study was 28.5±12.10. The mental health increased for 4.26 units per each unit of life satisfaction increase, decreased for 4.09 units per each unit of gender growth, increased for 2.94 units per each unit of increase in economic status and had a significant correlation with all the three components (p<0.001).
    Conclusion
    In order to improve people's mental health, it is recommended that healthcare officials may more attention to this matter through implementation of programs such as life skills’ training, stress resistance skills training, and helping individuals to be able to adapt themselves to their life environment.
    Keywords: General health, Economic factors, Ilam
  • Fatemeh Sajjadi, Maziar Moradi, Lakeh *, Marzieh Nojomi, Hamid R. Baradaran, Fereidoun Azizi Pages 1136-1149
    Background
    World Health Organization (WHO) defines three goals to assess the performance of a health system: the state of health, fairness in financial contribution and responsiveness. We assessed the responsiveness of health system for patients with diabetes in a defined population cohort in Tehran, Iran.
    Methods
    Total responsiveness and eight domains (prompt attention, dignity, communication, autonomy, confidentiality, choice, basic amenities and discrimination) were assessed in 150 patients with diabetes as a representative sample from the Tehran Glucose and Lipid Study (TLGS) population cohort. We used the WHO questionnaire and methods for analysis of responsiveness.
    Results
    With respect to outpatient services, 67% (n=100) were classified as Good for total responsiveness. The best and the worse performing results were related to information confidentiality (84% good responsiveness) and autonomy (51% good responsiveness), respectively. About 61% chose “communication” as the most important domain of responsiveness; it was on the 4th rank of performance. The proportions of poor responsiveness were higher in women, individuals with lower income, lower level of education, and longer history of diabetes. “Discrimination” was considered discrimination as the cause of inappropriate services by 15%, and 29% had limited access to services because of financial unaffordability.
    Conclusion
    Health system responsiveness is not appropriate for diabetic patients. Improvement of responsiveness needs comprehensive planning to improve attitudes of healthcare providers and system behavior. Activities should be prioritized through considering weaker domains of performance and more important domains from the patients’ perspective.
    Keywords: Responsiveness, Delivery of healthcare, Patient satisfaction, Diabetes mellitus, Iran
  • Abdolhalim Rajabi, Najmeh Maharlouei, Abbas Rezaianzadeh *, Abdolreza Rajaeefard, Ali Gholami Pages 1150-1158
    Background
    Iran has a high C-section rate (40.6% in 2005). The objective of this study was to assess the associations and population-attributable risks (PAR) of risk factors combinations and C-section in the Southwest Iran.
    Methods
    We performed a population-based cohort study using the reports provided by Shiraz University of Medical Sciences. The cohort included pregnant women within September 2012 and February 2013 (n=4229), with follow-up until delivery. Then, the actual delivery was recorded; i.e., C-section delivery, vaginal delivery, and miscarriage. A multiple logistic regression model was used to estimate the point and the interval probability. The adjusted population attributable risks (aPARs) were calculated through adjusted odds ratio from the final multiple logistic regression models for each variable.
    Results
    Of 4,217 deliveries, 2,624 ones were C-section (62.2%). The rate of C-section was significantly higher in healthcare departments of private clinics compared to governmental clinics. The rate increased steadily with the mother’s age, marriage age, family income and education. The multiple logistic regression analysis showed that local healthcare, supplementary insurance, maternal age, age of marriage, place of birth, family income, maternal education, education of husband and occupation were the key contributing factors to choose the mode of delivery. The multiple logistic regression analysis for reproductive factors showed that parity, previous abortion and stillbirth, previous infertility, birth weight (g) and number of live births were selected risk factors for C-section. Among the exposures, family income, location of healthcare and place of birth showed the highest population attributable risks: 43.86%, 19.2% and 18.53%; respectively.
    Conclusion
    In this survey, a relatively large contribution of non-medical factors was identified against the background of C-section. All of these factors influence the knowledge, attitudes and norms of the society. Thus, the attention of policymakers should be drawn to the factors associated with this mode of delivery.
    Keywords: C, section, Risk factor, Public health, Iran
  • Marzieh Yassin, Saeed Talebian *, Ismail Ebrahimi Takamjani, Nader Maroufi, Amir Ahmadi, Javad Sarrafzadeh, Anita Emrani Pages 1159-1168
    Background
    Myofascial pain syndrome is a significant source of mechanical pain. The aim of this study was to investigate the effects of arm movement on reaction time in females with latent and active upper trapezius myofascial trigger point.
    Methods
    In this interventional study, a convenience sample of fifteen women with one active MTP, fifteen women with one latent MTP in the upper trapezius, and fifteen normal healthy women were participated. Participants were asked to stand for 10 seconds in an erect standing position. Muscle reaction times were recorded including anterior deltoid (AD), cervical paraspinal (CP) lumbar paraspinal (LP), both of upper trapezius (UT), sternocleidomastoid (SCM) and medial head of gastrocnemius(GcM). Participants were asked to flex their arms in response to a sound stimulus preceded by a warning sound stimulus. Data were analyzed using one-way ANOVA Test.
    Results
    There was significant differences in motor time and reaction time between active and control groups (p< 0.05) except for GcM. There was no significant difference in motor time between active and passive groups except for UT without MTP and SCM (p< 0.05). Also, there were no significant differences in motor times between latent MTP and control groups. Furthermore, there was no significant difference in premotor times between the three groups.
    Conclusion
    The present study shows that patients with active MTP need more time to react to stimulus, but patients with latent MTP are similar to healthy subjects in the reaction time. Patients with active MTP had less compatibility with environmental stimulations, and they responded to a specific stimulation with variability in Surface Electromyography (SEMG).
    Keywords: Myofascial trigger point, Surface Electromyography (SEMG), Reaction Time
  • Fatemeh Hadi, Termeh Khosravi, Seyed Vahid Shariat, Amir Hossein Jalali Nadoushan* Pages 1169-1176
    Background
    Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible.
    Methods
    This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group.
    Results
    Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained.
    Conclusion
    Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients.
    Keywords: Physical Restraint, Psychiatric Emergency Settings, Case, Control Studies
  • Masoud Salehi, Masoud Roudbari* Pages 1177-1183
    Background
    The number of failed courses and semesters in students are indicatorsof their performance. These amounts have zero inflated (ZI) distributions. Using ZI Poisson and negative binomial distributions we can model these count data to find the associated factors and estimate the parameters. This study aims at to investigate the important factors related to the educational performance of students.
    Methods
    This cross-sectional study performed in 2008-2009 at Iran University of Medical Sciences (IUMS) with a population of almost 6000 students, 670 students selected using stratified random sampling. The educational and demographical data were collected using the University records. The study design was approved at IUMS and the students’ data kept confidential. The descriptive statistics and ZI Poisson and negative binomial regressions were used to analyze the data. The data were analyzed using STATA.
    Results
    In the number of failed semesters, Poisson and negative binomial distributions with ZI, students’ total average and quota system had the most roles. For the number of failed courses, total average, and being in undergraduate or master levels had the most effect in both models.
    Conclusion
    In all models the total average have the most effect on the number of failed courses or semesters. The next important factor is quota system in failed semester and undergraduate and master levels in failed courses. Therefore, average has an important inverse effect on the numbers of failed courses and semester.
    Keywords: Zero inflated, Course, Semester, Failure, Student
  • Morteza Nakhaei Amroodi *, Abdolrazzagh Iri, Salehe Akhoondi Pages 1184-1188
    Background
    Prevalence of recurrent shoulder dislocation in patients taking tramadol has not been studiedyet; so, this study aims to study the recurrent shoulder dislocation following tramadol induced seizure.
    Methods
    In this cross-sectional study, 205 patients with recurrent shoulder dislocation complaints (2 or more) referred to Shafa Orthopedic and Iranmehr hospitals Tehran, Iran, from October 2012 to October 2014 were studied. Data on patient history and physical examination, patient demographic information such as age, sex, age at first dislocation, total number of dislocation, cause of the first dislocation, history of tramadol use, number of dislocation following tramadol induced seizure, history of other drugs use, the dominant hand, involved side, direction of dislocations and greater tuberosity fracture was recorded using a pre-designed questionnaire. Categorical variables were compared by chi-square test and the means were compared with student T-test.
    Results
    In this study, 50 patients (24.4%) suffered from tramadol induced seizures and recurrent shoulder dislocation. Results showed that there was a significant relationship between the number of dislocation and tramadol use (P = 0.02). Recurrent shoulder dislocation following tramadol induced seizure was significantly associated with greater tuberosity fracture of humerus (P = 0.04); in 49 out of 50 patients (98%) dislocation was of anterior type.
    Conclusion
    The findings of this study suggest that tramadol induced seizure may increase the risk of recurrent shoulder dislocation. Furthermore, the prevalence of greater tuberosity fracture in shoulder dislocation increases following tramadol induced seizure; and anterior shoulder dislocation is the most common type of dislocation following tramadol induced seizure.
    Keywords: Recurrent shoulder dislocation, Tramadol, Seizure
  • Zahra Naghizadeh Moogari, Jalil Koohpayehzadeh *, Susanne Roff, Ali Montazeri, Seyyed Kamran Soltani Arabshahi, Shoaleh Bigdeli, Maryam Moosavi, Faranak Azaminejad, Mahmoud Tavousi Pages 1189-1195
    Background
    Examining educational environment (academic and clinical) by means ofa valid, reliable and comprehensive questionnaire is a major key inachievinga highly qualified student – oriented curricula. The Persian translation of Ambulatory Care Learning Education Environment Measure-ACLEEM questionnaire has been developed to support this goal, and its psychometrics has beenexplored in this administration in teaching hospitals affiliated to Tehran University of Medical Sciences.
    Methods
    This descriptive – analytical study involved medical residents in fourmajor clinics. In this study,the ACLEEM Questionnaire was conducted after translating and retranslating the questionnaire and examinethe face and content validity, construct validity, test retest reliability and internal consistency coefficient.
    Results
    In this study, 157 out of 192 residents completed the questionnaire (response rate 82%). The mean age of the residents was 31.81 years. The final mean of the questionnaire was calculated as 110.91 out of 200 (with 95% confidence interval). Test – retest stability of the questionnaire was between 0.322 and 0.968. The face validity of the questionnaire was confirmed. The content validity ratio was 0.64; and content validity Index was 0.78. In Exploratory factor analysis,eight factors were confirmatory that changed the orientation of some questions. The Cronbach's alpha coefficient of the whole questionnaire was 0.936.
    Conclusion
    According to thedata, thePersian version of the ACLEEM questionnaire has sufficient psychometric reliability and validity to be used forconducting research, teaching and practicingthe educational learning environment in ambulatory care in Iran.
    Keywords: Psychometric, Ambulatory Care, Educational Environment, Residents
  • Mir Farhad Ghaleh Bandi, Morteza Naserbakht *, Abdolreza Tabasi, Azin Marghaiezadeh, Mohammad Riazee Esfahani, Zohre Golzarian Pages 1196-1201
    Background
    Sleep apnea is temporary cessation or absence of breathing during sleep. Significant increase in blood pressure is clinically seen in apneic episodes. The aim of this study was to examine sleep apnea syndrome as a risk factor for non- arthritic anterior ischemic optic neuropathy (NAION) in a case control study.
    Methods
    Nineteen NAION patients (9 men and 10 women) and 31 age and sex matched control participants (18 men and 13 women) were evaluated for obstructive sleep apnea syndrome (OSAS). Full night polysomnography was performed and proportion of OSAS was compared between the NAION patients and the control group. Other risk factors for NAION such as hypertension, diabetes, hyperlipidemia, ischemic heart disease and tobacco consumption were also evaluated. Chi square test and independent samples t-test were used for statistical analysis.
    Results
    OF the 19 NAION patients, 18 (95%) had OSAS, and of the control group 13 (41.9%) had OSAS. The frequency of OSAS was significantly higher among NAION patients compared to the controls (p< 0.001). The Mean Respiratory Disturbance Index (RDI) was 37.65/h SD= 37.61/h in NAION patients and it was 15.05/h SD= 11.97/h (p= 0.018) in controls. The frequency of diabetes and hypertension was significantly higher in the NAION patients than in controls.
    Conclusion
    based on the results of this study, it seems that there is an association between NAION and OSAS.
    Keywords: Non, Arteritic Anterior Ischemic Optic Neuropathy, Obstructive Sleep Apnea Syndrome, Polysomnography, Respiratory Disturbance Index
  • Sepideh Nazi, Faranak Aliabadi* Pages 1202-1209
    Background
    To determine whether using mechanical ventilation in neonatal intensive care unit (NICU) influences motor development of low birth weight (LBW) infants and to compare their motor development with normal birth weight (NBW) infants at the age of 8 to 12 months using Peabody Developmental Motor Scale 2 (PDMS-2).
    Methods
    This cross sectional study was conducted on 70 LBW infants in two groups, mechanical ventilation (MV) group, n=35 and without mechanical ventilation (WMV) group, n=35 and 40 healthy NBW infants matched with LBW group for age. Motor quotients were determined using PDMS-2 and compared in all groups using ANOVA statistical method and SPSS version 17.
    Results
    Comparison of the mean developmental motor quotient (DMQ) of both MV and WMV groups showed significant differences with NBW group (p<0.05). Also, significant difference was found between the gross DMQ of MV group and WMV group (p< 0.05). Moreover, in MV group, both gross and fine motor quotients were considered as below average (16.12%). In WMV group, the gross motor quotient was considered as average (49.51%) and the fine motor quotient was considered as below average (16.12%).
    Conclusion
    It seems that LBW infants have poor fine motor outcomes. The gross motor outcomes, on the other hand, will be significantly more influenced by using mechanical ventilation. In addition, more differences seem to be related to lower birth weight. Very Low Birth Weight (VLBW) infants are more prone to developmental difficulties than LBW infants with the history of using mechanical ventilation especially in fine motor development.
    Keywords: LBW infants, Mechanical ventilation, Motor development, Peabody Developmental Motor Scale, 2 (PDMS, 2)
  • Sheida Azari, Hamid Reza Baradaran, Ladan Fata* Pages 1210-1218
    Background
    Academic failure of medical and medical sciences students is one of the major problems of higher education centers in many countries. This study aims to collect and compare relevant researches in this field in Iran.
    Methods
    The appropriate keywords were searched in the national and international databases, and the findings were categorized into related and non-related articles accordingly.
    Results
    Only 22 articles were included in this systematic review. In terms of content analysis, gender, living in a dorm, employment, marital status, age, special rights in the entrance exams, the time lag between diploma and university, diploma average, learning style, being nonnative students, being a transferred student, psychological problems, occupation of the mother, salary level, diploma type, field of study, self-esteem, exam anxiety and interest on the field of study were considered as the influential factors for academic failure of the students.
    Conclusion
    This systematic review showsthat there is no definite academic failure criterion. It is also suggested Iranian researchers should pay more attention on the documentation of the higher educational strategies that have been implemented to prevent avoidable academic failure and contain physiological academic failure.
    Keywords: Academic Failure, Medical Student, Medical Sciences Student
  • Reza Dehnavieh, Ali Reza Kalantari*, Mohammad Jafari Sirizi Pages 1219-1228
    Background
    The Family Physician Plan has recently been implemented in three provinces of Iran on a pilot basis and is going to be implemented throughout Iran in the future. Through a qualitative design, this study aims to determine probable implementation challenges of Family Physician Plan in Kerman.
    Methods
    This study was conducted in Kerman in 2013. Data were collected through interviews with 21 experts in the field. Sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis model.
    Results
    most prevalent establishment challenges of Family Physician Plan were classified into policy-making, financial supply, laws and resources.
    Conclusion
    The urban Family Physician Plan can be carried out more effectively by implementing this plan step by step, highlighting the relationships between the related organizations, using new payment mechanisms e.g Per Capita, DRG, make national commitment and proper educational programs for providers, development the health electronic Record, justifying providers and community about advantages of this plan, clarifying regulatory status about provider's Duties and most importantly considering a specific funding source.
    Keywords: Family Physician Plan, Healthcare, Kerman
  • Ali Javani, Masoud Abolhallaje, Mehdi Raadabadi, Hanieh Rezaee Dehaghi, Aslan Nazari, Hamed Nazari, Azadeh Chatrouz* Pages 1229-1235
    Background
    One of the main indexes of development is health index or the degree to which a society enjoys health and therapeutic services. The present study was done with the aim to analyze development levels in cities in Tehran regarding health infrastructural index using the standardized score and Morris’ model.
    Methods
    This is a descriptive and pragmatic study which ranks 14 cities in Tehran province using the standardized score and Morris’ models based on 10 selected health indexes. The required data were gathered using a researcher-made information list and the information gathered from the Statistics Center and Tehran University of Medical Sciences. The data were analyzed using Excel software.
    Results
    The development coefficient in the studied cities varies from 0.595 to -0.379 so that Rey city has the highest level of development and Pishva city has the lowest level of development among the studied cities. The more number of the cities (43%) was among the rather undeveloped group and none of the cities (0%) was in the rather developed group.
    Conclusion
    Regarding the findings, there is a big gap and difference regarding enjoying health and therapeutic infrastructural indexes among the cities in Tehran province. Therefore, it is suggested that development-oriented plans consistentent with development levels should be implemented in these cities.
    Keywords: Development, Standardized Score, Health
  • Maryam Beheshtian, Ardeshir Khosravi *, Alireza Olyaeemanesh, Hossein Malekafzali, Shirin Bonakdar Esfahani, Leila Hosseiny Ghavamabad, Saeideh Aghamohammadi, Mahnaz Nouri, Elaheh Kazemi, Mohammadreza Zakeri, Fatemeh Sagha Pages 1236-1248
    Background
    An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators.
    Methods
    This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool.
    Results
    We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data.
    Conclusion
    A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country.
    Keywords: Health Equity, Health Status Indicator, Health Survey, Iran
  • Amir Masoud Hashemian, Koorosh Ahmadi, Ali Taherinia, Mohammad Davood Sharifi, Javad Ramezani, Seyed Behzad Jazayeri, Soheil Saadat, Vafa Rahimi, Movaghar* Pages 1249-1254
    Background
    Simultaneous electrocardiographic (ECG) changes are seen in hemorrhagic brain events even in the absence of associated myocardial infarction (MI). This study was designed to assess the role of ECG changes to predict true MI in patients with hemorrhagic brain trauma.
    Methods
    Data of 153 patients with traumatic brain injury and concomitant ECG changes were recorded. Enzyme study was performed for the patients, and a cardiologist confirmed the diagnosis of MI.
    Results
    Overall, 83 females and 70 males older than 50 years of age were enrolled in the study. The most common type of hemorrhagic brain event was subarachnoid hemorrhage, and the most common ECG change was an inverted T wave. MI was confirmed in 15 (9.8%) patients. Patients with intracranial hemorrhage had significantly (p= 0.023) higher rates of associated MI than other types of brain hemorrhages. ST segment elevation was found to have a positive predictive value of 71.4% in males and 25% in females in terms of diagnosing a true MI associated with hemorrhagic brain events.
    Conclusion
    Although simultaneous cardiac changes are seen after sympathetic over- activity in brain hemorrhages, regular ECG screening of elder patients with traumatic brain injury is suggested, particularly in patients with intracranial hemorrhages.
    Keywords: Traumatic Brain Injury, Subarachnoid Hemorrhage, Electrocardiography, Intracranial Hemorrhage, Positive Predictive Value, Myocardial Infarction
  • Mohammad Khayatzadeh Mahani, Afsoon Hassani Mehraban *, Mohammad Kamali, Soroor Parvizy Pages 1255-1263
    Background
    The Occupation-Based Practice (OBP) is a central core of occupational therapy (OT).It refers to using a meaningful occupation based on the client’s interests, needs, health and participation in daily life. This study aimed to explore the facilitators of implementing OBP among Iranian occupational therapists.
    Methods
    Fourteen occupational therapists participated in this study. Data were collected through semi-structured interviews, and the sampling method was purposeful. The interviews were continued until data saturation was reached, and data were recorded and transcribed verbatim. Data were analyzed through qualitative content analysis using constant comparative analysis.
    Results
    Our analysis explored two themes: Factors attributed to context, and factors attributed to therapists. The first theme consisted of three subthemes: Educational programs of OT department, public information about OBP and clinical setting compatible with OBP. The second theme also contained three subthemes including: Positive attitude regarding effectiveness of OBP, emphasis on client-centered and family- centered practice and convincing the clients to utilize OBP.
    Conclusion
    The facilitators of implementing OBP are attributed to factors internal to the therapists as well as to issues in the external environment and context. Understanding these factors will help occupational therapists, OT educational staff, administrators and rehabilitation team members to facilitate the implementation of OBP.
    Keywords: Occupation Based Practice, Occupational therapist, Facilitators, Qualitative study
  • Shahriar Alian, Alireza Davoudi *, Narges Najafi, Roya Ghasemian, Fatemeh Ahangarkani, Zeinab Hamdi Pages 1264-1269
    Background
    Icterohemorrhagic form of leptospirosis has a high mortality rate. In this study, the clinical manifestations, epidemiologic and laboratory findings and outcome of Weil’s disease were investigated.
    Methods
    A descriptive cross- sectional study was conducted on 66 consecutive patients with icterohemorrhagic leptospirosis who were admitted to Razi Hospital (The Therapeutic Center of Infectious Diseases in the North of Iran) in 2013. The inclusion criteria were as follows: All patients who had clinical and epidemiological data suggestive of leptospirosis and displayed icterohemorrhagic form at the time of admission or during hospitalization. All patients were visited on admission, one, two and six weeks later. Demographic data, clinical, laboratory features and complications were evaluated, and statistical analysis was performed using SPSS version 13.0.
    Results
    Among 66 patients, 89.4% (n = 59) were male, 60% (n = 40) were farmers and 9.1% (n= 6) had a history of swimming in rivers. The most common complaints were fever and jaundice, respectively. The most common clinical symptoms were fever (90.9%), myalgia (75.8%), chills (70.8%) and headache (65.1%). Hyponatremia and hypernatremia were seen in 7.6% and 72.8% of the participants, respectively. Also, hypokalemia was observed in two patients (3%). Approximately, half of the cases had leukocytosis and 90% had thrombocytopenia. Rise of AST, ALT, ALP and bilirubin were seen in 95.2%, 93.6%, 76.2% and 100% of the patients, respectively. Of the patients, 42.4% experienced complications of icterohemorrhagic leptospirosis including acute renal failure (30.3%) pneumonia (25.8%), pancreatitis (4.5%), subarachnoid hemorrhage (1.5%) and gastrointestinal bleeding (1.5%). Three cases (4.5%) died, 42 cases (63.7%) were discharged with residual effects and 52 patients (78.8%) had positive serology.
    Conclusion
    The most significant biochemical abnormalities were thrombocytopenia, hyperbilirubinemia, hyponatremia and hypernatremia and azotemia and the latter remained stable in 2% of the patients at least until the end of the 6-week period.
    Keywords: Leptospirosis, Weil's syndrome, Icterohemorrhagic
  • Arsia Jamali, Saharnaz Nedjat *, Kazem Heidari, Raika Jamali, Kiana Hassanpour, Sima Nedjat, Pasha Anvari, Reza Majdzadeh Pages 1270-1277
    Background
    Investment in science is vital for the development and well-being of societies. This study aims to assess the scientific productivity of countries by quantifying their publication of systematic reviews taking the gross national income per capita (GNIPC) into account.
    Methods
    Medline and ISI Web of Science were searched for systematic reviews published between 1st January 2006 and 31st December 2010. The productivity of each country was quantified by exploring the authors’ affiliation. The GNIPC was used according to the World Bank Report. Concentration index (CI) was calculated as the index of inequality.
    Results
    CI of percentage of systematic reviews as a function of percentage of countries ranked by GNIPC was 0.82 which indicates inequality in production of systematic reviews in pro rich countries. Countries with high income produced 206.23 times more systematic reviews than low income countries, while this ratio for lower middle and upper middle countries was 9.67 and 12.97, respectively. The highest concentration index was observed in clinical sciences (0.76) and the lowest in public health (0.61).
    Conclusion
    This study demonstrates a significant gap between industrialized and non-industrialized countries in the production of systematic reviews. Addressing this gap needs tremendous national and international efforts.
    Keywords: Systematic review, Scientific productivity, Gross national income, Inequality
  • Zahra Eshaghi, Zahra Jafari *, Shohreh Jalaie Pages 1278-1286
    Background
    The incomplete maturation of brain in preterm children results in long-term neurodevelopmental impairment. This study aimed to investigate the static balance function in children with a history of preterm birth.
    Methods
    Participants were 31 preterm children including 21 moderately preterm (MPT), 10 very preterm (VPT), and 20 term children aged 5.5 and 6.5 years. The cervical vestibular-evoked myogenic potential (cVEMP) test and four static balance subscales of BOT-2 were performed.
    Results
    The VPT children showed a significant increase in P1 and N1 wave latencies in cVEMP test compared to those in the term children (p= 0.041). Mean scores in the four static balance subscales of BOT-2 were significantly lower in the preterm children compared to those in the term children (p= 0.025). The P1 wave latency (p= 0.003) and mean score of standing on a balance beam with open eyes (p= 0.039) were significantly lower in the VPT children compared to those in the MPT children. A significant correlation was observed between the mean score in exercise 4 (standing on one leg on a balance beam with closed eyes) of static balance subscales of BOT-2 and P1 (r= -0.267, p= 0.036) and N1 (r= -0.304, p= 0.016) wave latencies of cVEMP.
    Conclusion
    The longer latency of cVEMP waves along with a poor performance of children with a history of preterm birth suggests a possible defect in central vestibular pathway
    Keywords: Preterm Birth, Static Balance, Preschool Children, Vestibular Evoked Myogenic Potentials
  • Afsun Nodehi Moghadam, Maryam Goudarzian *, Farhad Azadi, Seide Masume Hosseini, Zahra Mosallanezhad, Nouraddin Karimi, Yassin Larne, Maryam Habibi, Poorya Yaghmaei Pages 1287-1292
    Background
    There is increasing evidence that visual impairment contribute to falling. The aim of this study was to determine the influence of vision impairment of old adult patients with cataract on the occurrence of falls and postural control.
    Methods
    According to the results of screening ophthalmic examination, 48 cataract patients (mean±SD aged 68.5 ± 6.08 yrs.) and 50 individuals without any obvious eye disorders (mean age ± SD 70.7 ± 5.97 yrs.) were enrolled in this study. The postural control was determined using the clinical test of Sensory Interaction and Balance (CTSIB) and Timed up and Go (TUG) test.
    Results
    The results of this study revealed that 18% (n = 9) of the normal individuals and 22.9% (n =11) of the cataract patients had at least two falls in the past 12 months. However, the result of chi-square test did not show any differences between the two groups (p= 0.36). The mean ± SD TUG times in cataract and control groups in our study were15.17 ± 3.58 and13.77 ± 4.90, respectively. However, no significant differences were found between the two groups (p= 0.12).The results of CTSIB test showed no significant differences between the two groups on standing on the floor with eyes open and eyes closed (p= 0.61,p= 0.89) and on standing on the foam with eyes open and eyes closed (p= 0.32, p= 0.74).
    Conclusion
    According to the results of CTSIB and TUG tests, vision impairment of old adultpatients with cataract is not associated with falls and balance disorders. Further work including assessment of postural control with advanced devices and considering other falls risk factors are also required to identify predictors of falls in cataract patients.
    Keywords: Balance, Falls, Cataract, Vision Loss