Background: The purpose of this study was to present a scientific reason for pressure ulcer risk scales: Cubbin& Jackson modified Braden, Norton, and Waterlow, as a nursing diagnosis tool by utilizing predictive validity of pressure sores.

Methods: Articles published between 1966 and 2013 from periodicals indexed in the Ovid Medline, Embase, CINAHL, KoreaMed, NDSL, and other databases were selected using the key word “pressure ulcer”. QUADAS-Ⅱ was applied for assessment for internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4.

Results: Seventeen diagnostic studies with high methodological quality, involving 5,185 patients, were included. In the results of the meta-analysis, sROC AUC of Braden, Norton, and Waterflow scale was over 0.7, showing moderate predictive validity, but they have limited interpretation due to significant differences between studies. In addition, Waterlow scale is insufficient as a screening tool owing to low sensitivity compared with other scales.

Conclusion: The contemporary pressure ulcer risk scale is not suitable for uninform practice on patients under standardized criteria. Therefore, in order to provide more effective nursing care for bedsores, a new or modified pressure ulcer risk scale should be developed upon strength and weaknesses of existing tools.

Background: Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature.

Methods: The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. 

Results: International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention.

Conclusion: Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.  

Background: Depression and smoking decrease health status in Chronic Obstructive Pulmonary Disease (COPD), but the combined effect of the two factors is unknown. This study aimed to assess the interactive effects of depression and smoking on the severity of patients with COPD.

Methods: A prospective cohort study including 2,268 patients with COPD was conducted in seven rural communities from May 2008 to May 2012. The relationships between the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index and depression and nicotine addiction were assessed. The product of depression and smoking was added to the logistic regression model to evaluate the multiplicative interaction and relative excess risk of interaction (RERI). The Attributable Proportion (AP) of interaction and the synergy index (S) was applied to evaluate the additive interaction of two factors.

Results: The severity of COPD in patients with depressive symptoms who never smoked was increased 1.74-fold and in smoking patients it increased by 6.08-fold. Highly addicted smokers with depressive symptoms had a nearly 40-fold increase in severity (all P<0.001). The increased values of the BODE index, HADS-D and Fagerström score also correlated positively (P<0.001). The co-presence of depressive symptoms and smoking significantly increased the BODE index by 11.99-fold with significant biological interactions, relative excess risk of interaction (RERI) was 12.12, the biological interactions were increased with increasing nicotine addiction.

Conclusions: Patients with depressive symptoms who also smoke have an increased risk of severity from COPD interaction effects. The risk for severity of COPD and depressive symptoms increased with increasing the severity of nicotine addiction.

Background: Transition into parenthood is a major developmental life event and is very significant because development in infanthood is affected by the transition process of mothers parenting an infant. This study aimed to develop the assessment tool for transition process of high risk infant’s caregiver in Korea.

Methods: The participants were 246 mothers of premature infant born with gestational age (< 37 weeks) or low birth weight (< 2500 gm), of less than 24 months of age. Preliminary items were derived from transition process scale for parent of children with autism. Factor analysis was performed to test construct validity of the scale, the correlation between transition processes and parenting efficacy was used for testing predictive validity.

Results: The final scale was composed of 23 items divided into 5 factors: wandering (7 items), devotion (5 items), acceptance (4 items), denial (4 items), frustration (3 items). The total variance for validity described by the 5 factors was 60.8% and the reliability of the scale was total Cronbach’s α 0.90 and wandering 0.85, devotion 0.78, acceptance 0.72, denial 0.72, and frustration 0.71. Correlation between transition process and parenting efficacy was statistically significant; wandering(r=-0.61, P <.001), devotion (r=-0.60, P<.001), acceptance (r=0.30, P <.001), denial (r=-0.31, P <.001) and frustration (r= -0.27, P <.001).

Conclusion: This final assessment scale will be used to investigate high-risk infant caregiver’s transition process and provide basic data for program development to provide differentiated support and care at each process.

Background: Maturity-onset diabetes of the young (MODY) is a heterogeneous entity of monogenic disorders characterized by autosomal dominant inheritance. Eleven genes were related, including HNF4α, GCK, HNF1α, IPF1, and HNF-1β, and various mutations are being reported.

Methods: To help the overall understanding of MODY-related pathologic mutations, we studied a large MODY family found in 2012, in Shandong, China, which contained 9 patients over 3 generations.DNA was extracted from the periphery blood samples of (i) 9 affected members, (ii) 17 unaffected members, and (iii) 1000 healthy controls. Three pooled samples were obtained by mixing equal quantity ofDNA of each individual within the each group. Totally 400 microsatellite markers across the whole genome were genotyped by capillary electrophoresis. The known MODY-related gene near the identified marker was sequenced to look for putative risk variants.

Results: Allelic frequency of marker D17S798 on chromosome 17q11.2 were significantly different (P<0.001) between the affected vs. unaffected members and the affected vs. healthy controls, but not between the unaffected members vs. healthy controls. MODY5-related gene, hepatocyte nuclear factor-1β (HNF-1β) on 17q12 near D17S798 became the candidate gene. A single nucleotide variant (SNV) of C77T in the non-coding area of exon 1 of HNF-1β was found to be related to MODY5.

Conclusion: This novel SNV of HNF-1β contributes to the diabetes development in the family through regulating gene expression most likely. The findings help presymptomatic diagnosis, and imply that mutations in the non-coding areas, as well as in the exons, play roles in the etiology of MODY.

Background: Female labor supply has been changed dramatically in the recent yr. In this study, we examined the effects of development on the relationship between fertility and female labor supply.

Methods: We used data of population and housing census of Iran and estimated three separate models. To do this we employed Logistic Regressions (BLR).

Results: The estimation results of our study showed that there was a negative relationship between fertility rate and female labor supply and there are some differences for this relationship in three models.

Conclusion: When fertility rate increases, FLS would decreases. In addition, for higher fertility rates, the woman might be forced to work more because of the economic conditions of her family; and negative coefficients of the fertility rate effects on FLS would increase with a diminishing rate.

Background: The latest WHO report indicates that refractive errors are the leading cause of visual impairment throughout the world. The aim of this study was to determine the prevalence of myopia, hyperopia, and astigmatism in 7 yr old children in Iran.

Methods: In a cross-sectional study in 2013 with multistage cluster sampling, first graders were randomly selected from 8 cities in Iran. All children were tested by an optometrist for uncorrected and corrected vision, and non-cycloplegic and cycloplegic refraction. Refractive errors in this study were determined based on spherical equivalent (SE) cyloplegic refraction.

Results: From 4614 selected children, 89.0% participated in the study, and 4072 were eligible. The prevalence rates of myopia, hyperopia and astigmatism were 3.04% (95% CI: 2.30-3.78), 6.20% (95% CI: 5.27-7.14), and 17.43% (95% CI: 15.39-19.46), respectively. Prevalence of myopia (P=0.925) and astigmatism (P=0.056) were not statistically significantly different between the two genders, but the odds of hyperopia were 1.11 (95% CI: 1.01-2.05) times higher in girls (P=0.011). The prevalence of with-the-rule astigmatism was 12.59%, against-the-rule was 2.07%, and oblique 2.65%. Overall, 22.8% (95% CI: 19.7-24.9) of the schoolchildren in this study had at least one type of refractive error.

Conclusion: One out of every 5 schoolchildren had some refractive error. Conducting multicenter studies throughout the Middle East can be very helpful in understanding the current distribution patterns and etiology of refractive errors compared to the previous decade.

Background: In the past few decades, Indoor Air Pollution (IAP) has become a primary concern to the point. It is increasingly believed to be of equal or greater importance to human health compared to ambient air. However, due to the lack of comprehensive indices for the integrated assessment of indoor air quality (IAQ), we aimed to develop a novel, Fuzzy-Based Indoor Air Quality Index (FIAQI) to bridge the existing gap in this area.

Methods: We based our index on fuzzy logic, which enables us to overcome the limitations of traditional methods applied to develop environmental quality indices. Fifteen parameters, including the criteria air pollutants, volatile organic compounds, and bioaerosols were included in the FIAQI due mainly to their significant health effects. Weighting factors were assigned to the parameters based on the medical evidence available in the literature on their health effects. The final FIAQI consisted of 108 rules. In order to demonstrate the performance of the index, data were intentionally generated to cover a variety of quality levels. In addition, a sensitivity analysis was conducted to assess the validity of the index.

Results: The FIAQI tends to be a comprehensive tool to classify IAQ and produce accurate results.

Conclusion: It seems useful and reliable to be considered by authorities to assess IAQ environments.

Background: Emotional intelligence (EI) has recently been considered as one of the necessary elements for success and achievement in medical fields. The present study was conducted in Iran to compare the EI in medical and non-medical students adjusted for the other relevant factors.

Methods: This cross-sectional study was conducted from October 2011 to January 2012 on 872 students of medicine, paramedical and non-medical groups in Tehran University and Tehran University of Medical Sciences, Tehran, Iran selected by multi-stage weighted cluster sampling. The Farsi version of revised Schutte Emotional Intelligence (FEIS) was used to estimate emotional intelligence.

Results: The mean of total EI was equal to 124.9 (SD=8.4) out of 205 and the means for its dimensions were as follows: regulation of emotions 39.3 (SD=5.1), utilization of emotions 26.7 (SD=3.6) and appraisal of emotions 33.5 (SD=5.3). While the paramedical and non-medical students' total EI score was significantly higher than the medical students', in the utilization of emotions dimension, the medical students scored significantly higher than the other two groups.

Conclusions: The lower levels of the medical students' total EI score in comparison with paramedical and non-medical students in this study demands the relevant authorities to pay even more attention to the selection and training of medical students.

Background: Hydatid cysts are formed in human body can be treated clinically by surgery or drugs such as albendazole (ABZ) and mebendazole (MBZ). The purpose of this study was comparing the effects of ABZ and MBZ on glutathione-S-transferase, alkaline phosphatase and protease enzymes activities in protoscoleces of hydatid cyst.

Methods: The culture supernatants containing the parasite Excretory / Secretory (E/S) products were collected every 12 h for 72 h. The E/S products of treated samples with 1µg/ml ABZ and MBZ and the control one were collected and after centrifugation then protein concentrations were measured according to Bradford method. GST, ALP and protease activities of E/S products were assessed photometrically.

Results: The mean of GST specific activity level in treated protoscoleces with ABZ and MBZ and in control group were obtained 69.44, 132.83 and 225.47U/mg/protein/ml respectively. The mean ALP activity level in treated protoscoleces with ABZ and MBZ and in control group were detected 19.22, 22.27 and 27.85 U/mg/protein/ml respectively. The protease activity level in treated protoscoleces with ABZ and MBZ were not detected. While the mean of protease activity level in control group was 7.61U/mg/proteins. Statistical analysis showed the significant difference between protein concentrations, the specific activities of GST, ALP and protease enzymes in treated protoscoleces in comparison with control group (P<0.05). Also, the significant difference were seen between specific activities of GST and ALP enzymes in treated protoscoleces with ABZ in comparison with treated group with MBZ (P<0.05).

Conclusion: ABZ is more effective on the enzymes activities (GST and ALP) as compared with MBZ.

Background: The present study was the first attempt for determination and measurement of pesticide residues in tomatoes used in salad production plants in Isfahan, central Iran.

Methods: A multiresidue method based on modified QuEChERS (quick, easy, cheap, effective, rugged and safe) sample preparation, followed by Gas Chromatography Mass Spectrometry (GC–MS) was developed and validated for the determination of 15 pesticides (permethrin, primicarb, dichlorvos, diazinone, fenpropathrin, carbaryl, chlorpyrifos, malathion, chlortalonil, brompropilate, propargit, tetradifone, phosalone, iprodion and endosulfane) from different classes. The recovery yields ranged from 83.84 to 119.73%and the relative standard deviation (RSD) was below 20.54%. The limits of detection (LODs) were between 1.63to 10.5 mg/kg and the limits of quantifications (LOQs) were between 5.43to35 mg/kg. The method has been successfully applied to the analysis of 22 tomato samples obtained from salad production plants in Isfahan in Sep to Dec 2014.

Results: An amount of 31.81% of samples showed contamination above maximum residue levels (MRLs) with pesticides. In addition, 13.6% of samples had contamination with diazinone and 18.18% of samples with chlorpyrifos.

Conclusion: A full consideration is essential for tomatoes used in salad and food productions. It suggests a need for revision of the current trend of supervision for tomatoes and other vegetables presented in wholesale markets. In all, the study confirms that pesticide residue determination in food products, especially in raw fruits and vegetables, is a very demanding task in public health safety and trade.

Background: One substantial part of microarray studies is to predict patients’ survival based on their gene expression profile. Variable selection techniques are powerful tools to handle high dimensionality in analysis of microarray data. However, these techniques have not been investigated in competing risks setting. This study aimed to investigate the performance of four sparse variable selection methods in estimating the survival time.

Methods: The data included 1381 gene expression measurements and clinical information from 301 patients with bladder cancer operated in the years 1987 to 2000 in hospitals in Denmark, Sweden, Spain, France, and England. Four methods of the least absolute shrinkage and selection operator, smoothly clipped absolute deviation, the smooth integration of counting and absolute deviation and elastic net were utilized for simultaneous variable selection and estimation under an additive hazards model. The criteria of area under ROC curve, Brier score and c-index were used to compare the methods.

Results: The median follow-up time for all patients was 47 months. The elastic net approach was indicated to outperform other methods. The elastic net had the lowest integrated Brier score (0.137±0.07) and the greatest median of the over-time AUC and C-index (0.803±0.06 and 0.779±0.13, respectively). Five out of 19 selected genes by the elastic net were significant (P<0.05) under an additive hazards model. It was indicated that the expression of RTN4, SON, IGF1R and CDC20 decrease the survival time, while the expression of SMARCAD1 increase it.

Conclusion: The elastic net had higher capability than the other methods for the prediction of survival time in patients with bladder cancer in the presence of competing risks base on additive hazards model.

Mendelian susceptibility to mycobacterial diseases (MSMD) is a rare inheritance syndrome, characterized by a disseminated infection with mycobacterium in children following BCG vaccination at birth. Regarding the vaccination program in Iran, it may consider as a public health problem. The pathogenesis of MSMD is dependent on either insufficient production of IFN-gamma (γ) or inadequate response to it. Here, we want to introduce three cases including two siblings and one girl from two unrelated families with severe mycobacterial infections referred to Immunology, Asthma and Allergy Research Institute (IAARI), from 2013 to 2015; their MSMD was confirmed by both cytokine assessment and genetic analysis. Regarding the clinical features of the patients, cell proliferation against a mitogen and BCG antigen was ordered in a lymphocyte transformation test (LTT) setting. ELISA was performed for the measurement of IL-12p70 and IFN- γ in whole blood samples activated by BCG + recombinant human IFN-γ and BCG + recombinant human IL-12, respectively. In contrast to mitogen, the antigen-dependent proliferation activity of the patients’ leukocytes was significantly lower than that in normal range. We identified a homozygous mutation in IL12RB1 gene for two kindred who had a homozygous mutation affecting an essential splice site. For the third patient, a novel frameshift deletion in IL12RB1 gene was found. The genetic study results confirmed the impaired function of stimulated lymphocytes to release IFN-γ following stimulation with BCG+IL-12 while the response to rhIFN-γ for IL-12p70 production was relatively intact. Our findings show that cellular and molecular assessments are needed for precise identification of immunodeficiency disorders especially those without clear-cut diagnostic criteria.

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