Vol 45 No 11 (2016)

Review Article(s)

  • XML | PDF | downloads: 237 | views: 664 | pages: 1388-1398

    Background: Diabetes disease is one of the 4 main types of non-communicable diseases. No research has been conducted in order to identify data items for Diabetic Personal Health Record (DPHR), in Iran. This study, with the aim of systematically developing the DPHR was done to supply ultimately the country with a national model through Delphi method.

    Methods: We conducted a systematic review of the literature using the following electronic databases: PubMed, Web of sciences, Scopus, Science Direct, and ACM digital library. The year of the study included the obtained articles was 2013. We used a 3-step method to identify studies related to DPHR. Study selection processes were performed by two reviewers independently. The eligible studies were included in this review. Quality of studies was assessed using a mixed approach scoring system. Reviewers used 2-step method for the validation of the final DPHR model.

    Results: Initially, 2011 papers were returned from online databases and 186 studies from gray literature search. After removing duplicates, study screening, and applying inclusion and exclusion criteria, 129 studies were eligible for further full-text review. Considering the full-text review, 34 studies were identified for final review. Given the content of selected studies, we determined seven main classes of DPHR. The highest score belongs to home monitoring data class by mean of 19.83, and the lowest was general data class by mean of 3.89.

    Conclusion: Together with representative sample of endocrinologist in Iran achieved consensus on a DPHR model to improve self-care for diabetic patients and to facilitate physician decision making.


  • XML | PDF | downloads: 209 | views: 530 | pages: 1399-1410

    Background: This study aimed to use a mixed-method approach to investigate affecting factors on the performance of Community Health Workers (CHW) in Iran’s villages.

    Methods: This study was conducted during 2014-2015 with a mixed method in three phases of literature review, Delphi technique and developing a rich picture. Overall, in order to finalize the affecting factors and their relationships between qualitative content analysis, Delphi technique, AHP technique and Focus Group Discussion were used, respectively.

    Results: Affecting factors on CHW performance were divided into four main categories, 10 sub-themes and 35 contents. Increase in the level of people’s awareness, disease patterns, demographic structure and lifestyle were placed in four priorities respectively on the basis of importance.

    Conclusion: To the most extent CHW cannot face current needs of rural communities. It challenges equitable access to healthcare services and also conflicts with the primary philosophy of CHW presence in rural areas. CHW can be used in two forms; either as an assistant to rural family physicians or with the same previous functions.



Original Article(s)

  • XML | PDF | downloads: 149 | views: 353 | pages: 1411-1419

    Background: External causes of death are still among the main causes of death in the countries of the former Soviet Union. We studied epidemiology of injuries among elderly in a typical Kazakhstani city.

    Methods: Data on all injuries among individuals aged 60 yr or older in the city of Semey (former Semipalatinsk) from 2010 to 2012 was collected from medical files. We present absolute numbers and incidence rates for the main ICD-codes in Chapters XIX and XX of ICD-10 by gender, ethnic background and place where the injury occurred.

    Results: Altogether, there were 6065 injuries in 2010-2012. The overall incidence of increased from 4746.6 per 100000 in 2010 to 5577.7 per 100000 in 2012. Injuries to the elbow and forearm, injuries to the shoulder and upper arm, and injuries to the knee and lower leg were the most common and comprised 17.3%, 15.5% and 14.6% of all injuries, respectively. Falls constituted 82.2% of all injuries. Most injuries occurred at home and among ethnic Russians.

    Conclusion: The incidence and the absolute number of injuries among elderly in Semey increased during the study period in both men and women. Given that the population of Kazakhstan is getting older, injuries are expected to require more attention from the public health professionals and health authorities. More than four-fifths of traumas resulted from falls making this cause of injury the first target for preventive measures.


  • XML | PDF | downloads: 117 | views: 337 | pages: 1420-1426

    Background: We aimed to identify the role of SIRT6 gene polymorphism rs350846 in human longevity.

    Methods: SIRT6 C/G genotypes were determined using Taqman SNP Genotyping Assays in 169 long-lived inhabitants (LG group aged 90-110 yr), 158 healthy internal controls (internal control group; aged 26-82 yr) and 176 healthy external controls (external control group; aged 20-82 yr) without a family history of exceptional longevity. Statistical analysis was conducted using SPSS 16.0.

    Results: BMI and TG level were lower in the longevity than in the two control groups, while serum LDL-c and HDL-c and SBP and DBP levels in long-lived individuals were higher than in the two control groups (P<0.01). The waist circumference was obviously different (P=0.001) among the three groups, with the maximum observed in the external group. No statistically significant differences of the gender FBG and TC were seen in long-lived individuals than in the two control groups. Significant genotype differences existed among the different groups except for the longevity and internal control group. The frequency of the minor allele-C was 0.319. The minor allele frequency of rs350846 in SIRT6 was much higher in the external control than in the other groups. BMI, SBP and HDL-c displayed significant effect on longevity.

    Conclusion: The C allele of rs350846 in SIRT6 gene, CC and CG genotypes as well as BMI, systolic pressure and HDL-c are associated with longevity. Further studies are needed to validate our results.


  • XML | PDF | downloads: 276 | views: 422 | pages: 1427-1435

     Background: The aim of the study was to analyze the reliability of the Korean version of the NEWS and to investigate the relationship between walking and environmental factors by gender.

    Methods: A total of 1407 Korean adults, aged 20-59 yr, participated in the study. Data were collected between Sep 2013 and Oct 2013. To examine the test-retest reliability, 281 of the 1407 participants were asked to answer the same questionnaire (Korean NEWS-A scale) after a 7-d interval.

    Results: The ICC range of the entire questionnaire was 0.71-0.88. The item on land use mix-diversity had the highest ICC, and that on physical barriers had the lowest. In addition, presents the partial correlation coefficients for walking and the NEWS-A score, adjusted for social demographic variables. Overall, land use mix-diversity (P<0.034) and land use mix-access (P<0.014) showed a positive relationship with walking.

    Discussion: Examination of the reliability of the Korean NEWS-A scale based on Korean adults who reside in large cities showed that all items had statistically satisfactory reliability. Korean NEWS-A scale may be a useful measure for assessing environmental correlates of walking among population in Korea.


  • XML | PDF | downloads: 126 | views: 259 | pages: 1436-1445

    Background: There is conflicting reports on the respiratory health effects of indoor risk factor exposure. The aim of this study was to assess the association of indoor environmental factors to pulmonary function in an adult population in Zunyi City of Southwest China.

    Methods: Between July and Sep 2012, we conducted a cross-sectional survey of people aged ≥18 yr in 11 inner-city areas of Zunyi. Data on asthma and asthma-related symptoms and selected home environmental factors were assessed by questionnaire. Lung function measurements, including FVC, FEV1, FEV1/FVC and PEFR, were assessed and compared. Exposure to indoor and outdoor PM2.5 was monitored by measurement of PM2.5 emission relative concentration.

    Results: Cooking oil fumes, environmental tobacco smoke (ETS) and coal fuel use were associated with impaired lung function among adults in summer season (P<0.05). Subjects exposed coal fuel combustion, cooking oil fumes, pest in kitchen, mosquito repellent, fluffy blanket, pets, visible mold in bedroom and ETS (active and passive smoking) tended to exhibit greater decreases in FVC, FEV1 and PEFR values compared with their non-exposed counterparts (P<0.05). Median PM2.5 relative concentrations in kitchen, sleeping area and outdoor were 486.0cpm, 463.0cpm and 459.0cpm, respectively. PM2.5 relative concentration in indoor kitchen and sleeping area were significant higher than outdoor (P<0.001).

    Conclusion: A negative association between kitchen, sleeping area risk factors and ETS exposure and a reduction in lung function in summer was revealed in Zunyi.


  • XML | PDF | downloads: 156 | views: 288 | pages: 1446-1454

    Background: This study aimed to examine the impact of ego-resilience and family function on quality of life in childhood leukemia survivors.

    Methods: This study targeted 100 pediatric leukemia survivors, who visited the Pediatric Hemato-Oncology Center in South Korea from Aug to Dec 2011. A structured questionnaire of ego-resilience, family function and quality of life used to collect data through direct interview with the pediatric patients and their parents. The correlation between the study variables analyzed using the Pearson’s correlation coefficient, and the impact on quality of life analyzed using a stepwise multiple regression.

    Results: Ego-resilience (r = 0.69, P<0.001) and family function (r =0.46, P< 0.001) had a positive correlation with quality of life and all the sub-categories of quality of life. Ego-resilience was a major factor affecting quality of life in childhood leukemia survivors, with an explanatory power of 48%. The explanatory power for quality of life increased to 53% when age and family function were included.

    Conclusion: Ego-resilience, age, and family function affect quality of life in childhood leukemia survivors. Hence, strategies are required to construct age-matched programs to improve quality of life, in order to help restore the necessary ego-resilience and to strengthen family function in childhood leukemia survivors.


  • XML | PDF | downloads: 173 | views: 487 | pages: 1455-1464

    Background: This study was focused on the probability of carcinogen risk of low-level ingestion and dermal exposure with polycyclic aromatic hydrocarbons (PAHs) from drinking water in Tehran, capital of Iran.

    Methods: Concentrations of 16 PAHs were measured in the tap, bottled and heated tap water in four different seasons. Using a questionnaire-based survey, exposure with PAHs from drinking water was evaluated via direct ingestion, swimming, washing and showering. Finally, a comprehensive risk assessment was performed in four age groups. Rank correlation was used to represent variability in risk analysis and obtained coefficients were used for sensitivity analysis. In addition, Monte Carlo simulation was implemented to determine risk probability distributions and to calculate cumulative probability of the total risks in different age groups.

    Results: The lifetime average daily dose and the dermal absorbed dose were 0.69E-06 and 1.33E-05 mg/kg/day, respectively. The total estimated excess lifetime cancer risk (ELCR) of ingestion and dermal exposure were 1.57E-05 and 17.24E-05.

    Conclusion: Sum of estimated ingestion and dermal ELCR was 18.81E-05, which was higher than the acceptable value recommended by WHO. It means a total of 1504 lifetime cancer cases in residents of Tehran. Monte Carlo simulation indicated that risk probability above the acceptable level was 96.2% in dermal exposure. Moreover, sensitivity analysis indicated that tap water consumption (Pspearman >0.92) and washing activities (Pspearman>0.95) had the greatest correlation on the cancer risk.


  • XML | PDF | downloads: 174 | views: 408 | pages: 1465-1472

    Background: Omega 3 and vitamin E are two critical nutrients which include beneficial effects in coronary artery disease (CAD). The aim of this study was to assess the effects of omega 3 alone supplementation or in combination with vitamin E on serum glucose and lipid levels and insulin resistance in CAD patients.

    Methods: Participants of this clinical trial included 60 male patients with CAD who selected from Tehran Heart Center in Tehran, Iran in 2014. They received 4 g/day omega 3 plus 400 IU/day vitamin E (OE), 4 g/day omega 3 with vitamin E placebo (OP), or omega 3 and vitamin E placebo (PP) for two months. Serum glucose, lipids and insulin were assessed and HOMA-IR was calculated before and after the trial and effects of these nutrients on the highlighted parameters were compared within the study groups.

    Results: Serum glucose level increased significantly in OP group (P=0.004), but not in OE group. OE and OP groups showed a significant decrease in fasting serum TG (P=0.020 and P=0.001, respectively). Serum insulin and HOMA-IR decreased significantly in OE group (P=0.044 and P=0.039, respectively) but did not change significantly in OP group.

    Conclusion: Although, omega 3 supplementation may include adverse effects on serum glucose level, co-administration of omega 3 and vitamin E can beneficially decrease serum insulin and insulin resistance in CAD patients.



  • XML | PDF | downloads: 179 | views: 383 | pages: 1473-1480

    Background: Sarcoidosis is a multisystem inflammatory disease of unknown origin with characterization of small granulomas. Angiotensin-converting enzyme (ACE) is a pathophysiologic marker of sarcoidosis. We present the ACE insertion/deletion (I/D) polymorphism in correlation with serum ACE level in Iranian patients with sarcoidosis.

    Methods: From Jan 2014 to Jan 2015, 102 Iranian patients who histopathologically diagnosed for sarcoidosis and 192 healthy age and sex-matched controls were recruited. PCR was used for detection of I/D polymorphism in ACE gene.

    Results: Frequency of II/ID/DD genotype in sarcoidosis disease was 17%, 35.5%, and 47.1%, respectively. The frequency of D allele was 0.65. A significant association between I/D genotypes and mean of sACE level was seen (DD=85.2±22.9, P<0.001). More frequent genotype in sarcoidosis patients was DD (47%), ID genotype (45.9%) was found more in controls. Logistic regression analysis adjusting age and sex showed that ID to II (OR=0.35, 95%CI=0.17-0.73, P=0.005) and DD to II (OR=2.11, 95%CI=0.98-4.54, P=0.05) could be considered as a predictor factor for the disease activity. No significant model for men in sarcoidosis group was seen, while women with II/ID were associated with a reduced risk for the disease.

    Conclusion: Although more regional studies with appropriate statistical scale must be done to provide a better diagnosis and prognostic tool for this disease, this study demonstrates that ID and DD genotype could be predictive factors for sarcoidosis.



  • XML | PDF | downloads: 189 | views: 479 | pages: 1481-1490

    Background: The objective of this study was to determine the residual concentrations of ethion and imidacloprid in cucumbers grown in greenhouse. The effect of some simple processing procedures on both ethion and imidacloprid residues were also studied.

    Methods: Ten active greenhouses that produce cucumber were randomly selected. Ethion and imidacloprid as the most widely used pesticides were measured in cucumber samples of studied greenhouses. Moreover, the effect of storing, washing, and peeling as simple processing procedures on both ethion and imidacloprid residues were investigated.

    Results: One hour after pesticide application; the maximum residue levels (MRLs) of ethion and imidacloprid were higher than that of Codex standard level. One day after pesticide application, the levels of pesticides were decreased about 35 and 31% for ethion and imidacloprid, respectively, which still were higher than the MRL. Washing procedure led to about 51 and 42.5% loss in ethion and imidacloprid residues, respectively. Peeling procedure also led to highest loss of 93.4 and 63.7% in ethion and imidacloprid residues, respectively. The recovery for both target analytes was in the range between 88 and 102%.

    Conclusion: The residue values in collected samples one hour after pesticides application were higher than standard value. The storing, washing, and peeling procedures lead to the decrease of pesticide residues in greenhouse cucumbers. Among them, the peeling procedure has the greatest impact on residual reduction. Therefore, these procedures can be used as simple and effective processing techniques for reducing and removing pesticides from greenhouse products before their consumption. 

  • XML | PDF | downloads: 144 | views: 390 | pages: 1491-1500

    Background: Role of dietary modifications on the treatment and management of diabetes and complications was shown by many researchers. This study was designed to examine the association of major dietary patterns with diabetes-related cardio-metabolic risk factors in Iranian diabetes.

    Methods: Totally, 525 type 2 diabetic subjects with mean age 55 ± 10 yr were included in this cross-sectional study in 2014 that followed for at least two years by the Diabetes and Metabolic disease Clinic of Tehran University of Medical Sciences, Tehran, Iran. Blood samples were collected after 12 h fasting for glycemic and lipid profiles. Information on the general characteristics, anthropometric, blood pressure measurements and physical activity level was collected. Dietary data were obtained by a validated food frequency questionnaire. Dietary patterns were obtained factor analysis (principal component analysis).

    Results: Three major dietary patterns retained through principal component analysis: Western like (high in sweets, fast foods, carbonated drinks, red meat, mayonnaise, nuts, refined grains, potato and visceral meat), Asian like (high in vegetables, low-fat dairy, fish, poultry and egg), and Traditional like (high in high fat dairy, oils, whole grains, vegetables and fruits). Western like dietary pattern was positively associated with fasting serum glucose (P=0.05), total cholesterol (P=0.005) and low-density lipoprotein cholesterol (P=0.008). After extensive adjustment for potential confounders, the association of serum total cholesterol and Western like dietary pattern remained significant (P=0.03).

    Conclusion: Modifications in dietary pattern, especially in those who have a Western dietary pattern, may be effective in preventing or delaying diabetes-associated cardio metabolic complications.



Short Communication(s)

  • XML | PDF | downloads: 125 | views: 379 | pages: 1502-1506

    Background: Sustainable Development Goals (SDGs) aim to transform our world, and each goal has specific targets to be achieved by 2030. For the goals to be achieved, everyone needs to do their part: governments, academia, the private sector and all people. This paper summarizes the main evidence-based recommendations made by excellent academics and scholars who discussed their experiences and views during the conference to respond to the challenges of sustainable health development.

    Methods: To contribute to exploring to the academia's role in reaching SDGs, the 1st International Conference on Sustainable Health Development was held at Tehran University of Medical Sciences, on 24-25 April 2016, in Tehran, Iran.

    Results: In line with Goal 3 of SDGs: "ensure healthy lives and promote well-being for all at all ages", the conference discussed various aspects of Universal Health Coverage (UHC), as well as Global Action Plans for prevention and control of Non-Communicable Diseases (NCDs), and explained the special role of academic public health institutes in education, research and service provision in the two above-mentioned areas.

    Conclusion: To fulfill the requirements of SDGs, modern approaches to funding, education, teaching, research priority setting and advocacy, which in turn need novel strategies in collaboration and constructive partnerships among academic public health institutes from low, middle and high-income countries, are essential.


Case Report(s)

  • XML | PDF | downloads: 136 | views: 381 | pages: 1507-1410

    Hydatid disease commonly involves liver but in rare cases, it can involve cardiac structures. A 75-yr-old farmer from Parsabad-Moghan, northwestern Iran was presented to the Emergency Room of Tehran Imam Khomeini Hospital, Tehran, Iran with dyspnea and without chest pain in 2014. A lesion compatible with hydatid cyst was found in echocardiography and confirmed by serology and MRI. Surgical treatment was done but the patient was died in recovery room because of cardiac arrhythmia. In endemic areas, hydatid cyst should be considered in differential diagnosis of heterogeneous echogenic lesions even if the serologic tests are negative. Physician can use cardiac MRI to earn valuable information about the lesion and its relation to other structures. However, with all of these assessments, surgical removal of cardiac cysts may have some complications.


Letter to the Editor