Vol 46 No 9 (2017)

Review Article(s)

  • XML | PDF | downloads: 917 | views: 928 | pages: 1156-1166

    Background: After the establishment of Primary Health Care (PHC) program in Iran, health indicators have improved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran’s PHC system (strengths, weaknesses, opportunities and threats) in terms of health system’s control knobs.

    Methods: The search was conducted through two English `databases of Web of Knowledge and PubMed, two English publications of Science Direct and Springer and two Persian databases of Magiran and SID. Keywords were selected from MeSH and included primary health care, PHC and Iran in both Persian and English. No time limit was considered.

    Results: Iran's PHC system has numerous successes in dealing with health system’s control knobs; which largely part of that related to the health network implementation, the role of Behvarz, improvement of health indicators in rural areas and the elimination of urban-rural inequality, but there are some weaknesses, opportunities and threats in the Iranian PHC system as well.

    Conclusion: By considering socio-economic changes the current structure of PHC system needs to be reformed to coordinate with phenomenon of chronic diseases, accidents and aging. The current information system in PHC does not provide the required information for decision makers and policy makers so it needs to be transformed to the electronic system with unique electronic health file for individuals.


  • XML | PDF | downloads: 343 | views: 458 | pages: 1167-1175

    Background: Hair follicle stem cells exist in different sites. Most of the hair follicle stem cells are reside in niche called bulge. Bulge region is located between the opening of sebaceous gland and the attachment site of the arrector pili muscle.

    Methods: Data were collected using databases and resources of PubMed, Web of Science, Science Direct, Scopus, MEDLINE and their references from the earliest available published to identify English observational studies on hair follicle bulge region.

    Results: Bulge stem cells are pluripotent with high proliferative capacity. Specific markers allow the bulge cells to be isolated from mouse or human hair follicle. Stem cells isolated from bulge region are label retaining and slow cycling hence these cells are defined as label-retaining cells. Bulge cell populations, due to their plasticity nature are able to differentiate into distinct linage and could contribute in tissue regeneration.

    Conclusion: The current review discuss about bulge stem cells characteristics and biology including their cycle, location, plasticity, specific markers and regenerative nature. Also the differences between mouse and human hair follicles are investigated.



  • XML | PDF | downloads: 552 | views: 896 | pages: 1176-1183

    Background: From old times, the human kind has used clays, externally or internally, for maintaining body health or treating some diseases. Meanwhile there are few scientific articles reviewing the beneficial effects of clays on body function. Bentonite clay is one of the available clays in nature, used as traditional habits, and remedies in many cultures.

    Methods: These articles explored among 2500 scientific articles published in PubMed to sort the scientific works have been done on the effects of this clay on body function (it was about 100 articles).

    Results: Bentonite has a broad range of action on different parts of body.

    Conclusion: As traditional remedies seem to have a deep root in maintaining body health, it merits doing more research works on bentonite clay and its impacts on body function.



Original Article(s)

  • XML | PDF | downloads: 379 | views: 388 | pages: 1184-1192

    Background: The aim of this study was to provide evidence for developing intervention and effective management for the prevention of malaria based on epidemiological analysis and assessment of Korean soldiers’ knowledge on malaria and malaria preventive behavior.

    Methods: The data were collected from 294 Korean soldiers nearby the demilitarized zone in Gyeonggi Province in 2016. Multiple regression analyses were applied for statistical analysis.

    Results: The level of education (β=.24, P<.001), educational experience on malaria (β=.21, P<.001) and ranks like corporal (β=.13, P<.05), and sergeant (β=.13, P<.05) were observed to be associated with the level of knowledge of malaria (F=9.62, =.12, P<.001). Knowledge of malaria (β=.25, P<.001) and malaria education experience (β=.22, P<.001) were the factors that influenced malaria prevention behavior and practice (F=12.45, =.18, P<.001).

    Conclusion: The level of knowledge and education experience was associated with malaria prevention practice. Therefore, malaria education is very important for the soldiers in nearby DMZ for prevention of malaria. The findings provide implications for the development of intervention programs focusing on increasing the levels of knowledge and practices related to malaria.



  • XML | PDF | downloads: 727 | views: 378 | pages: 1193-1203

    Background: Population aging has become increasingly serious in China. The demand for medical insurance of the elderly is increasing, and their health status and life satisfaction are becoming significant issues. This study investigates the effects of medical insurance on the health status and life satisfaction of the elderly.

    Methods: The national baseline survey data of the China Health and Retirement Longitudinal Survey in 2013 were adopted. The Ordered Probit Model was established. The effects of the medical insurance for urban employees, medical insurance for urban residents, and new rural cooperative medical insurance on the health status and life satisfaction of the elderly were investigated.

    Results: Medical insurance could facilitate the improvement of the health status and life satisfaction of the elderly. Accordingly, the health status and life satisfaction of the elderly who have medical insurance for urban residents improved significantly. The regression coefficients were 0.348 and 0.307. The corresponding regression coefficients of the medical insurance for urban employees were 0.189 and 0.236. The regression coefficients of the new rural cooperative medical insurance were 0.170 and 0.188.

    Conclusion: Medical insurance can significantly improve the health status and life satisfaction of the elderly. This development is of immense significance for the formulation of equal medical security.

  • XML | PDF | downloads: 200 | views: 312 | pages: 1204-1210

    Background: Human papillomavirus (HPV) infection has been considered as main cause of cervical cancer. Recently, aberrant DNA methylation at tumor suppressor genes (TSGs), leading to inactivation, has also been an early epigenetic event and cofactor in cervical carcinogenesis. This study was performed to evaluate an association between the hypermethylation of p16INK4α gene’s promoter and HPV exposure in non-invasive samples (liquid-based papanicolaous samples) in Vietnamese population.

    Methods: 109 liquid-based papanicolaous test samples were archived and admitted from the Medic Medical Center and Au Lac Clinic Laboratory, Vietnam, from 2011–2014. Methylation-Specific-PCR (MSP) was performed to analyze methylation status from the liquid-based papanicolaous test samples identified whether HPV/or non-HPV, high-risk/low-risk HPV infection.

    Results: An upward trend was observed concerning the p16INK4α hypermethylation frequency in high-risk HPV infection, counting for 55.6%, and the low methylation frequency in low-risk and non-HPV infected samples, counting for 22.9%, 8.0%, respectively. The significant correlation between candidate p16INK4α hypermethylation and HPV exposure was observed (P<0.0001). Moreover, the odds ratio (OR) and relative risk (RR) were found in statistical significant value. (OR=5.76, 95%CI: 2.36 – 14.04, P<0.01; RR=3.11, 95%CI: 1.75–5.53, P<0.01).

    Conclusion: Presence of p16INK4α hypermethylation was the specific characteristic of high-risk HPV infected samples in Vietnamese population. The OR and RR values showed that the strong correlation between p16INK4α hypermethylation and high-risk HPV infection, in which increased the risk of cervical cancer. The combination of p16INK4α hypermethylation and HPV detection based biomarker could be used in non-invasive samples obtained from high-risk cancer patients, offer significant practical advantages.



  • XML | PDF | downloads: 295 | views: 363 | pages: 1211-1216

    Background: Currently, the studies on the relationship between type 2 diabetes and platelets indicators were carried out on a selective small sample population generally. Large sample studies in this area are rare, especially in Chinese population. In this study, we aimed to investigate the relationship between type 2 diabetes and the mean platelet volume (MPV), platelet count (PLT) and platelet distribution width (PDW).

    Methods: This is a cross-sectional analysis of the routine health examination data from 20128 participants with complete baseline data in Yinzhou District 2013. The detection of indicators in this study was completed by automatic hematology analyzer.

    Results: The PDW and PLT were not significantly different between diabetic group and non-diabetic group, (16.00% vs. 16.00%, P=0.88, and 194*109/L vs. 196*109/L, P=0.05 respectively). The MPV was significantly higher in diabetic group (9.3fl vs. 9.2fl, P<0.05). MPV was an independent risk factor of diabetes mellitus (Unadjusted OR=1.07 (95% CI: 1.03, 1.11), Adjusted for age, sex OR=1.07 (95% CI: 1.02, 1.12)). The adjusted odds ratio of diabetes rose with increasing MPV levels and were most pronounced in subjects with MPV levels exceeding the 90th percentile (MPV≥10.70 fl, Crude or=1.23 adjusted or=1.19).

    Conclusion: There was no relationship between the presence of diabetes with PDW and PLT. The MPV was independently associated with the presence of diabetes.


  • XML | PDF | downloads: 327 | views: 336 | pages: 1217-1222

    Background: We aimed to identify factors influencing the therapeutic outcome of orthokeratology on controlling juvenile myopia progression, and the risk factors for complications.

    Methods: Myopic patients (n=724) in Shenzhen Second Hospital from Jan 2011 to Jan 2016 fitted with orthokeratology lenses and followed-up for 6–65 months were reviewed retrospectively. Univariate and multivariate logistic regression analyses were used to screen for the factors that can improve treatment outcome and prevent the development of complications.

    Results: Patients where the orthokeratology treatment was effective displayed a shorter myopia time, smaller diopter and corneal curvature, larger corneal endothelium density, high proportion of overnight wear and longer wearing times compared with patients whose treatments were ineffective. Additionally, wearing Ortho-k for 6 or 12 months yielded improved corrective effect and achieved higher comfort level. Logistic regression analyses showed that myopia time, diopter, corneal curvature e value, corneal endothelium density, time with Ortho-k and corrective effect after wearing Ortho-k for 6 or 12 months were all independent factors influencing the treatment effects. Results showed corneal curvature, anterior chamber depth and central corneal thickness were independent risk factors.

    Conclusion: This study systematically identified the factors leading to effective treatments, and those carrying a risk for complications, to provide guidance for the prescription and follow-up of orthokeratology in the treatment of juvenile myopia.



  • XML | PDF | downloads: 236 | views: 315 | pages: 1223-1230

    Background: China had implemented policies to limit antimicrobials prescription since 2004; we conducted this study to reflect the effect of these national policies by analyzing antimicrobial prescription trends of medical insurance in patients from 2003 to 2014 in Changsha city, China.

    Methods: The participants were inpatients of the medical insurance of urban workers (UEBMI). Data were extracted from medical insurance information system of Changsha Medical Insurance Institution, which directly connects with hospitals information systems.

    Results: Trend analysis showed great changes in antimicrobial prescription and inpatients’ cost on antimicrobials over the study period. Antimicrobial prescription rates gradually declined over the study period from 79.0% in 2003 to 43.5% in 2014 (adjusted OR0.205; 95%CI 0.198 to 0.213). There was a quicker decline from 2011 to 2014 (with implementing national antimicrobial stewardship action plan) than the period from 2003 to 2010 (with implementing antimicrobials use education and self-management strategies). The proportion of inpatients used one antimicrobial increased significantly from 25.6% in 2003 to 46.7% in 2014, while the proportion of inpatients used three or more antimicrobials gradually decreased. Bacterial culture rate increased from 20.4% in 2003 to 36.6% in 2014 (adjusted OR 2.248; 95% CI 2.149 to 2.352). The average costs on antimicrobials decreased significantly, from 277.43 US Dollar in 2003 to 91.05 US Dollar in 2014.

    Conclusion: National efforts to promote rational use of antimicrobials in clinical practice have had a positive effect over the past decade in China.



  • XML | PDF | downloads: 289 | views: 328 | pages: 1231-1236

    Background: We investigated the application of a predictive nursing education process on the degree of comfort and quality of life for cancer patients.

    Methods: A total of 168-cancer patient in Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China between June 2014 and June 2016 were enrolled and admitted for surgery or radiotherapy/chemotherapy treatment. Patients were randomly divided into control and observation groups, each containing 84 cases. Patients in the control group received routine cancer care, whereas the observation group received care incorporating a predictive nursing education process. Patients were assessed after admission and prior to discharge via the Kolcaba's comfort status scale (through a General Comfort Questionnaire (GCQ)), quality of life scale (QOL), and Barthel Index (BI) for activities of daily living (ADL). Patient mental state was also evaluated using the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD).

    Results: GCQ, QOL, and BI scores of the observation group were all significantly higher than those of the control group (P <0.05). HAMA and HAMD scores were significantly lower in the observation group compared to the control group (P < 0.05).

    Conclusion: The predictive nursing education process could significantly improve degree of comfort and activities of daily living for cancer patients, and thus improve mental states and quality of life.



  • XML | PDF | downloads: 336 | views: 608 | pages: 1237-1246

    Background: This study aimed to determine the prevalence of hearing impairment (HI) by age and gender in a population aged 5 yr and older residing in Tehran, Iran.

    Methods: In this cross-sectional study, 140 clusters each including 10 households from Tehran, Iran were sampled between 2012 and 2013 using cluster random sampling. Trained audiologists examined the participants during face-to-face interviews. The hearing of the participants was evaluated before the removal of wax or other foreign bodies. In this study, HI was categorized as mild (grade 1, 26-40 db), moderate (grade 2, 41-60 db), severe (grade 3, 61-80 db), and deaf (grade 5, 81 db or more). All participants signed informed consent forms. The SATA software was used for data analysis.

    Results: Of 6521 individuals, 4370 (67%) were interviewed. The prevalence of HI (auditory threshold of 0.5, 1, 2, 4 KHz and more than 25 db in the better ear) was 14.27 (11.53-17.91) of whom 9.52 (7.07-11.98) had grade 1, 4.04 (3.02-5.06) had grade 2, 0.67 (0.33-1.02) had grade 3 HI and 0.48 (0.16-0.8) were deaf. About 5.19% of the participants had disabling hearing impairment. All HI grades increased significantly with age but no significant difference was observed between men and women.

    Conclusion: The considerable prevalence of HI in Iran in comparison with other developing countries, with regards to the trend of aging in the population, seems concerning. The results of the study could be used as a treatment and research guideline for future works in the area of policymaking and plan to decrease these disorders.



  • XML | PDF | downloads: 398 | views: 424 | pages: 1247-1255

    Background: Complementary health insurance is increasingly used to remedy the limitations and shortcomings of the basic health insurance benefit packages. Hence, it is essential to gather reliable information about the amount of Willingness to Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable complementary health insurance.

    Methods: The study sample consisted of 300 household heads all over provinces of Iran in 2013. The method applied was double bounded dichotomous choice and open-ended question approach of contingent valuation.

    Results: The average WTP for complementary health insurance per person per month by double bounded dichotomous choice and open-ended question method respectively was 199000 and 115300 Rials (8 and 4.6 USD, respectively). Household’s heads with higher levels of income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size.

    Conclusion: The WTP value can be used as a premium in a society. As an important finding, the study indicated that the households were willing to pay higher premiums than currently collected for the complementary health insurance coverage in Iran. This offers the policy makers the opportunity to increase the premium and provide good benefits package for insured people of country then better risk pooling.



  • XML | PDF | downloads: 317 | views: 369 | pages: 1256-1264

    Background: This study aimed to determine drug resistance mutations in patients with virological failure and find correlation between HIV drug resistance test and viral load.

    Methods: Blood sample was collected from 51 patients who suspicious treatment failure in the center of Imam Khomeini Hospital, Tehran, Iran in 2015. Viral voluntary counseling and testing load test was done and the patients with viral load above 1000 copies choose for detection of drug resistance mutations by genotyping method (29 patients).

    Results: The majority of patients (82.75) harbored the HIV subtype CRF 35 A-D. The 86.2% patients compromised at least one resistance mutation. The analysis of reverse transcriptase showed M184V (68.9%), T215YISF (44.8%), K103N (27.6%) and the analysis results of protease revealed G73SC (13.8%) and I47VA (6.9%). Eventually, the significant correlation between viral load and drug resistance was found.

    Conclusion: The result of our research stress the significance of recognizing drug resistant on time that prohibits the accumulation of drug resistance mutation and circulates the resistance strain of HIV-1 virus and the importance of national study according to the reliable findings for treatment guidelines.


  • XML | PDF | downloads: 366 | views: 747 | pages: 1265-1274

    Background: Female genital mutilation is an intentional inhumane procedure that threatens girls and women's health. It is especially widespread in developing countries due to cultural, traditional and religious preferences. The aim of the current study was to investigate how circumcision affects women's sexual function.

    Methods: This cross-sectional study was conducted in the urban and rural area of Piranshahr County, Iran, in 2015 among convenience samples of 200 women, 15-49 yr old, who were applying to health care centers for receiving routine health care services. Data collection was conducted with the use of a self-administered written questionnaire to assess female sexual function, mental well-being, and quality of life.

    Results: Significant differences were found between circumcised and non-circumcised women in total score of female sexual function index (FSFI) in domains of desire, arousal, vaginal moisture, orgasm, satisfaction, and pain [(P<0.001), MD(95%CI)=5.64(3.64 to 7.64)] and based on Hotelling's T-square, significant differences were found in dimensions of quality of life and FSFI.

    Conclusion: The revealed sexual dysfunction among mutilated women gives ground to require that public health systems take actions aimed at implementing special sexual education program to improve sexual functions of mutilated women and changing beliefs and social norms in the community level.


  • XML | PDF | downloads: 594 | views: 405 | pages: 1275-1284

    Background: Nitrite (NO2-) and nitrate (NO3-) contaminations of groundwater are considered as one of the major health challenges in recent decades. This study aimed to evaluate the nitrite and nitrate concentrations in the drinking groundwater of Shiraz, South-central Iran by statistical models.

    Methods: From 43 active wells of Shiraz drinking water supplies, 344 samples were collected in the high and low precipitation seasons from 2010 to 2014. Nitrate and nitrite concentrations were tested by a DR6000 spectrophotometer, and the results were analyzed by different software, including SPSS ver. 20, ArcView GIS 9.3. It was done by variable and multivariate regression models. In all tests, the level of significance was set at 5%.

    Results: Nitrate concentrations in the samples were in the range of 5 to 72 mg/l, and 38 (11%) of the samples had nitrate concentrations above the standard level 10 mg/L as nitrogen. The annual mean concentration of nitrite varied from 0 to 0.025 mg/l. There was an inverse correlation between nitrate and nitrite concentrations and well depths.

    Conclusion: The most important reason for the high concentration of nitrate in Shiraz drinking groundwater supplies were lack of health privacy of wells, the impact of residential construction around drinking water wells, and placement of wells in the direction of groundwater flow.


  • XML | PDF | downloads: 317 | views: 516 | pages: 1285-1291

    Background: Considering the importance of hospital wastewaters as potential reservoirs for the dissemination of bacterial pathogens such as Escherichia coli and antibiotic resistance genes in the environment, the need for such information becomes imperative.

    Methods: E. coli strains were isolated from hospital wastewater sources in Tehran, Iran, over a 24-month sampling period (Jun 2014- Jun 2016) and identified using standard bacteriological methods. Quinolone resistance among the strains was determined using Kirby-Bauer method and the frequency of plasmid-mediated quinolone resistance genes (qnrA, qnrB, qnrS) was investigated by PCR.

    Results: In total, 80 E. coli strains were isolated during the study period, of which 51 (63.8%) isolates were resistant to tested antibiotics. Of note, 13 isolates were resistant to all the antibiotics employed. The highest rates of antibiotic resistance were obtained for nalidixic acid (60%), followed by norfloxacin (30%), and ciprofloxacin (25%). Of the 51 quinolone-resistant strains, 24 (47.1%) isolates harbored qnr genes. None of the isolates harboured the qnrA gene, while 11 (45.8%) and 7 (29.2%) isolates contained qnrB and qnrS, respectively.

    Conclusion: Our findings showed high rates of quinolone resistance (63.8%) and qnr genes, underlining the importance of hospital wastewaters as reservoirs for dissemination of potentially pathogenic E. coli and horizontal gene transfer between other waterborne bacterial species. Other possible mechanisms of resistance should also be investigated for better characterization of quinolone-resistant E. coli isolates.


Letter to the Editor