Vol 46 No 10 (2017)

Review Article(s)

  • XML | PDF | downloads: 352 | views: 318 | pages: 1309-1317

    Background: Modern hygiene administration in Japan and Korea began to be organized in the end of 19th Century by accepting Western public health system. Then, how did the elite in these two East Asian countries recognize and understand Western public health movement in the 19th Century? Answering this question could provide historical knowledge about the background of starting modern hygiene administration in East Asia. 

    Methods: To understand the birth of modern public health system in East Asia, Japanese and Korean elite’s records on Western countries were reviewed. The documents examined were The Iwakura Embassy 1871-73 published in 1878 as an account of Japanese Meiji government’s special ambassador sent to the United States and Europe, and Seoyugyeonmun (observations on travels in the West) published in 1895 by a Korean intelligent.

    Results: The Iwakura Embassy 1871-73 suggested modern water supply and drainage, roadside trees, and parks, to prevent contagious diseases and improve urban hygiene. Seoyugyeonmun emphasizes that hygiene is an important task that civilized government has to be in charge. So, specific tasks of public health should be imposed on sanitary police.

    Conclusion: Public health was one of the major factors that contributed to national prosperity in the 19th century. Such recognition enabled organization of hygiene administration to be part of the project pursuing enlightenment, modernization, and civilization at the end of the 19th century in Japan and Korea.


Original Article(s)

  • XML | PDF | downloads: 357 | views: 272 | pages: 1318-1323

    Background: This paper is aimed at studying the therapeutic effects of in situ replantation of alcohol-devitalized bone segments to treat malignant bone tumors of the knee joint.

    Methods: We retrospectively analyzed clinical data for 45 patients from January 2013 to January 2016 who underwent replantation following alcohol-devitalization of bone segments and 40 who underwent prosthesis implantation. The two groups were comparable in basal clinical biometric data, including gender, age, tumor type and location, Enneking staging, and maximum tumor diameter. Radical tumor resection was combined with neoadjuvant chemotherapy following the two-implantation procedures.

    Results: The median follow-up time was 25 months, and the outcomes were compared. We found no differences in the length of bone lesions, surgery time, intraoperative blood loss, amount of postoperative drainage, and perioperative complications, which were just three for each method. We also found no significant differences in limb function scores, internal fixation imaging scores, tumor-free survival rate, and overall survival rate between the two groups. Replantation following alcohol-devitalization of tumor-bearing bone segment demonstrated similar clinical outcomes compared with prosthesis implantation in the treatment of primary malignant bone tumors of the knee joint.

    Conclusion: Both therapies enjoy good application safety and effectiveness. Because alcohol devitalization is inexpensive and easy to apply in the clinic, it should be considered a preferred method in the treatment of bone tumors.


  • XML | PDF | downloads: 331 | views: 275 | pages: 1324-1331

    Background: The purpose of this study was to investigate the incidence and mortality rates of cervical cancer during 2006-2014 in Ningbo, China.

    Methods: A retrospective study involved 3418 newly diagnosed cervical cancer cases and 854 death cases were performed. All cases were registered in Cancer Registry Center of Ningbo Centers for Disease Control and Prevention. Results were expressed as standardized age-specific cancer incidence/mortality rates with confidence intervals. All P-values presented were two-sided and the statistical significance was set at P<0.05.

    Results: The crude incidence rate was 34.35 per 100000 in females aged 50-54 years. Females aged 80-84 years had the highest crude mortality rates, which were 12.91 per 100000. The average age-standardized incidence and mortality rates by Chinese Standard Population were 6.29 and 1.49 per 100000, respectively. The average age-standardized incidence and mortality rates by World Standard Population were 8.02 and 1.91 per 100000, respectively. The incidence trend graph showed that annual percent change (APC) increased rapidly by 30.2% (P<0.01) during 2006-2014, while the mortality trend graph indicated a rapid increase in mortality annually by 8.8% (P<0.01) during 2006-2014.

    Conclusion: We observed an increased trend for both incidence and mortality rates of cervical cancer in Ningbo during 2006 to 2014, which indicated the urgent need for free regular screening for high-risk populations by the government.


  • XML | PDF | downloads: 220 | views: 311 | pages: 1332-1337

    Background: We aimed to investigate the effect of vaginal stump ligation in laparoscopic cervical cancer surgery on the prevention of cancer cell detachment.

    Methods: The study was conducted from 2010 to 2015, in Xuzhou Maternity and Child Health Care Hospital, Jiangsu Province, China. Seventeen cases of laparoscopic surgery of cervical cancer in control group were observed, and the vaginal stump was irrigated with normal saline after the operation and the washing fluid was searched for cancer cells. Moreover, 43 cases of cervical cancer patients received the same operational procedure, and the vaginal stump was ligated in the surgery and the vagina was incised below the ligature.

    Results: The number of cancer cells in the vaginal washing fluid of the experimental group was significantly more than that of the control group. Furthermore, there was no significant difference in the operation time, intraoperative blood loss, the number of pelvic lymph node dissected, vaginal resection length and parametrium resection length. By comparing the postoperative recovery indicators and complications, we found no significant difference in anal exsufflation time, the incidence of vaginal stump infection, the recovery time of postoperative urinary function and incidence of lymphocysts. Finally, there was no significant difference in the quality of life scores between the two groups.

    Conclusion: Vaginal stump ligation can reduce cancer cell detachment in cervical cancer surgery, and therefore can help preventing cancer cell implantation and tumor recurrence caused by cancer cell detachment.


  • XML | PDF | downloads: 312 | views: 308 | pages: 1338-1346

    Background: Ankylosing Spondylitis (AS) is a chronic, progressive, and inflammatory disease. The objective of this study was to construct a hypothetical model to determine factors affecting health-related quality of life (HRQOL) of AS patients (ASHRQOL).

    Methods: A survey was conducted on 275 patients who visited Chonnam National University Bitgoeul Hospital. Data of different variables were collected over two months in 2015.

    Results: A hypothetical model did not reach recommended level of fit verification. Therefore, health perception variable was eliminated on theoretical basis. Path between function and HRQOL was added after eliminating unimportant path before completing the final modified model.

    Conclusion: The final revised model met recommended levels of fit test except AGFI. The model explained 57.6% of ASQOL. Further study is needed to develop efficient interventional strategy for improving ASHRQOL.


  • XML | PDF | downloads: 526 | views: 2537 | pages: 1347-1358

    Background: Public policymaking is complex and lacks research evidences, particularly in the Eastern Mediterranean Region (EMR). This policy analysis aims to generate insights about the process of hospital accreditation policy making in Iran, to identify factors influencing policymaking and to evaluate utilization of evidence in policy making process.

    Methods: The study examined the policymaking process using Walt and Gilson framework. A qualitative research design was employed. Thirty key informant interviews with policymakers and stakeholders were conducted. In addition hundred and five related documents were reviewed. Data was analyzed using framework analysis.

    Results: The accreditation program was a decision made at Ministry of Health and Medical Education in Iran. Many healthcare stakeholders were involved and evidence from leading countries was used to guide policy development. Poor hospital managers’ commitment, lack of physicians’ involvement and inadequate resources were the main barriers in policy implementation. Furthermore, there were too many accreditations standards and criteria, surveyors were not well-trained, had little motivation for their work and there was low consistency among them.

    Conclusion: This study highlighted the complex nature of policymaking cycle and highlighted various factors influencing policy development, implementation and evaluation. An effective accreditation program requires a robust well- governed accreditation body, various stakeholders’ involvement, sufficient resources and sustainable funds, enough human resources, hospital managers’ commitment, and technical assistance to hospitals.


  • XML | PDF | downloads: 267 | views: 471 | pages: 1359-1365

    Background: Visceral leishmaniasis (VL) caused by Leishmania infantum is the most severe form of leishmaniasis in Iran, which causes a high mortality rate in the case of inaccurate diagnosis and treatment. This study aimed to clone of K26 gene from Iranian strain of L. infantum and register the sequencing results in Genbank to facilitate the preparation a new K26 antigen for the detection of L. infantum infection.

    Methods: L. infantum was obtained from an infected domestic dog in Meshkin-Shahr area from northwestern Iran in 2015. Canine visceral leishmaniasis was confirmed by direct agglutination test (DAT), rK39 dipstick and parasitological methods. L. infantum was confirmed by N-acetyl glucosamine -1-phosphate transferase (nagt)–PCR and its sequencing. The band of interest for k26 form Iranian strain of L. infantum was purified by gel extraction kit after PCR amplification and then ligated into pBluescript II SK (+) and pET-32a (+), respectively. The sequences of recombinant plasmids were analyzed and submitted to Genbank.

    Results: The submission of rk26 nucleotide sequence was performed to the GeneBank/NCBI Data Base under accession number KY212883. The related gene was showed a homology about 99% to L. chagasi and L. infantum k26 gene, while the level of homology in comparison with different strains of L. donovani ranged from 84-94%.

    Conclusion: The successful rk26 cloning into an expression vector performed in this study could help to produce a new recombinant antigen for serodiagnosis of VL especially in areas where L. infantum is the main causative agent.



  • XML | PDF | downloads: 274 | views: 296 | pages: 1366-1373

    Background: There is no published study evaluating the performance of cumulative sum (CUSUM) algorithm on meningitis data with limited baseline period. This study aimed to evaluate the CUSUM performance in timely detection of 707 semi-synthetic outbreak days.

    Methods: Simulated outbreaks were generated using syndromic data on fever and neurological symptoms from Mar 2010 to Mar 2013 in Hamadan Province, the west of Iran. The performance of CUSUM algorithms, numbered from 1 to 11, in timely detection of outbreaks was measured using sensitivity, specificity, false alarm rate, likelihood ratios and area under the receiver operating characteristics (ROC) curve.

    Results: The highest amount of sensitivity was related to algorithm11 (CUSUM (3-9 D 11)) and it was 52% (95% CI: 49%, 56%). Minimum amount of false alarm rate was related to CUSUM (1-7 D 5) algorithm equal to 8% (95% CI: 5, 10) and the best amount of positive likelihood ratio was related to CUSUM (1-7 D 4) equal to 4.97. CUSUM (1-7 D 1) has the best performance with AUC curve equal to 73% (95 CI%: 70%, 76%), as well.

    Conclusion: The used approach in this study can be the basis for applying CUSUM algorithm in conditions that there is no access to recorded baseline data about under surveillance diseases or health events.


  • XML | PDF | downloads: 626 | views: 294 | pages: 1374-1378

    Background: Cheating rate is rising and engages newer methods. This study performed to estimate the rate of research misconduct in the thesis of undergraduate and postgraduate medical students in 2015.

    Methods: In this cross sectional study, all undergraduate and postgraduate medical students graduated during the study period in 2015, from the School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran were asked to fill a small checklist anonymously. It consisted of two demographic questions and two other ones for estimation of research misconduct. All three major types of research misconduct were explained in the checklist. We used the Randomized Response Technique for sensitive question in this survey. We asked the respondent to choose one question randomly and answer to it. The probability of selection of each question was equal.

    Results: There were 149 filled questionnaires out of which 44 (31%) were graduated for General Practitioner, 63 (44%) for Residency, 31(21%) for Master Degree and 6 (4%) for Ph.D. Fifty-two percent (75) were male. More than half of participants were graduated between 2011 and 2012. The majority of participants were native (104, 81%). Undergraduate students had an estimation of 19% research misconduct in performing the thesis while this was 26% of postgraduate students. Males were nearly two times comparing to females in this issue (30% vs. 16%).

    Conclusion: This high estimation must be considered in future policy making about observing strictly on researches.



  • XML | PDF | downloads: 187 | views: 220 | pages: 1379-1385

    Background: Atherosclerosis is a disease that affects large and medium size arteries in the body that underlies coronary heart disease. Several nucleotide changes in mitochondrial tRNA genes have been reported in various diseases. The purpose of the study was to identify hotspot mitochondrial tRNA mutations in atherosclerotic patients.

    Methods: In this case-control study, the variations of ten mitochondrial tRNA genes (about 50%) were investigated in 70 patients from October 2013 and June 2015 suffered from atherosclerosis. The related mitochondrial area was amplified using PCR methid. The mutation analysis was performed by Single Strand Conformational Polymorphism (SSCP) and Restriction Fragment Length Polymorphism (RFLP). All the positive samples were sequenced.

    Results: We found one novel heteroplasmic mutation (m.5725T>G) and three reported single nucleotide polymorphisms (SNPs) previously in other diseases including m.5568A>G, m.5711A>G and m.12308A>G.

    Conclusion: These tRNA mutations can alter their steady state level and affect the structure of tRNA. The role of mitochondrial tRNA mutations in the pathogenesis of atherosclerosis could potentially be important for the understanding of mitochondrial dysfunction in coronary atherosclerotic plaque formation.



  • XML | PDF | downloads: 234 | views: 280 | pages: 1386-1394

    Background: We aimed to assess the frequency of hematologic changes, response to treatment, rate of discontinuation and dose reduction in Hepatitis C positive patients, treated with Interferon and ribavirin from Apr 2009 to Mar 2014.

    Methods: In this cross-sectional study, out of registered patients, 554 were assessed and 150 patients with positive HCV PCR, regular patient visits to clinic and complete records were included. HCV viral load, complete blood count and liver enzyme levels were measured before initiation of treatment and monthly.. Exclusion criteria's were other types of hepatitis and HIV infection, autoimmune or blood diseases, illegal drug use and treatment with bone marrow suppressors. The data was analyzed using SPSS.

    Results: Out of 150 patients, 135 (90%) were male. Mean age was 39.7± 10.7 (range 23-74) yr old. Forty-six patients (30.7%) had genotype 1 and 99 (66%) genotypes 2 and 3. Treatment regimens were prescribed as Pegafron+Ribavirin in 125 (83.3%), Interfron+Ribavirin 9 (6%) and Pegintron+Ribavirin in 16 (10.7%) of patients... The prevalence of anemia in genotype 1 patients was higher (P=0.044). There was no association between sex and leukocyte changes.  Thirty-four (22.7%) patients had moderate and severe thrombocytopenia. Six patients had severe anemia and Ribavirin dose was adjusted.

    Conclusion: The hematological changes are common side effects of conventional hepatitis C treatment regiments. Although drug dose adjustment is not usually necessary, due to severe anemia in genotype 1 patients, we should treat high-risk patients cautiously and made the appropriate changes in drug dosage at the right time.



  • XML | PDF | downloads: 258 | views: 412 | pages: 1395-1403

    Background: The aim of this study was to determine the incidence and prevalence of obesity in Tehranian children.

    Methods: Data from children participated in Tehran Lipid and Glucose Study (TLGS) were evaluated. Cut off points for definition of obesity was the CDC’s standard thresholds of the 95th percentile and 85th percentile for overweight. Prevalence, annual incidence of obesity, cumulative incidence over 10 year and the incidence density (cases per person-years) totally were calculated.

    Results: The annual incidence of obesity was 1.9 and 3.4% per year in the first 3 yr and decreased to 0.9 and 2.5% in the last 3 yr of follow-up in girls and boys, respectively. Incidence density rates were in line with cumulative incidence, with a rate of 20.7 per 1000 person-years between the ages of 5.6 and 15.5 yr. The prevalence of obesity was higher among children who had obese parents (P=0.03). Among all ages, across the quartiles of parents’ BMI, the prevalence of obesity increased with rising in paternal (P=0.001) or maternal BMI (P=0.004). Physical activity of mothers affected the prevalence of obesity in children at mean ages of 5.3 and 9.1 yr. Across quartiles of mother’s physical activity, from heavy to light, the prevalence of obesity increased among children, from 4.4% to 5.9% in children, aged 5.3 (P=0.02) and from 11.6% to 13.0% in children, aged 9.1 yr (P=0.03).

    Conclusion: Prevalence of obesity among children increased with age. Cumulative incidence of obesity in children who were overweight at baseline was much higher than other children.



  • XML | PDF | downloads: 474 | views: 691 | pages: 1404-1412

    Background: Work ability of nurses is an index of their job satisfaction and is a crucial factor in job quality and security. This study aimed to investigate the association between work ability and quality of working life and to determine the effective demographic and background variables, among nurses.

    Methods: The present study was conducted among nurses, working in educational hospitals under the supervision of Tehran University of Medical Sciences in 2014. Work Ability Index (WAI) and Work-related Quality of Life (WRQoL) were used.

    Results: The mean WAI was significantly associated with total WRQoL score and the two of its sub-items including Stress at Work, and General Well-Being (P-value=0.001). Moreover, the results showed a significant correlation between total WRQoL and WAI Subscales including mental resources (P-value=0.001), number of current diseases (P-value=0.02), and work ability in relation to the job demands (P-value=0.04). The WRQoL and WAI showed significant associations with age and job experience (P-value=0.001). The average score of WAI and WRQoL was statistically different among various working units (P-value=0.001). 

    Conclusion: Overall, results support the association between nurses work ability and WRQoL. Monitoring the WRQoL and work ability of employees would help organizations to know their status and take measures to ameliorate the working conditions.


  • XML | PDF | downloads: 238 | views: 244 | pages: 1413-1421

    Background: Spatial scan statistic has been shown as a useful tool to investigate spatial patterns and detecting the spatial clusters of cancer. This study conducted to study spatial analysis of breast cancer and its late-stage cases, one of the most common women cancers in Iran and the world.

    Methods: We used space-time and purely spatial scan statistic implemented in SaTScan software to detect clusters of breast cancer and late-stage cases, at city level by applying Poisson and Bernoulli distribution. Data on 40017 of breast cancer cases that reported to the Ministry of Health and Medical Education (MOHME) during 2005 to 2010 were included.

    Results: Purely spatial and spatiotemporal high rates significant clusters of breast cancer and its late-stage cases with Poisson distribution were in the same geographical area including southwest, north, and northeast.

    Conclusion: Significant clusters areas have probably differences with other areas in terms of delay in diagnosis and access to appropriate health services because late-stage breast cancer cases had the greatest impact on formation of clusters. However, more studies are essential to be conducted in different areas of country to explain more precisely clusters detected areas and detecting reasonable justification for existence of significant clusters.



Short Communication(s)

  • XML | PDF | downloads: 221 | views: 283 | pages: 1422-1429

    Background: Leishmaniasis as an emerging and reemerging disease is increasing worldwide with high prevalence and new incidence in recent years. For epidemiological investigation and accurate identification of Leishmania species, three nuclear and mitochondrial genes (ITS-rDNA, Hsp70, and Cyt b) were employed and analyzed from clinical samples in three important Zoonotic Cutaneous Leishmaniasis (ZCL) foci of Iran.

    Methods: In this cross-sectional/descriptive study conducted in 2014-15, serous smears of lesions were directly prepared from suspected patients of ZCL in Turkmen in northeast, Abarkouh in center and Shush district in southwest of Iran. They were directly prepared from suspected patients and DNA was extracted. Two nuclear genes of ITS-rDNA, Hsp70 and one mitochondrial gene of Cyt b within Leishmania parasites were amplified. RFLP was performed on PCR-positive samples. PCR products were sequenced, aligned and edited with sequencher 4.1.4 and phylogenic analyses performed using MEGA 5.05 software.

    Results: Overall, 203 out of 360 clinical samples from suspected patients were Leishmania positive using routine laboratory methods and 231 samples were positive by molecular techniques. L. major L. tropica, and L. turanica were firmly identified by employing different molecular genes and phylogenic analyses.

    Conclusion: By combining different molecular genes, Leishmania parasites were identified accurately. The sensitivity and specificity three genes were evaluated and had more advantages to compare routine laboratory methods. ITS-rDNA gene is more appropriate for firm identification of Leishmania species.




Case Report(s)

Letter to the Editor