Background: Escherichia coli is the most prominent cause of infectious diseases that span from the gastrointestinal tract to extra-intestinal sites such as urinary tract infection, septicaemia, and neonatal meningitis. The emergence and spread of antibiotic resistance in E. coli is an increasing public health concern across the world. Rising resistance in E. coli isolates is also observed in Iran. This review summarizes the status of antibiotic resistance of E. coli isolates in Iran from 2007 to 2016.

Methods: The data of the prevalence of E. coli antibiotic resistance were collected from databases such as Web of Science, PubMed, Scopus, Embase, Cochrane Library, Google Scholar and Scientific Information Database.

Results: Antibiotic resistance in E. coli is on the rise.

Conclusion: Prevalence of antibiotic resistance of E. coli varies from region to region in Iran.

Background: No epidemiological studies have targeted the association between experience of orthodontic treatment and symptoms of temporomandibular joint (TMJ) in a large adult population. In this study, we investigated whether experience of orthodontic treatment is associated with symptoms of TMJ in adults.

Methods: We used data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V), conducted in 2011. Trained dentists asked subjects to report their experience of orthodontic treatment and symptoms of TMJ. Overall, 5936 subjects aged over 19 yr were included in this study (2528 males). The data were analyzed using the chi-square test and multiple logistic regression tests.

Results: The group with experience of orthodontic treatment had more symptoms of TMJ than the group without orthodontic experience. After adjusting for all covariates (i.e., age, sex, marital status, income, education, stress, teeth injury, and occupation), the adjusted odds ratio was 2.53 (95%CI 1.74-3.67).

Conclusion: Experience of orthodontic treatment could be related to increased symptoms of TMJ.

Background: This paper aims to explore the application value of tuberculosis-specific enzyme-linked immunospot assay (T-SPOT.TB) in the diagnosis of tuberculosis.

Methods: Fifty one patients with tuberculosis (TB) admitted to Wuxi No.5 People’s Hospital, Wuxi, China from June 2015 to June 2017 were selected as the TB group, and 40 patients without tuberculosis admitted in the same period were randomly selected as the non-TB group. Patients in the two groups received T-SPOT.TB, TB antibody (TB-Ab) test and mycobacterium TB deoxyribonucleic acid (TB-DNA) test, and the results were compared.

Results: Comparisons of the sensitivity of the three methods showed that the sensitivity of T-SPOT.TB was the highest, followed by TB-DNA from sputum samples, and that of TB-Ab was the lowest. The specificity of TB-Ab was the highest, followed by T-SPOT.TB, and that of TB-DNA from sputum samples was the lowest. In the receiver operating characteristic (ROC) curve analysis, the area under curve (AUC) of T-SPOT.TB (0.896) was the highest, followed by TB-DNA from sputum samples (0.772), and that of sputum smears (0.698) was the lowest.

Conclusion: T-SPOT.TB can quickly and accurately determine the presence of tuberculosis infection, and it is a non-invasive examination, which can further assist in the diagnosis and guide the treatment.

Background: Essential medicine policy is a successful global health policy to promote rational drug use. The aim of this study was to evaluate the impact of the National Essential Medicines Policy (NEMP) on the rational drug use in primary care institutions in Jiangsu Province of China.

Methods: In this exploratory study, a multistage, stratified, random sampling was used to select 3400 prescriptions from 17 primary care institutions who implemented the NEMP before (Jan 2010) and after the implementation of the NEMP (Jan 2014). The analyses were performed in SPSS 18.0 and SPSS Clementine client.

Results: After the implementation of the NEMP, the percentage of prescribed EML (Essential Medicines List) drugs rose significantly, the average number of drugs per prescription and average cost per prescription were declined significantly, while the differences of the prescription proportion of antibiotics and injection were not statistically significant. BP (Back Propagation) neural network analysis showed that the average number of drugs per prescription, the number of using antibiotics and hormone, regional differences, size of institutions, sponsorship, financial income of institutions, doctor degree, outpatient and emergency visits person times were important factors affecting the prescription costs, among these the average number of drugs per prescription has the greatest effect.

Conclusion: The NEMP can promote the rational use of drugs in some degree, but its role is limited. We should not focus only on the EML but also make comprehensive NEMP.

Background: To examine the prevalence of overweight and obesity among schoolchildren in our region and to compare the results with previous studies conducted in the same region in 2005 and 2009.

Methods: This study was conducted at seven primary and three high schools in the center of the province of Isparta, Turkey in 2014, randomly selected for two studies of obesity five and nine years previously. Students were weighed and measured, and BMI was calculated. The results were then compared with those from 2005 and 2009.

Results: The study consisted of 7116 students, 3445 (48.4%) females, and with a mean age of 11.7±2.7 yr (range 5.8-18.9 yr). The prevalence of overweight was 13.6% and that of obesity 9.9%. When the data were compared with the 2005 and 2009 studies, a statistically significant increase was determined in the prevalence of overweight (X² = 4.826, P=0.0280 and X² =19.012, P<0.0001). The prevalence of obesity in the 2005 and 2009 studies was 11.6% and 12.5%, compared to 9.9% this study. The decrease observed in this study was statistically significant (X²=8.720, P=0.0031 and X²=20.708, P<0.0001). The total prevalence's of overweight and obesity combined were 23.8%, 23.5% and 23.5% for 2005, 2009 and 2014, respectively.

Conclusion: The prevalence of combined overweight and obesity was stable over the nine years, but there was significant increase in the prevalence of overweight. Population-based preventive strategies, therefore, need to be maintained and intensified.

Background: We aimed to investigate the expression levels of multidrug resistance gene 1 (MDR1), multidrug resistance-associated protein 1 (MRP1) and multidrug resistance P-glycoprotein (P-gp) in peripheral blood of patients with refractory epilepsy.

Methods: Patients with epilepsy (n=24) and those with refractory epilepsy (n=24) were selected, and 30 normal volunteers were enrolled as control. The expression level of MDR1 genes was detected using semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). The expression levels of P-gp and MRP1 were detected via Western blotting. The above-mentioned patients with refractory epilepsy were randomly divided into the oxcarbazepine group (OB group) and placebo group (OZ group). After consecutive 8-week oral administration of drugs, the curative effect and adverse reactions of patients with refractory epilepsy were observed, and the life quality of patients was evaluated.

Results: The expression levels of MDR1 genes, P-gp and MRP1 in peripheral blood of patients with refractory epilepsy were significantly increased compared with those of patients with epilepsy, (P<0.05). At 8 weeks after the drug therapy, the effective rate and life quality of patients in OB group were significantly higher than those of patients in OZ group (P<0.01). There was no significant difference in the incidence rate of adverse reactions during the treatment between the two groups. After treatment, the expression levels of MDR1, P-gp and MRP1 in peripheral blood of patients in OB group were significantly lower than those of patients in OZ group (P<0.01).

Conclusion: Oxacillipine could effectively improve the effective treatment rate of patients with refractory epilepsy. The mechanism may be related to MDR1, MRP1 and Pgp expression.

Background: The interaction between inherited mutated genes and environmental factors is believed to play a crucial role in cancer development. The main aim was to identify lifestyle-related risk factors for breast cancer among Jordanian women.

Methods: A hospital-based multicenter case-control study was conducted in Jordan in 2016. Overall, 405 cases and 418 controls, in 3 large hospitals where cancer patients are treated, participated. The prevalence of individual and groups of cancer-related risk factors was estimated descriptively using percentages and odd ratios with their correlated 95% Confidence interval (CI). The predictors of the occurrence of breast cancer were determined using logistic regression to estimate unadjusted association and adjusted association.

Results: Women in the case group (mean=49.2 yr, SD 10.2) were older than those in the control group (mean=45.9, SD 10.9). Physical activity (sufficiently active) (OR=2.76; 95% CI=1.96-3.87) and fruit and vegetable intake (good or optimal) (OR=1.71 95% CI=1.25-2.35) were found to be associated with reduced breast cancer risk. However, calcium intake (>3 times a week) (OR=0.51; 95% CI=0.34-0.77) was associated with increased risk of breast cancer.

Conclusion: Lifestyle risk factors were identified, and certain modifications to lifestyle are needed. Women’s awareness of these factors should be raised through appropriate channels, as a priority of the health authorities. Increasing the amount of high-quality research in this area remains one of the best ways to fight breast cancer, reducing its incidence and associated morbidities.

Background: Pregnancy is a period of time when women tend to suffer from the weakening of their psychophysical fitness. This research evaluated several selected elements of the lifestyle of pregnant women compared to those of non-pregnant women.

Methods: Overall, 482 women attended to the Childbirth School in Gynecological-Obstetric Hospital “Inflancka” in Warsaw, Poland, in the years 2011-2013; Group 1 contained 214 pregnant, and Group 2 contained 268 non-pregnant completed a survey inquiry. The research tool applied was Juczyński’s “Inventory of Health Behaviour” (Inwentarz Zachowań Zdrowotnych). In this tool, the author evaluates health behaviors through four separate categories: dietary habits, prophylactic behaviors, mental attitude, and health behaviors. The differences between the data were defined through the Student’s t-test for independent groups, with a minimal level of significance set at P ≤ 0.05.

Results: Pregnant women take care of following a healthy lifestyle. The general health behaviour index figure was significantly higher in Group 1 as compared with the Group 2 (P<0.001). A higher level (P<0.001) of healthy behaviour was typical of physically-active individuals, regardless of their Group (1 & 2).

Conclusion: Pregnancy might cause women to increase their interest in matters of their own health and adopt a healthier lifestyle. Physical activity can influence other health-related practices.

Background: To study the nursing method of mild hypothermia therapy for moderate or severe hypoxic-ischemic encephalopathy (HIE) in neonates.

Methods: According to the inclusion and exclusion criteria, 48 patients were selected from Nanfang Hospital from December 2015 to October 2016 and randomly divided into the control group (n=24) and observation group (n=24). The control group received routine treatment and nursing, while the observation group received the same treatment as the control group combined with mild hypothermia treatment and nursing. The clinical effects were compared.

Results: The total effective rate in the observation group was increased and mortality was decreased, and the differences were statistically significant (P=0.029 and 0.033, respectively).  The 28 d neonatal behavioral neurological assessment and nursing satisfaction scores in the observation group were higher than those in the control group, and the differences were statistically significant (P=0.017 and 0.008, respectively).

Conclusion: Mild hypothermia therapy for moderate or severe HIE in neonates is safe and effective, and the correct nursing method is important for guaranteeing proper clinical treatment.

Background: For the world can get rid of the HIV/AIDS pandemic by 2030, there is need for more to be done especially in the case of countries in Africa. In Nigeria, such efforts have included Faith-Based Organizations (FBOs) recognized as partners in the National Response Framework. However, the extent to which these FBOs contribute to efforts to control the pandemic will depend on their capacity. Therefore, this study aimed to ascertain the technical and managerial capacity of these FBOs to respond to the pandemic in Nigeria.

Methods: We utilized social survey in examining the capacity of three purposively selected FBOs in the Southeast of Nigeria to respond to the pandemic. Thus, the focus group discussion and the key informant interviews were used. The data for the study was collected between Feb and Apr 2014.

Results: The study discovered a general low capacity but high willingness of the FBOs to get involved. One of the FBOs studied was better placed than others and had even established committee on the pandemic. However, in another FBO, the pandemic was still seen largely with moral lens that blame those infected rather than provide support. All the FBOs were ambivalent on the use of condoms as a prevention method.

Conclusion: There is need for sustained capacity building for the FBOs in order to provide them with knowledge on the pandemic and help them act out the role envisaged for them in the National Response Framework in Nigeria.

Background: A high-reliability organization (HRO) is a separate paradigm can indicate medical error reduction and patient safety improvement. Hospitals, as vital organizations in the health care system, can transform to HROs to achieve optimal performance and maximum safety in order to manage unpredicted events efficiently. Therefore, the aim of this research was to determine the knowledge of managers and staffs of Farabi Eye Hospital, Tehran, Iran about HROs model, and the extent of HROs establishment in this hospital in 2015- 2016.

Methods: In this descriptive-analytical and cross-sectional study, data were collected through HROs questionnaire and checklist. Validity of questionnaire and checklist was confirmed by expert panel, and the questionnaire reliability by Alpha-Cronbach method with 0.85. The collected data were analyzed with Spearman’s correlation coefficient and Mann-Whitney test using the SPSS software version 19.

Results: Most of the respondents were familiar with HROs model to some extent and only 18.8% had a high level of knowledge in this regard. In addition, there was no significant correlation between the knowledge of staffs and managers with establishment of HROs model in Farabi eye hospital.

Conclusion: Managers and staffs of Farabi Eye Hospital did not have a high knowledge level of the model of HROs and had little information about the functions and characteristics of these organizations. Therefore, we suggest HROs training courses and workshops should be established in this hospital to increase the knowledge of the managers and staffs for better establishment of HROs model.

Background: The present study was conducted approximately 40 years ago, but its results have not been released. At the time of this study, the importance of the gut microbiota was not fully understood.

Methods: Meriones persicus rodents, as one of the major reservoirs of Yersinia pestis bacterium in Iran, were compared in a disease endemic area (Akanlu, Hamadan, western Iran) and a non-endemic zone (Telo, Tehran, Iran) from 1977 to1981.

Results: This study was able to transmit the resistance to Y. pestis to other rodents creatively by using and transferring gut microbiota.

Conclusion: The study indicated for the first time that the gut microbiota could affect the sensitivity to plague in Meriones in Telo.

Background: Autosomal recessive non-syndromic hearing loss (ARNSHL) a most frequent hereditary type of hearing impairment, exhibit tremendous genetic heterogeneity. We aimed to determine the contribution of three common DFNB loci (DFNB4, DFNB28, and DFNB93), and mutation analysis of Gap Junction Beta-2 gene (GJB2) and GJB3 genes in ARNSHL subjects in southern Iran.

Methods: Thirty-six large ARNSHL pedigrees (167 individuals) with at least two affected subjects (72 patients) were included in this descriptive study from Hormozgan Province of Iran, during 2014 - 2015. The variation of GJB2 and GJB3 genes were screened using direct sequencing method. The negative samples for GJB2 and GJB3 genes mutations were analyzed for the linkage to DFNB4, DFNB28, and DFNB93 loci by genotyping the corresponding short tandem repeat (STR) markers using polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE) methods.

Results: DNA sequencing of GJB2 were identified heterozygous mutation (964 C/T) in 13.88% of the studied families. Three missense mutations (788G/A, 284C/T and 973G/C) were also detected in coding region of the GJB3 gene. The 284C/T mutation in the GJB3 occurs in compound heterozygosity along with the 964T/C mutation in the GJB2 in one family. Finally, we found no evidence of linkage to either of DFNB4, DFNB93 and DFNB28 loci.

Conclusion: Highlighting the hypothesis that a genetic interaction between GJB2 and GJB3 genes could be lead to ARNSHL, however, no evidence of linkage to the DFNB loci was found. 284C/T variant in GJB3 gene might be pathogenic when accompanied by variant in GJB2 in a digenic pattern. However, further large-scale familial and functional studies are required to challenge this hypothesis.

Background: Continuous quality improvement of the hospital services is a basic requirement of medical tourism industry. The different dimensions of hospital services quality are assessed constantly to improve the service of medical tourism. The aim of this study was to determine the services quality of medical tourism in private and public hospitals.

Methods: In this cross-sectional study, the quality of hospital services were assessed in view of 250 Iraqi tourists referred to Ahvaz private and public hospitals in 2015. Data were collected using a valid medical tourism SERVQUAL questionnaire (MTSQ). This questionnaire includes 8 main dimensions with 31 items. Finally, Mann-Whitney, Kruskal-Wallis and Wilcoxon tests were used to analyze the data.

Results: The mean of age of patients was 39±2.2 yr. The mean of hospital length of stay was 3.87±1.36 days. The most patients were admitted to Orthopedics, Otorhinolaryngology, Obstetrics, and Gynecology departments, respectively. There was a negative gap in all of the dimensions of service quality in the studied hospitals (P>0.001). The highest and lowest quality gap was seen in the “exchange and travel facilities” (-2.63) and the “tangibles” (-0.68) dimension, respectively.

Conclusion: There was a negative gap in all of the dimensions of service quality in the studied hospitals. Therefore, the hospital services quality is improved to attract the foreign patients.

Background: Food handlers play a significant role in the dissemination and transmission of enteropathogenic microorganisms, including intestinal parasites. The aim of this study was to determine the prevalence of intestinal parasites in food handlers of Bandar Abbas, southern Iran.

Methods: In this cross-sectional study, 800 stool samples were randomly collected in a period of 6 months from Jun to Nov 2015. The diagnosis was made on direct wet mount, formalin-ether concentration, Ziehl-Neelsen, and Trichrome stained slides.

Results: 34.9% of participants were positive for stool parasites. The most infected individuals were seen in the workers of bakeries 54.3%, factories 41.1% fast foods 35.7%, supermarkets 34.7%, restaurants 33.9%, offices 29.8%, butchers 27.3% and coffee shops 26.7% respectively (P<0.05). The intestinal parasites were Blastocystis hominis 24.3%, Entamoeba coli 8%, Giardia lamblia 6.8% and Dientamoeba fragilis 4.3% respectively. Only two infections by Hymenolepis nana (0.3%) and one by Enterobius vermicularis (0.1%) were detected in this study. Living in the workplace and direct contact with the raw foodstuff affected the prevalence of intestinal parasites (P<0.05).

Conclusion: The use of concentration methods for the detection of intestinal parasites as well as continuous and effective education in short-term courses to promote hygienic behavior is suggested.

Background: This short communication report some new results obtained from a medical survey among 900 Vietnamese patients in 2015, looking into possibly influential sociodemographic factors as far as patient satisfaction is concerned, to establish empirical relationships between them for policy implications.

Methods: The study employed the baseline category logit models to establish empirical relationships between predictor variables and responses, which reflect different levels of satisfaction.

Results: Income, medical expenditure, and insurance coverage have the positive influence on improving patient satisfaction. However, insurance reimbursement rate has the negative influence. Patients with residency status are more demanding than those without. The more seriously ill, the less likely a patient finds the health services to be satisfactory. The probability of satisfaction conditional on insurance reimbursement is lower for patients with residency status, and higher for those without.

Conclusion: There exist thresholds of income, expenditures, and insurance reimbursement rate, surpassing which probabilistic trends shift. The expenditure threshold for resident patients is almost three times of that for non-residents. An insurance threshold exists only within the group of non-resident patients, ~65%, suggesting that getting a reimbursement rate higher than this can be very difficult. Therefore, the government’s ambitious goal of universal coverage may be both unrealistic and too rigid as patients with different conditions show different perceptions toward healthcare services.

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