Vol 47 No 2 (2018)

Review Article(s)

  • XML | PDF | downloads: 296 | views: 363 | pages: 148-155

    Background: In pesticide exposure groups such as farmers, the risk of prostate cancer was increased, although the report of the cause of evidence is limited. We selected chlorophenol compounds as an important group of the contaminated pesticide with highly toxic 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD). This meta-analysis, the risk of death from prostate cancer was analyzed.

    Methods: PubMed, Scopus, Scholar Google and web of Sciences until 2016 were searched. The standardized mortality rate (SMR) and 95% confidence intervals (CI) were obtained from the studies. We tested statistical heterogeneity with Cochrane Q test and I2 index. Egger test was used for evaluating publication bias. Random or fixed-effects models and meta-regression were also used in our analysis. Moreover, Cochrane tool was used to assess the risk of bias.

    Results: Five available papers consist of 28706 exposed populations were assessed. Overall standardized mortality rate as combined result of prostate cancer risk from the fixed model was 1.2 (95% confidence interval (CI) 1.02 to 1.42, P=0.027). Some biases are more probable in these studies such as confounding by indication, loss to follow up and misclassification.

    Conclusion: A contaminated pesticide with dioxins between other pesticides is an important risk factor for prostate cancers.



  • XML | PDF | downloads: 360 | views: 353 | pages: 156-165

    Background: With the rapid development of social economy in China, various public health emergencies frequently occur. Such emergencies cause a serious threat to human health and public safety, especially in rural China. Owing to flaws in emergency management mechanism and policy, the government is not capable to effectively deal with public health emergencies. Therefore, this study aimed to discuss the path to improve the emergency management mechanism for public health emergency in rural China.

    Methods: This study was conducted in 2017 to detect the emergency management mechanism of public health crisis (EMMPHC) in Rural China. Data were collected using the following keywords: Rural China, public health emergency, emergency management mechanism, organization mechanism, operation mechanism in the databases of PubMed, Scopus, Web of Science, and CNKI.

    Results: EMMPHC in rural China can be enhanced from the following three aspects. First, a permanent institution for rural emergency management with public health management function is established. Second, the entire process of emergency management mechanism, including the stages of pre-disaster, disaster, and post-disaster, is improved. Finally, investment in rural public health is increased, and an adequate reserve system for emergency resources is formed.

    Conclusion: The new path of EMMPHC in rural China can effectively help the local government accomplish the dispatch capability in public health emergency, and it has important research significance for the protection of public health and social stability of residents in rural China.



  • XML | PDF | downloads: 511 | views: 544 | pages: 166-177

    Background: One of the main challenges of healthcare systems is to protect people from consequences of health expenditures. Such expenditures may lead to catastrophic financial loss in families so that many people deny demanding necessary healthcare services, which results in harms to their health status. The aim of this systematic review was to investigate the catastrophic health expenditures trend and its related factors in Iran.

    Methods: This systematic review and meta-analysis was conducted on studies conducted between 1984 and 2014. Data were collected through searching electronic databases and searching engines of PubMed, Scopus, EconLit, Google Scholar, Science Direct, MagIran, and Scientific Information Database (SID). The random effects were used with 95% confidence interval for the meta-analysis.

    Results: Out of 561 initially retrieved articles, finally 42 were included in the final analysis. The studies were conducted between 1984 and 2014. The overall proportion of exposure to catastrophic health expenditure in Iran was 7.5% (95% CI, 6.2 – 9.1). In the urban and rural areas, the proportion was 2.3% (95% CI, 1.8 – 2.9) and 3.4% (95% CI, 2.8 – 4.1) respectively. The overall proportion of exposure to the catastrophic health expenditure in hospitals was 35.9% (95% CI, 23.5 – 54.3).

    Conclusion: The catastrophic expenditures proportion of healthcare is relatively high in Iran and the government is expected to adopt effective measures in this regard, especially for the inpatient care. There are needs for special supporting policies for the financial protection of specific patients, the poor and villagers.



  • XML | PDF | downloads: 251 | views: 538 | pages: 178-187

    Background: The aim of this study was systematic review and meta-analysis of prevalence in current and relevant literature about this developmental disorder to present the profile of malocclusion in Iran.

    Methods: This review study was carried out with systematically identified and critically assessed studies reporting malocclusion prevalence among Iranian population in permanent dentition. National and international databases were searched for articles about prevalence of malocclusion by Angle classification in different regions of Iran from 1994 to 2015. After applying inclusion and exclusion criteria, the quality of articles was checked by professional checklist. Data extraction and meta-analysis was performed. A random-effect model was employed. Publication bias was checked.

    Results: Of 2768 articles, 21 cases were included .The pooled prevalence of malocclusion was about 87% (95% CI: 78.3–92.2) in Iranian population; however, the prevalence of malocclusion across individual studies varied considerably (ranging from 23.7% to 99.7%). Prevalence of normal occlusion, class I, II and III malocclusion were reported as 13.3% (CI 95%: 7.8–21.7), 50.7% (CI 95%: 42.9-58.4), 21% (CI 95%: 17.5-25.1), 5.5% (CI 95%: 3-10); respectively. Maximum prevalence of malocclusion was in the East of Iran.

    Conclusion: The results showed a high prevalence of malocclusion in Iranian population. The baseline information could be appropriately utilized for the future planning to meet the orthodontic treatment need among the Iranian population.



  • XML | PDF | downloads: 586 | views: 513 | pages: 188-197

    Background: Adiantum capillus-veneris Linn (Maidenhair fern) is an herb belonging to the family Pteridaceae. It is named as “Pare-siavashan” in medical and pharmaceutical textbooks of Iranian Traditional Medicine. The fronds of Maidenhair fern were mainly administrated by ancient physicians as single medicine or in combination with other plants in multi-herbal formulations for curing different diseases. Because of different chemical compositions, the herb fronds were also assessed for its numerous pharmacological effects. Therefore, the current study was done to review the traditional usage and modern pharmacological and toxicological effects of Maidenhair fern.

    Methods: Scientific databases and publications including Web of Science, PubMed, Scopus, Science direct, Cochrane Library, SID (for Persian papers) and medical and pharmaceutical textbooks of traditional medicine as well were searched for “Adiantum capillus-veneris”, “Maidenhair fern” and “Pare-siavashan” without limitation up to 2016.

    Results: Maidenhair fern exhibited to possess anti-diabetic, anticonvulsant, analgesic, hypocholesterolemic, goitrogenic, anti-thyroidal, antibacterial, antifungal, wound healing, antiobesity, anti hair loss, anti-asthmatic, anti-inflammatory, antidiarrheal and antispasmodic, antioxidant as well as diuretic, anti-urolithiatic and detoxifying effects in modern medicine. Ancient physicians declared some of the confirmed pharmacological effects.

    Conclusion: Maidenhair fern frond can be a good candidate for clinical purpose. Therefore, future researches on the other mentioned effects in traditional medicine are recommended.


Original Article(s)

  • XML | PDF | downloads: 385 | views: 634 | pages: 198-208

    Background: We aimed to describe the trends and associated factors of hypertension among residents aged ³15 yr in Guangzhou, China.

    Methods: Three standardized cross-sectional health surveys were conducted in 2004, 2009 and 2013 using a multi-stage cluster sampling method, and a total of 69128 qualified participants were included in the study. The data were obtained through physical health examination and questionnaire survey.

    Results: The age-standardised prevalence of hypertension increased from 12.5% to 16.0% between 2004 and 2009 and declined from 16.0% to 14.0% between 2009 and 2013, and crude prevalence respectively was 14.6%, 19.1% and 18.8% in 2004, 2009 and 2013. The proportion of optimal blood pressure dropped from 51.1% to 33.2%, high-normal blood pressure increased from 20.1% to 28.9%, grade 1 hypertension and grade 2 or 3 hypertension increased from 11.5% to 13.6% and 3.9% to 5.8% between 2004 and 2013. The average age was significantly increased (P<0.001) from 42.8 to 47.5 yr, and the average body mass index slightly increased (P<0.001) from 22.4 to 23.0. Logistic regression analysis shows that higher age, male, higher body mass index, smoking and drinking alcohol were potential risk factors for hypertension.

    Conclusion: Both crude and age-standardized prevalence of hypertension were initially increased, but subsequently decreased in Guangzhou during 2004–2013. The optimal blood pressure population decreased significantly while the high-normal blood pressure population increased substantially during the survey period.


  • XML | PDF | downloads: 232 | views: 313 | pages: 209-218

    Background: The National Health Insurance Service (NHIS) conducted a screening test to detect chronic diseases such as hypertension and diabetes in Korea. This study evaluated the effects of health screening for DM on pharmacological treatment.

    Methods: The data from qualification and the General Health Screening in 2012, the insurance claims of medical institutions from Jan 2009 to Dec 2014, and the diabetic case management program extracted from the NHIS administrative system were used. Total 16068 subjects were included. Visiting rate to medical institution, medication possession ratio and the rate of medication adherence of study subjects were used as the indices.

    Results: The visiting rates to medical institutions were 39.7%. The percentage who received a prescription for a diabetes mellitus medication from a doctor was 80.9%, the medication possession ratio was 70.8%, and the rate of medication adherence was 57.8%.

    Conclusion: The visiting rate, medication possession ratio and rate of medication adherence for DM medication were not high. In order to increase the visiting rate, medication possession ratio and rate of medication adherence, NHIS should support environment in which medical institutions and DM patients can do the role of each part.


  • XML | PDF | downloads: 279 | views: 357 | pages: 219-224

    Background: To investigate the effects of negative emotions and life events on women's missed miscarriage.

    Methods: Overall, 214 women diagnosed with a missed miscarriage by prenatal examination from 2016-2017 in Xiamen Maternal and Child Health Care Hospital, Xiamen, China were selected as the observation group compared to 214 women as control group. The general data of the patients were investigated by self-programmed questionnaires. Zung Self-Rating Anxiety Scale, Center Epidemiological Studies Depression Scale; Life Events Scale for Pregnant Women were used conduct the study. General data, anxiety, depression and life events were compared between the two groups of patients, and statistically different factors were included in the multivariate Logistic regression analysis.

    Results: There were statistically significant differences in the educational level, pre-pregnancy health status, planned pregnancy, pre-pregnancy or gestational gynecological inflammation and the initiative to obtain knowledge of prenatal and postnatal care between the two groups of pregnant women (P<0.01); there were also statistically significant differences in score of life events, score of anxiety and score of depression between them (P<0.01). The high educational level, good health status before pregnancy and the initiative to obtain the knowledge of prenatal and postnatal care were taken as the independent protective factors for the missed miscarriage in pregnant women, while life events, anxiety and depression were independent risk factors for it.

    Conclusion: Negative emotions and life events increase the risk of women's missed miscarriage, and the high educational level, good health status before pregnancy and the initiative to obtain the knowledge of prenatal and postnatal care reduce the risk of women's missed miscarriage.


  • XML | PDF | downloads: 293 | views: 281 | pages: 225-230

    Background: Medical tourism suffers from the lack of a consensus regarding the involved categories. This study aimed to address this gap from the academic disciplines and publications perspective.

    Methods: Totally 1954 citations were identified through a formula of keyword search of SCOPUS. In order to classify the various subject areas, we followed the international standard classification of education (ISCED) developed by UNESCO. Moreover, the trends of publications were identified based on their popularity between 2000 and 2017.

    Results: The category with the most interests on publication about medical tourism was ‘health and welfare’, followed by ‘social science’. Even though various disciplines were involved in the medical tourism, it seems that a downward trend has been experienced since 2015.

    Conclusion: The identified key trends of medical tourism publications will benefit researchers exploring the categories of medical tourism or health travel. The results contribute to advance the state of knowledge from the academic perspective.


  • XML | PDF | downloads: 274 | views: 316 | pages: 231-236

    Background: The aim of this study was to observe the effect of intensive statin therapy on symptomatic intracranial arterial stenosis.

    Methods: overall, 120 patients with symptomatic intracranial arterial stenosis were admitted to the Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China from January 2010 to May 2013. They were randomly divided into three groups and were given different doses of atorvastatin orally for 1 year or more, and followed up for 12 months. The three groups were assessed for clinical end-point event rates and changes in cerebral blood flow value before and after treatment to assess the effectiveness of intensive statin therapy.

    Results: The incidence rates of end-point cerebrovascular events in the low-dose group (10 mg/d), the general-dose group (20 mg/d) and the intensive treatment group (40 mg/d) were 26.3%, 13.5% and 5.4% respectively during the 12-month follow-up after treatment. There was a significant difference between the low dose group and the intensive treatment group (P<0.05). The relative cerebral blood flow and relative cerebral blood volume of the three groups were significantly higher than those before treatment (P<0.05), and the relative time to peak for the intensive treatment group was shorter than that before treatment (P<0.001).

    Conclusion: Atorvastatin at 40 mg/d has a significant advantage compared with atorvastatin at 20 mg/d and 10 mg/d in reducing cerebrovascular events and improving cerebral blood flow. 


      Keywords: Statin, Enhanced lipid-lowering, Intracranial atherosclerotic stenosis, CT perfusion imaging


  • XML | PDF | downloads: 308 | views: 315 | pages: 237-245

    Background: This study estimated the prevalence of respiratory symptoms and disorders among workers exposed to exposure to volatile organic compound (VOCs) in an automobile manufacturing factory in Tehran, Iran in 2016.

    Methods: Subjects of this case-control research were included 80 samples including 40 workers exposed to different level of BTEX as well as 40 unexposed individuals were considered as control group. Methods 1501 and 7602 presented by the National Institute of Occupational Safety and Health (NIOSH) were used for the sampling and analysis of compounds in the air. Gas Chromatography-Flame Ionization Detector (GC-FID) was used for analysis of compounds of interest. Six silica samples were collected during the campaign. Silica analyses were performed by using visible absorption spectrophotometry system. Lung functions were evaluated for 80 workers (40 exposed, 40 nonexposed) using spirometry system.

    Results: The average amount of total dust and free silica measured in factory were 7.3±1.04 mg.m-3 and 0.017±0.02 mg.m-3 respectively. Average benzene, toluene, ethyl-benzene and xylene exposure levels in exposed subject’s median were 0.775±0.12, 1.2±2.08, 45.8±8.5, and 42.5±23.9 ppm respectively. Statistical tests showed significant difference between pulmonary function tests (except PEF) of exposed and non-exposed individuals before and after employment (P<0.05). Workers exposed to VOCs presented lower levels of FVC, VC, and PEF than the control group except FEV1/FVC%, FEV1, FEF2575 and FEV1/VC%.

    Conclusion: Decline in lung volumes and respiratory symptoms, significant difference associated with the exposure to dust or gas, duration of exposure, and smoking habit. Therefore, lung function tests should be performed before and after the employment to identify sensitive workers candidates.

  • XML | PDF | downloads: 321 | views: 312 | pages: 246-255

    Background: According to the general health policies issued in 2014, Health Impact Assessment (HIA) or Health Annex should be implemented in Iran. The present study provided a model for executing HIA in the Iranian context as a developing country.

    Methods: This is a system design study with the qualitative approach. The data on the system components were gathered via reviews of the literature, in-depth interviews and focused group discussions (FGDs) with experts. The information were contently analyzed in order to draft the model and a consensus was reached on by the steering committee.

     Results: Fifteen in-depth interviews and six FGD meeting were conducted. The equity-based approach in assessing the health impacts of policies, programs and projects were chosen as the most practical tool. Experts believe that for the next five years, HIA should be used just for the "national projects" so that the ministries and national agencies could be empowered. Components of the model including structure, procedures, and standards, management style, mission and resources were prepared. The national regulations and protocols were sent to the SCHFS Secretariat for final revision and the council approval.

    Conclusion: The hasty implementation of HIA will face serious resistances as the health-oriented attitude and behavior in both government and non-governmental sectors will gradually form. Also, the overlapping of the contents of HIA with other tools such as Environmental, Cultural and Social Impact Assessments, currently used by other sectors, causes difficulties in implementing the HIA by the Ministry of Health and Medical Education.

  • XML | PDF | downloads: 271 | views: 294 | pages: 256-263

    Background: Asthma is the first cause of children hospitalization and need for emergency and impose high economic burden on the families and governments. We aimed to investigate the economic burden of pediatric asthma and its contribution to family health budget in Iran.

    Methods: Overall, 283 pediatric asthmatic patients, who referred to two tertiary pediatric referral centers in Tehran capital of Iran, included from 2010-2012. Direct and indirect asthma-related costs were recorded during one-year period. Data were statistically analyzed for finding association between the costs and factors that affect this cost (demographic variables, tobacco smoke exposure, control status of asthma and asthma concomitant diseases).

    Results: Ninety-two (32.5%) females and 191(67.5%) males with the age range of 1-16 yr old were included. We found the annual total pediatrics asthma related costs were 367.97±23.06 USD. The highest cost belonged to the medications (69%) and the lowest one to the emergency (2%). We noticed a significant increasing in boys’ total costs (P=0.011), and 7-11 yr old age group (P=0.018). In addition, we found significant association between total asthma costs and asthma control status (P=0.011).

    Conclusion: The presence of an asthmatic child can consume nearly half of the health budget of a family. Our results emphasis on improving asthma management programs, which leads to successful control status of the disease and reduction in economic burden of pediatric asthma.



  • XML | PDF | downloads: 341 | views: 444 | pages: 264-272

    Background: This study aimed to investigate the incidence of antibiotic-resistance and virulence genes in vancomycin-resistant Enterococcus faecium isolated from different sources in southwest Iran from Mar to Sep 2015.

    Methods: Overall, 120 E. faecium isolates (80 VRE and 40 vancomycin-susceptible enterococci [VSE] isolates) were obtained from four hospitals. The resistance of the VRE isolates was determined by disk diffusion method. Multiplex PCR was performed to detect the virulence genes carried by the E. faecium isolates, namely, enterococcal surface protein (esp), hyaluronidase (hyl), and collagen-binding adhesin (acm).

    Results: All the VRE isolates exhibited multidrug resistance, with the rates of resistance to ampicillin, erythromycin, and ciprofloxacin reaching high levels. The isolates were least resistant to chloramphenicol and nitrofurantoin, but all of them were susceptible to linezolid. 46.6%, 20.8%, and 86.6% of the E. faecium isolates carried the esp, hyl, and acm genes, respectively.

    Conclusion: There is a significant difference between the prevalence of esp and hyl genes in the VRE and VSE isolates. In the VRE isolates, the high prevalence of multidrug resistance were found and the difference in the prevalence of esp among various sources was significant. The findings reflected a relationship between the prevalence of esp and hyl and resistance to certain antibiotics.




  • XML | PDF | downloads: 193 | views: 305 | pages: 273-279

    Background: The aim of this study was comparison characteristics of family and demographics of children with antenatal hydronephrosis, in 2nd and 3rd trimester of pregnancy, in order to the need for postnatal management.

    Methods: This cross-sectional study described some information from family of children with antenatal hydronephrosis, at the Pediatric Urology Research Center of Children’s Hospital Medical Center of Tehran University of Medical Sciences. Data for 193 children, admitted in 2012-2013, were collected retrospectively. They were allocated to two groups of 2nd and 3rd trimester, based on the time of diagnosis antenatal hydronephrosis. Data analysis was done using SPSS. Chi-Square, Fisher-exact and independent t-test also Mantel-Hanzel test were used. P-value<0.05 was considered as statistically significant.

    Results: Of 193 infants (36 female, 157male), the antenatal hydronephrosis of 76 cases (39.4%) have been diagnosed in the 2nd trimester. In addition, 110 cases (57%) were bilateral and 33 cases (17.1%) had severe antenatal hydronephrosis. Consanguinity marriage, being unilateral or bilateral and the severity of antenatal hydronephrosis were significant with the specific trimester that it has been diagnosed (P<0.05).

    Conclusion: Infants with bilateral and severe grade of antenatal hydronephrosis also with the history of consanguinity marriage among their parent will diagnose in the second trimester more than the third trimester and will refer for some surgical correction, relating to other kidney diseases such as vesicoureteral reflux, more than others. Thus, this is a good sign for caring infants.



  • XML | PDF | downloads: 219 | views: 250 | pages: 280-285

    Background: This study was conducted in Yazd Province, Central Iran aimed to investigate the relationship between adverse events and breast cancer during 2012-2014.

    Methods: Hospital-based case-control study of 150 women with breast cancer and 150 healthy women (did not have breast cancer) was conducted. Sampling was performed in the form of accessibility. Data collection was conducted using questionnaire through interview. The collected data were entered into SPSS for statistical analysis.

    Results: The mean age of participants was 51.58 yr. Eight percent of cases and 1.3% of the controls had experienced the sister’s death over the past 5 yr, this difference was statistically significant (P=0.03). Factors such as disability due to illness, divorce, unemployment, the second marriage, addiction, ill spouse, child’s problems (such as conflict, unemployment, addiction, legal troubles, illness), taking care of their own parents or their husband’s parents, migration, change of habitat, loss of home, communication problems, job-relevant factors were not significantly different between the two groups (P>0.05). Mean of severity of adverse events in both groups was significantly different (8.92±8.29 in the case group, 5.72±5.6 in the control group) (P=0.000).

    Conclusion: There was no significant relationship between adverse events in the last 5 yr and the risk of breast cancer. Factors such as personality and ability to cope with problems may positively influence this relationship.



  • XML | PDF | downloads: 337 | views: 461 | pages: 286-291

    Background: Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran.

    Methods: In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center’s staff.

    Results: The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data.

    Conclusion: Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.


Letter to the Editor