Vol 47 No 8 (2018)

Review Article(s)

  • XML | PDF | downloads: 360 | views: 707 | pages: 1068-1076

    Background: The circadian rhythm regulation plays a crucial role in people`s healthy lives affected by factors consisting of cosmic events related to the universe and earth, environmental factors (light, night and day duration, seasons) and lifestyles. These factors changes lead to disturbance of circadian rhythm and it causes increasing the incidence of mental diseases like depression and physiological problems like cancers, cardiovascular disease and diabetes.

    Methods: The present review searched Elsevier, SID, Pub Med, Springer, and Google Scholar databases for relevant articles were published between 1996 and 2017. Keywords used included lifestyle, circadian rhythm, cancer, metabolic diseases and cosmic factors.

    Results: Circadian rhythm can be affected by lifestyle, heredity, cosmos spin and seasonal factors. Two first factors have physically direct effects on circadian rhythm and health, while other factors influence on them mentally. After all, all of them lead to cancer, cardiovascular diseases and metabolic obesity.

    Conclusion: Although environmental factors are universal events which are unrelated to human control but affect human`s body and circadian rhythm. Other factors are manageable by human to prevent disturbance of circadian rhythm making physical disorders.



  • XML | PDF | downloads: 248 | views: 280 | pages: 1077-1083

    Background: There is a growing global demand for medical tourism while more people are moving across borders in Asia, offering new opportunities to the high-value medical tourism market. The purpose of this study was to provide grounds for promoting the International Meditour Coordinator (IMC), issued as a national license in Korea and to provide the evidence for the efficient use of the IMC in the field of health care.

    Methods: We examined the trend of professional manpower in the rapidly-changing Korean medical market by analyzing the operational status of professional manpower in order to promote medical tourism, which began in 2009 in Korea. We also analyzed the problems of the national qualification system for the IMC and sought to improve the professionalism and usability of the national qualification system by improving the quality satisfaction of the professionals who support the growth of the medical tourism industry.

    Results: In Korea, IMCs are responsible for detailed support services in clinics, support to tourists, medical tourism marketing to support the advancement of domestic and international medical institutions in each market, medical tourism counseling, risk management, and administrative work, thereby contributing to the development and enhancement of competitiveness in Korea’s global healthcare industry.

    Conclusion: To support the growth of the medical tourism industry, which is a global trend, and increase user satisfaction with the quality of medical tourist services, it is urgently necessary to establish human resource management policy guidelines in the medical tourism industry based on the current operational status of professional human resources and the future prospect of supply and demand in the sector.



  • XML | PDF | downloads: 187 | views: 218 | pages: 1084-1089

    Background: Nursing is not just task-based work, but also emotional work. Nurses are also obliged to satisfy patients’ emotional needs, which often results in burnout and depression. We aimed to propose an effective method for reducing their emotional burden. 

    Methods: We took theoretical measure to verify some theories on emotion and emotional labor.

    Results: Empathy can be enhanced by reading literature. It has been recognized from ancient times that reading is an empathic experience in its very essence. Reading is not possible without the reader identifying and sympathizing with the character in the story.

    Conclusion: Reading literature is not only an efficient means of enhancing empathy, but also very practical to implement. Among programs that proved efficient are role exchange programs, here-and-now spontaneity, perspective taking, simulation exercises, and so on. The problem with them is that they require special facilities and equipment. If they are not available, reading practice would be the best alternative.


Original Article(s)

  • XML | PDF | downloads: 277 | views: 318 | pages: 1090-1097

    Background: This study was designed to investigate the clinical effects of different treatment methods on stress urinary incontinence (SUI) in perimenopausal women, and to evaluate urodynamic characteristics.

    Methods: Seventy-two menopausal female patients with stress urinary incontinence were included in the Second Affiliated Hospital of Soochow University from January 2016 to July 2017. The cases were divided into 3 groups of 24 each, depending on the treatment received. Group A patients received treatment with electrical stimulation combined with biofeedback; those in group B received conventional pelvic floor muscle exercise therapy; and those in group C did not have any treatment. Relevant clinical parameters of urination were determined including pelvic floor muscle strengths, urine dynamics indexes and ICS quality of life survey scores; results were averaged in each group for comparisons among the three groups before and after the 60-day study period.

    Results: After treatment for 60 days, both group A and B patients displayed a clear improvement in their urinary incontinence, pelvic floor muscle strength, leakage times, frequency of urination, urine dynamics index and ICS scores (P<0.05), with group A showing the most improvement. Women in group C showed no significant difference before and after the 60-day study period (P>0.05).

    Conclusion: Both the method of electrical stimulation combined with biofeedback, and conventional pelvic floor muscle exercises could help perimenopausal women with stress urinary incontinence; however, electrical stimulation combined with biological feedback seems to bring about better clinical effects.


  • XML | PDF | downloads: 273 | views: 285 | pages: 1098-1107

    Background: The study examined the baseline findings of a controlled intervention study comprising anthropometric measurements, nutrient intakes, and physical activity among overweight or obese children in Kota Bharu, Kelantan, Malaysia.

    Methods: The study was completed in 2016 and the baseline data were gathered from four groups in a school-based randomized community trial among Year Five students from primary schools in Kota Bharu, Kelantan, Malaysia. Participants completed anthropometry assessment, three-day dietary record, and Physical Activity Questionnaire for Older Children (PAQ-C).

    Results: The prevalence of obesity was higher among the boys (52.5%). Mean energy intake was significantly higher among boys as compared to the girls (P=0.003). Twenty-five percent of the participants had exceeded the recommended nutrient intakes (RNI) of energy recommended. The calcium, thiamine, riboflavin, and niacin were also significantly higher among boys as compared to the girls (P˂0.05). Boys also exhibited a significantly higher score on performance of physical activity (mean=2.68; SD=0.60) as compared to the girls (mean=2.38; SD=0.51) however it is still in the category of moderately active. Approximately 14.4% of children had a very low physical activity level.

    Conclusion: Overweight and obese boys had higher energy and fat intakes but were more physically active as compared to the girls. These findings might be useful in planning appropriate intervention strategies to be designed and delivered especially for this cohort.


  • XML | PDF | downloads: 257 | views: 232 | pages: 1108-1118


    Background: With the rapid growth of China’s economy, the country’s economic, social, and environmental development has also shown significant differences in various regions. Improving the health level of residents has gradually become a hot issue. We aimed to explore the difference of the health level of the residents in different regions of China and its influential factors.

    Methods: A panel regression model was established using statistical data from 31 provinces in the eastern, central, and western regions of China from the years 2000 and 2016 to examine the influence of economic, environmental, and social factors on the health level of residents in these regions and investigate the regulating role of public service factors.

    Results: Environmental pollution significantly promotes human mortality in the eastern and central regions of China. The urbanization rate significantly reduces human mortality in the eastern and central regions. Per capita gross domestic product in the eastern and western regions has a significant U-shaped relationship with human mortality. The number of beds in health institutions per 10,000 persons, average years of schooling, and endowment insurance contribution service have varying degrees of influence on residents’ health level in the three regions of China. In particular, endowment insurance contribution service significantly reduces human mortality in the eastern region, whereas its impact on the western region is insignificant.

    Conclusion: Differential policies in environmental pollution control, economic growth, and medical and public health should be formulated to reduce mortality in China, specifically in the eastern, central, and western regions.



  • XML | PDF | downloads: 159 | views: 204 | pages: 1119-1127

    Background: Diabetes is now a real global disease in particular due to various health problems associated with it. This study aimed to establish the relationship between diabetes and some biochemical parameters to assess the metabolic profile of an adult diabetic population in the region of Tebessa (Northeast Algeria).

    Methods: A cross-sectional survey was conducted at the Public Health Facility and the House of Diabetics in Tebessa between Feb 2013 and Apr 2013. The study included 200 subjects (100 controls and 100 diabetics) aged 18-85 yr, chosen completely randomly.

    Results: Type 2 diabetes mellitus (37%) was significantly more frequent than type 1 diabetes mellitus (13%). It was significantly more frequent in women than in men. The diabetes was highly correlated with the age and body mass index of patients. Moreover, the two types of diabetics have significantly more diseases and metabolic disorders compared to control subjects.

    Conclusion: Diabetics especially type 2 has significantly higher metabolic disorders and associated diseases than type 1 and control subjects.



  • XML | PDF | downloads: 222 | views: 170 | pages: 1128-1136

    Background: The para-Bombay phenotype is characterized by a lack of ABH antigens on red cells, but ABH substances are found in saliva. Molecular genetic analysis was performed for seven Chinese individuals serologically typed as para-Bombay in Blood Station Center of Ningbo, Zhejiang Province, Ningbo, China from 2011 to 2014.

    Methods: RBCs’ phenotype was characterized by standard serologic technique. Genomic DNA was sequenced with primers that amplified the coding sequence of α (1, 2)-fucosyltransferase genes FUT1 (or H) and FUT2 (or Se), respectively. Routine ABO genotyping analysis was performed. Haplotypes of FUT1 were identified by TOPO cloning sequencing. Phylogenetic tree of H proteins of different organisms was performed using Mega 6 software.

    Results: Seven independent individuals were demonstrated to possess the para-Bombay phenotype. RBC ABO genotypes correlated with ABH substances in their saliva. FUT1 547delAG (h1), FUT1 880delTT (h2), FUT1 658T (h3) and FUT1 896C were identified in this study. FUT1 896C was first revealed by our team. The H-deficient allele reported here was rare and the molecular basis for H deficient alleles was diverse as well in the Chinese population. In addition, the FUT2 was also analyzed, only one FUT2 allele was detected in our study: Se357. Phylogenetic tree of the H proteins showed that H proteins could work as an evolutionary and genetic marker to differentiate organisms in the world.

    Conclusion: Molecular genetic backgrounds of seven Chinese individuals were summarized sporadic and random mutations in the FUT1 gene are responsible for the inactivation of the FUT1-encoded enzyme activity.



  • XML | PDF | downloads: 199 | views: 241 | pages: 1137-1144

    Background: We investigated the air quality changes from 2003-2013 in Istanbul, Turkey.

    Methods: We studied SO2, CO and PM concentration patterns in 10 districts of Istanbul. The data was obtained from air pollution monitoring stations of Istanbul Metropolitan Municipality Environmental Protection Department. We compared the variations of mean concentrations monthly, yearly and seasonally. The winter season was accepted from Oct to Mar and the summer season from Apr to Sep.

    Results: The highest monthly average values for all measurements of sulfur dioxide and CO were 12.61, 949.19 µg/m3 in Sarachane respectively. The Highest value of the monthly average of the Particulate Matter was 72.07 µg/m3 in Kartal district. During the period between 2003-2013, monthly mean concentration values of different districts differed significantly in levels of SO2 (P=0.012), CO (P=0.029), and PM (P=0.024).

    Conclusion: The emissions of air pollutants (SO2, PM, and CO) decreased considerably from 2003 to 2013.



  • XML | PDF | downloads: 193 | views: 277 | pages: 1145-1150

    Background: Vitamin D plays important roles in various physiological processes. Vitamin D deficiency is common among pregnant women in some regions, such as China. Our study aimed to determine the prevalence of Vitamin D deficiency during second trimester of pregnancy in Shanghai China, and explore its risk factors and effects on pregnant outcomes.

    Methods: Overall, 23100 pregnant women (2013 to 2017, Shanghai, China) were included and vitamin D concentrations were measured at 16 weeks of gestation. Correlations between vitamin D concentrations and participants’ general data and maternal and infant outcomes were analyzed by chi square test. Non-conditional multivariate logistic regression analysis was used to screen the independent risk factors for vitamin D deficiency.

    Results: Vitamin D deficiency was significantly correlated with aging, education level, smoking, dirking, BMI before pregnancy, body weight gain during pregnancy (P<0.01), the use of vitamin D supplement and milk consumption, and older than 30 years, drinking, smoking, BMI before pregnancy> 36, body weight gain during pregnancy< 40g per day, no daily milk consumption, no vitamin D supplement, and education lever below college were independent risk factors for vitamin D deficiency in second trimester of pregnancy. In addition, vitamin D deficiency in second trimester of pregnancy was closely correlated with the occurrence of a serious of adverse maternal and infant outcomes.

    Conclusion: Vitamin D deficiency was still common among women in second trimester of pregnancy in Shanghai China. Vitamin D deficiency was closely correlated with the occurrence of a serious of adverse maternal and infant outcomes.


  • XML | PDF | downloads: 179 | views: 282 | pages: 1151-1159

    Background: Due to the amphipathic properties of biosurfactants which act on surfaces and interfaces interest by a variety of industries such as cosmetic, pharmaceutical, bioremediation and petroleum-related industries has recently increased.

    Methods: Detection of a high-efficiency biosurfactant producer using preliminary screening methods from soil contaminated with crude oil was carried at the Microbiology Laboratory at Shahid Beheshti University, Tehran, Iran in 2013. Then after characterization of some physico-chemical properties of produced biosurfactant and production optimization conditions, processes of purification and complete identification were done.

    Results: Pseudomonas aeruginosa sp. ZN was selected as high-efficiency biosurfactant producing strain from soil contaminated with oil from Ahvaz City, Khuzestan Province, southern Iran. The biosurfactant production in modified BH2 culture medium supplemented with 1% n-hexadecane occurred during exponential phase resulting in a reduction surface tension from 70 to 29 mN/m. Strain ZN produced biosurfactant with different properties to other Pseudomonas reported. These characterizations included continued production at C/N ratio range of 10-40; the produced biosurfactant could not separate stable emulsion of span-80-kerosene: Tween-80-distilled water (30:70) within 24 h. The produced biosurfactants were able to increase hydrophobicity of bacterial cell to 55%. Recovery of biosurfactants from cell-free supernatant was performed with acid precipitation and ammonium sulfate precipitation. Chemical analysis such as spraying techniques on developed TLC plate and staining methods of supernatant indicated that produced biosurfactants were glycolipids, characterized by ESI-MS analysis of extracted product as di-rhamnolipids.

    Conclusion: Ability of this strain to produce biosurfactant in the presence of cooked oil and n-hexadecane make it an optimistic candidate for biodegradation of some derivatives of crude oil and food industry.


  • XML | PDF | downloads: 166 | views: 208 | pages: 1160-1165

    Background: The distribution of medical resources in China has long been in an unbalanced state. Since 2009, the government has initiated the planning and construction of a sound grass-roots medical and health service system, increased investment in grass-roots medical and health institutions, but it has not received the expected results. In order to solve the problem, the medical consortium—with a full-featured, hierarchical and resource-sharing structure has been proposed.

    Methods: Overall, 1000 Electronic questionnaires about cognitive status of residents on medical alliance were randomly distributed in 50 community health service centers in 10 cities including Xuzhou, Nanjing, Hefei, Jinan, Zhengzhou, Changsha, Wuhan, Xi'an, Nanchang and Chengdu, China.

    Results: 94.84% of the respondents responded they had heard about the construction of medical alliance, but they did not know the specific content. When asked about the preferred medical institution after illness, 93.50% participants preferred third-tier general hospital or specialist hospital. 62.58% of the respondents believe that the establishment of the medical alliance has not yet played a role and they are concerned that it cannot be effectively implemented. 62.27% of respondents were attracted by the convenience of medical alliance, 20.72% of respondents thought that they could easily get to famous doctors when they were in need, and 5.46% of respondents thought that there was no advantage in medical alliance.

    Conclusion: The establishment of the medical alliance is an effective means to promote the optimal allocation of medical and health resources. Government should perform its functions, and medical institutions and the whole society should all participate.


  • XML | PDF | downloads: 404 | views: 215 | pages: 1166-1171

    Background: The aim of this study was to investigate the effects of TV, magazines, radio, and internet following on body mass index (BMI) and obesity-related literacy among adults

    Methods: In this cross-sectional study, the subjects were recruited from an outpatient center in the city of Sombor, Serbia during Mar-Apr 2013. We collected data by a questionnaire from 657 (397 women; 59%) subjects, aged from 18 to 87 yr (Mean = 45; SD =14). The questionnaire consisted of personal data, body height and weight, frequency of television, radio, magazines and internet following and personal opinion on the impact of smoking, alcohol consumption, stress and physical inactivity on obesity.

    Results: Spearman’s rank correlation analysis showed that BMI increased with longer TV viewing with a very weak strength of the correlation (r=0.104; P=0.009) and decreased with more internet following with a weak strength of the correlation (r=-0.200: P<0.001). Multiple linear regression analysis revealed that only internet use had a significant independent effect on BMI. The frequency rise of internet following from "rare" to "often" and "every day" decreased BMI by 0.5 per each grade. Internet followers showed a significantly better knowledge of the importance of smoking (P = 0.003), alcohol consumption (P<0.001) and physical inactivity (P=0.004) for obesity in comparison to non-followers.

    Conclusion: Internet is the only media that independently and positively influence weight control and the literacy on obesity among adults.

  • XML | PDF | downloads: 228 | views: 380 | pages: 1172-1180

    Background: The analysis of the residual contents of heavy and toxic metals in foodstuff especially milk could be an important indicator of safety, quality, and level of pollution of the region in which the milk was produced. Therefore, the present investigation was carried out to assess human health risk of residues levels of four metals (Cd, Cu, Pb, and Zn) through consumption of raw and pasteurized cow's milk.

    Methods: In this analytical-observational study, totally 72 samples of raw and pasteurized cow's milk samples were collected from market basket of Hamadan City, western Iran in 2014. After preparation and processing the samples in the laboratory, the concentration of metals were determined using inductively coupled plasma (ICP-OES). Moreover, all statistical analyses were performed using the SPSS statistical package according to Shapiro-Wilk test for normality, One Way ANOVA (Duncan Multiple Range Test), Independent t-test and Pearson’s correlations.

    Results: The mean concentrations (µg/kg) of Cd, Cu, Pb and Zn in raw milk samples were 0.36±0.28, 9.77±3.91, 32.83±20.80 and 253.70±87.96, respectively and in the pasteurized milk samples were 5.57±9.33, 8.41±5.99, 25.54±26.50 and 90.12±91.52, respectively. HRI values in adults and children via consumption of raw and pasteurized cow's milk were within the safe limits (HRI < 1).

    Conclusion: Considering the serious contamination of some samples of raw and pasteurized milk by Cd, Pb and Zn, a control of heavy metals content during the whole production processing of milk must be applied.


  • XML | PDF | downloads: 229 | views: 286 | pages: 1181-1191

    Background: This study aimed to determine risk factors that occurrence time of traffic accidents. Traffic accident occurrence time is defined as the time between a driver’s getting his/her license and having the first accident, involving death or injury between 2008-2012 and there were investigated.

    Methods: This study was conducted with the Cox Regression and life tables models included among survival analysis models. Data of all 11.671 traffic accidents in Kayseri in Turkey were analyzed for the 5-yr period.

    Results: The non-occurrence rate of traffic accidents involving injury is mostly affected by gender, age, education, number of vehicles involved in accident, road surface material, daylight, type of road, direction of road and time of the day. The non-occurrence rate of fatal traffic accident duration is mostly affected by gender, age, education, daylight and horizontal alignment. The rate of having an accident involving death or injury after getting driver's license is 30.3% in the first 5 yr, it is 50.1% in the first 10 yr and 91.7% in 25 yr.

    Conclusion: As the non-occurrence time increases, occurrence of accidents in earlier years will decrease. In other words, the number of accidents in earlier years will be lower. This will cause a decrease in the number of accidents in total.



  • XML | PDF | downloads: 217 | views: 273 | pages: 1192-1200

    Background: The aim of this study was to develop and evaluate the psychometric properties of a questionnaire for the measurement of reproductive health among female adolescents in Iran.

    Methods: This cross-sectional study was conducted among 289 female students aged 12-15 yr in Tehran, Iran from 2015-2016. The participants were selected using multi-stage random cluster sampling. In addition, the Belief-Based Reproductive Health Questionnaire (BBRHQ) was designed using the properties of the Theory of Planned Behavior (TPB).

    Results: Exploratory factor analysis of 104 items identified a six-factor solution. These factors jointly accounted for 67% of the observed variance of outcome variable. The confirmatory factor analysis indicated a good fit to the data. In addition, the Cronbach’s alpha coefficient showed an excellent internal consistency (alpha=0.92).

    Conclusion: Belief-Based Reproductive Health Questionnaire (BBRHQ) is a valid and reliable instrument for measurement of reproductive health behaviors of adolescents.



  • XML | PDF | downloads: 252 | views: 441 | pages: 1201-1208

    Background: The shortage of nurses is a global health problem and one of the main challenges for healthcare systems throughout the world including Iran. One of factors that affect the migration trends is psychological needs satisfaction. This study aimed at identifying the psychological factors which persuade Iranian nurses to migrate and suggesting necessary measures in this regard.

    Methods: This qualitative study was conducted through a traditional content analysis approach on 20 working Iranian nurses who are migrating to other countries between 2015 and 2017. Data were collected through interviews and observation in different wards of hospitals in Iran. Data were written and analyzed after reduction, naming them, obtaining analytical codes, and identifying the categories and subcategories using traditional method.

    Results: Three main categories in relation to satisfaction of the psychological needs and reasons for migration were obtained after data analysis. The first category was “authority” with two subcategories of independent decision-making power and being unconsidered, the second category was “social support” with three subcategories of communication with health team members, communication with nurse colleagues, and communication with nurse managers, and the third category was “job promotion” with four subcategories of addressing the routines, nurse role, job promotion opportunities, and teaching organizational environment.

    Conclusion: Identifying problems and obstacles to achieve the goal is the first step to solve the problem. This study provided further and clearer understanding of psychological causes regarding decision of nurses to migrate to developed countries, and nurses noted that the decision to migrate is in the search to meet their psychological needs.



Letter to the Editor