Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 1 9 M Davari A Haycox T Walley 2015 10 03 Background: The Iranian healthcare system is primarily an insurance based system. This structure has an important influence on the efficiency and equity of the provision of healthcare in Iran. This paper reviews the history of the Iranian healthcare system and the impact of the Iranian health insurance system on healthcare performance based on the results of interviews with key opinion leaders and empirical evidence. Methods: This review uses mixed methods: a systematic literature review of electronic databases supplemented by hand searching of books and journals including Government publications and other grey literature. The issues identified were explored through a series of semi-structured interviews with key informants from within the Iranian healthcare system. The interviews were recorded transcribed, coded, classified, and analysed thematically. Empirical evidence was also sought to support or contradict the views expressed in the interviews. Results: Sixteen interviews with key informants were conducted and presented anonymously. The interviewees raised many issues which were summarised into five main issues: increasing health expenditures, lack of systematic health technology assessment, very limited financial resources, challenging management and regulation, and uncovered population. Conclusion: A wide range of issues have affected the efficiency, quality and equity of the services provided by the Iranian healthcare system. The initial and most important step toward improving the efficiency, equity and quality of the health insurance system is to focus on evidence-based policy making to generate feasible, reasonable and comprehensive reforms. https://ijph.tums.ac.ir/index.php/ijph/article/view/2510 https://ijph.tums.ac.ir/index.php/ijph/article/download/2510/2490

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 10 17 H Hooshyar P Rostamkhani M Rezaian 2015 10 03 Many microscopic-based epidemiological surveys on the prevalence of human intestinal pathogenic and non-pathogenic protozoa including intestinal amoeba performed in Iran show a high prevalence of human intestinal amoeba in different parts of Iran. Such epidemiological studies on amoebiasis are confusing, mainly due to recently appreciated distinction between the Entamoeba histolytica, E. dispar and E. moshkovskii. Differential diagnosis can be done by some methods such as PCR-based methods, monoclonal antibodies and the analysis of isoenzyme typing, however the molecular study of these protozoa in Iran is low. Based on molecular studies, it seems that E. dispar is predominant species especially in the central and northern areas of Iran and amoebiasis due to E. histolytica is a rare infection in the country. It is suggested that infection with E. moshkovskii may be common among Iranians. Considering the importance of molecular epidemiology of amoeba in Iran and also the current data, the present study reviews the data currently available on the molecular distribution of intestinal human amoeba in Iran. https://ijph.tums.ac.ir/index.php/ijph/article/view/2511 https://ijph.tums.ac.ir/index.php/ijph/article/download/2511/2491

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 18 20 ME Motlagh R Safari M Karami A Khosravi 2015 10 03 Background: Life expectancy at birth as an alternative summary measure of mortality represents number of years which a newborn will be alive based on the current age specific death rates. As it summarizes death rates across all age range in a given population is the most common summary measure of mortality. The aim of this study was to correct death rates for underreport and estimate life expectancy at birth in rural population of Iran in 2008. In addition, this study aimed to assess the Vital Horoscope system's data quality. Methods: Data were obtained from all Health Houses in Iranian villages in 2008. In order to adjust over 5 years old death rates for underreport, we used Brass Growth Balance method. Since this method is not applicable to under 5 years old, we used child mortality rates projected based on the Iranian Demographic and Health survey 2000 to correct death rates. Results: Adjusted life expectancy at birth for males was 71.5 year and for females was 74.4 year. Completeness of the death data was 88% for males and 79% for females. Adjusted child (under 5) mortality rate by sex in males and females was 25.9 and 23.8 per 1000 live births respectively. Adult mortality for males was 167.2 and 98.3 for females per 1000. Conclusion: Data based on Vital Horoscope system are a suitable source to estimate life expectancy and other mortality statistics. Also has an acceptable completeness on death registration. Further studies to investigate accuracy of data from the Vital Horoscope system are suggested. https://ijph.tums.ac.ir/index.php/ijph/article/view/2512 https://ijph.tums.ac.ir/index.php/ijph/article/download/2512/2492

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 25 30 M Jawaid M Farhan Z Masood SMN Husnain 2015 10 03 Background: Pre-operative informed consent is an important aspect of surgery, yet there has been no formal training regarding it in Pakistan. This study was done to assess the preoperative informed consent practice. Methods: After taking informed permission, a questionnaire was filled in during an interview with 350 patients, who have undergone elective surgical procedures under routine practice conditions from July to October 2010. All the patients were asked a set of standard questions which related to the information they were provided before the operation as a part of standard informed consent practice. Results: Most i.e. 307 (87.7%) patients were informed about their condition but very few 12 (3.4%) were briefed regarding complications. Only 17 (4.9%) patients said they knew about the risks and complications of proposed anesthesia. One hundred thirty-eight (39.4%) patients said that they were allowed to ask questions while giving consent. Most of the time 196 (56%) consent was taken one day before surgery but in few 2 (0.6%) instances it was taken on the morning of surgery and on operation table in some cases 3 (0.9%) as reported by patients. The consent form was signed by the patients themselves in only 204 (58.3%) cases and by their relatives in the rest. About half the number of patients 171 (48.9%) interviewed were satisfied from the information they received as informed consent process. Conclusion: This study highlights the poor quality of patient knowledge about surgical procedures and the inadequate information provided. https://ijph.tums.ac.ir/index.php/ijph/article/view/2513 https://ijph.tums.ac.ir/index.php/ijph/article/download/2513/2493

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 31 35 H Sipahi R Durusoy I Ergin H Hassoy A Davas AO Karababa 2015 10 03 Background: Thesis is an important part of specialisation and doctorate education and requires intense work. The aim of this study was to investigate the publication rates of Turkish Public Health Doctorate Theses (PHDT) and Public Health Specialization (PHST) theses in international and Turkish national peer-review journals and to analyze the distribution of research areas. Methods: List of all theses upto 30 September 2009 were retrieved from theses database of the Council of Higher Education of the Republic of Turkey. The publication rates of these theses were found by searching PubMed, Science Citation Index-Expanded, Turkish Academic Network and Information Center (ULAKBIM) Turkish Medical Database, and Turkish Medline databases for the names of thesis author and mentor. The theses which were published in journals indexed either in PubMed or SCI-E were considered as international publications. Results: Our search yielded a total of 538 theses (243 PHDT, 295 PHST). It was found that the overall publication rate in Turkish national journals was 18%. The overall publication rate in international journals was 11.9%. Overall the most common research area was occupational health. Conclusion: Publication rates of Turkish PHDT and PHST are low. A better understanding of factors affecting this publication rate is important for public health issues where national data is vital for better intervention programs and develop better public health policies. https://ijph.tums.ac.ir/index.php/ijph/article/view/2514 https://ijph.tums.ac.ir/index.php/ijph/article/download/2514/2494

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 36 41 N Bijeh SR Attarzadeh Hosseini K Hejazi 2015 10 03 Background: Cardiovascular disease is the most common cause of death in the world. The aim of this study was to determine the effect of aerobic exercise on serum inflammatory markers in untrained middle-aged women. Methods: Nineteen healthy female middle-aged were selected by convenience sampling method and were randomly divided into two experimental (n=11) and control (n=8) groups. The exercise protocol included aerobic exercise training lasted for 6 months and 3 sessions per week and every session lasted for 60 minutes and with intensity of 55-65 percent of maximum heart rate reserve (MHR). Blood samples were taken to measure serum leptin and C-Reactive Protein (CRP) before and after aerobic training period. General linear- Repeated measures (GL-RM) was used to comparing of within, Interactive and between means groups. The level of significance was set at P< 0.05. Results: The level of serum leptin in middle-aged women did not change significant. However, the levels of CRP during this period did not change significantly. Conclusion: Six months of aerobic exercise does not induce significant change in serum levels of CRP, while leptin levels reduced in middle-aged women. Regular physical activity probably causes decrease in serum leptin level if body mass index and body fat mass reduce simultaneously. https://ijph.tums.ac.ir/index.php/ijph/article/view/2515 https://ijph.tums.ac.ir/index.php/ijph/article/download/2515/2495

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 42 47 N Taheri S Semnani G Roshandel M Namjoo H Keshavarzian AG Chogan F Ghasemi Kebria H Joshaghani 2015 10 03 Background: Due to the high toxicity of aflatoxin and its effects on public health, determination of aflatoxin level in Wheat flour samples in the Golestan province, north of Iran was investigated. To examine the effect of seasonal changes, summer and winter sampling was performed with standard sampling methods. Methods: A total of 200 flour samples were collected from 25 factories. HPLC method with immunoaffinity chromatography was used to measure aflatoxin types (G2, G1, B2 and B1). Statistical analysis was performed by the Pearson correlation test, One-way ANOVA and multivariate regression analysis. Results: Mean total aflatoxin levels of samples were 0.82 and 1.99 ng/g in summer and winter, respectively. Aflatoxin B1 levels were detected in 3.1%, 7.4% over permissible limits by worldwide regulations in samples collected in summer and winter, respectively. Aflatoxins in winter were higher than summer. The highest frequency of aflatoxin contamination in winter was B2 (98%) and in summer G1 (51%). The relationship between humidity and rate of aflatoxin B1 and total aflatoxin was significant in winter. Results of multivariate regression were showed the strongest relationship with humidity and aflatoxin level. Despite the contamination of flour samples, there was no contamination higher than the standard limit of Iran Standard Institute. But it was significantly higher than similar studies from other regions. Conclusions: Therefore, with regard to negative impacts of aflatoxin on health, aflatoxin contamination should be considered in future programs. Decrease of aflatoxin contamination may be made practical through reducing wheat storage duration and controlling humidity. https://ijph.tums.ac.ir/index.php/ijph/article/view/2516 https://ijph.tums.ac.ir/index.php/ijph/article/download/2516/2496

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 9 2012 09 15 48 55 KH Shahandeh R Majdzadeh E Jamshidi N Loori 2015 10 03 Background: Community-based participatory research (CBPR) increasingly is being used to address health issues. Few evidence exist to indicate how builds the capacity of communities to function as health promoter and what resources are required to promote successful efforts. This article presents the result of a capacity assessment for preventing drug abuse through CBPR, which working with rather than in communities, to strengthen a community's problem-solving capacity. For exploring the perception of stakeholders, a dynamic model of the dimensions of community and partnership capacity served as the theoretical framework. Methods: In this descriptive research, stakeholder analysis helps us to identify appropriate of stakeholders (Key stakeholders). Data were collected using a topic guide concerned with capacity for preventing drug abuse. Interviews were audiotape and transcribed. Data were analyzed thematically. Results: CBPR has been undertaken to involve local people in making decisions about the kind of change they want in their community and the allocation o food intake was estimated from 3-days diet records. Serum levels of zinc, fasting blood sugar, and insulin were measured by conventional methods. Also homeostatic model assessment of insulin resistance was calculated. Results: Serumlevels of fasting blood sugar, insulin and homeostatic model assessment of insulin resistance slightly decreased in zinc group, but these changes were not statistically significant. Serum zinc levels (P =0.012), energy (P=0.037), protein (P=0.019) and fat (P=0.017) intakes increased statistically significant in the zinc group after intervention but not in the placebo group. Conclusion: Oral supplementation with zinc could be effective in increasing serum zinc levels and energy intake with no effects on fasting blood sugar, homeostatic model assessment of insulin resistance and insulin levels. https://ijph.tums.ac.ir/index.php/ijph/article/view/3693 https://ijph.tums.ac.ir/index.php/ijph/article/download/3693/3367

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 44 2 2015 02 15 218 27 Lyly Nazemi Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran AND Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran AND Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Ingmar Skoog Dept. of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unite, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden. Ingvar Karlsson Dept. of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unite, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden. Saeed Hosseini Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran AND Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Mohammadi Psychiatry Research Center, Rozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Hosseini Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Javad Hosseinzade Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran AND Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Seyed Alireza Mesbah-Namin Dept. of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Masoud Baikpour Dept. of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 14 Background: Malnutrition and dehydration are two most common types of ailments residents of nursing homes (NH) prone to. It is very important to assess these problems because they can predispose the residents to severe illnesses. The aim of this study was to gather information on nutritional status and its associated risk factors in elderly residents of NHs in Tehran, Iran. Methods: From 16 NHs in Tehran, 263 residents were randomly selected. Data were collected via questionnaires, including demographic characteristics, past medical history, present health problems and daily routines. The MNA questionnaire was used to gather information regarding their nutritional status. Results: The present study showed that 10.3% of the elderly residents in nursing homes were malnourished. 66.4% of males and 70.8% of females were at risk of malnutrition. Multivariate analysis showed that after adjusting for confounders the following elderly-related factors were the independent risk factors of malnutrition: consuming half or less than of the food (OR=8.0, 95%CI=3.7-17.7), having no teeth or good prosthesis (OR=1.7, 95%CI=1.1-2.7), diabetes (OR=1.6, 95%CI=1.1-2.4), smoking (OR=0.6, 95%CI=0.3-1.2), studying (OR=0.4 95%CI=0.2-0.9) and praying in their free time (OR=1.8 95%CI=1.2-2.6). Conclusion: The subjects’ health-related factors and their free-time activities and nutritional behavior are the most important factors associated with poor nutrition among elderly residents of NHs; however, further investigation is needed to clarify the role of other factors in maintaining a suitable nutritional plan for them. https://ijph.tums.ac.ir/index.php/ijph/article/view/3691 https://ijph.tums.ac.ir/index.php/ijph/article/download/3691/3365

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 44 2 2015 02 15 228 37 Alireza Ostadrahimi Dept. of Nutrition, Biochemistry and Diet Therapy, School of Nutrition, Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Akbar Taghizadeh Dept. of Animal Science, School of Agriculture, University of Tabriz, Tabriz, Iran. Majid Mobasseri Dept. of Internal Medicine, School of Medicine, Bone Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Nazila Farrin Dept. of Nutrition, Biochemistry and Diet Therapy, School of Nutrition, Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Laleh Payahoo Dept. of Nutrition, Biochemistry and Diet Therapy, School of Nutrition, Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Zahra Beyramalipoor Gheshlaghi Dept. of Animal Science, School of Agriculture, University of Tabriz, Tabriz, Iran. Morteza Vahedjabbari Dept. of Nutrition, Biochemistry and Diet Therapy, School of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran. 2015 10 14 Background: Diabetes is a global health problem in the world. Probiotic food has anti-diabetic property. The aim of this trial was to determine the effect of probiotic fermented milk (kefir) on glucose and lipid profile control in patients with type 2 diabetes mellitus. Methods: This randomized double-blind placebo-controlled clinical trial was conducted on 60 diabetic patients aged 35 to 65 years.Patients were randomly and equally (n=30) assigned to consume either probiotic fermented milk (kefir) or conventional fermented milk (dough) for 8 weeks. Probiotic group consumed 600 ml/day probiotic fermented milk containing Lactobacillus casei, Lactobacillus acidophilus and Bifidobacteria and control group consumed 600 ml/day conventional fermented milk.Blood samples tested for fasting blood glucose, HbA1C, triglyceride (TG), total cholesterol, HDL-C and LDL-C at the baseline and end of the study. Results: The comparison of fasting blood glucose between two groups after intervention was statistically significant (P=0.01). After intervention, reduced HbA1C compared with the baseline value in probiotic fermented milk group was statistically significant (P=0.001), also the HbA1C level significantly decreased in probiotic group in comparison with control group (P=0.02) adjusting for serum levels of glucose, baseline values of HbA1c and energy intake according to ANCOVA model. Serum triglyceride, total cholesterol, LDL-cholesterol and HDL- cholesterol levels were not shown significant differences between and within the groups after intervention. Conclusion: Probiotic fermented milk can be useful as a complementary or adjuvant therapy in the treatment of diabetes. https://ijph.tums.ac.ir/index.php/ijph/article/view/3688 https://ijph.tums.ac.ir/index.php/ijph/article/download/3688/3362

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 44 2 2015 02 15 238 43 Arash Hemmati Dep. of Microbiology, Rasht Branch, Islamic Azad University, Rasht, Iran. Elham Hooshmand Dep. of Veterinary, Rasht Branch, Islamic Azad University, Rasht, Iran. Mohammad Javad Hosseini Molecular Biology Research Center, School of Medicine, Baqiyatallah University, Tehran, Iran. 2015 10 14 Background: This study was conducted with the aim of determining surface water contamination with cysts of Entamoeba histolytica using PCR in Rasht City, Northern Iran. Methods: In this cross-sectional study, 49 water samples including 18 rivers and 6 wetlands were collected from different regions near the city of Rasht in autumn of 2012. After filtration using 0.22 µm nitrate cellulose membrane filters, the samples were examined using microscope and PCR method. Results: In microscopic examination, four samples of the 49 samples were positive for cysts of E. (histolytica / dispar / muschkovskii). By using PCR method and molecular analysis, one sample was positive for E. histolytica. Conclusion: In the molecular analysis, contamination by E. histolytica was proved in the waters of Rasht City. Further investigations including more samples and necessary preparations must be applied to prevent contamination. https://ijph.tums.ac.ir/index.php/ijph/article/view/3687 https://ijph.tums.ac.ir/index.php/ijph/article/download/3687/3361

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 44 2 2015 02 15 244 53 Mohammad Hassan Abolhassani Dept. of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Fariba Kolahdooz Aboriginal and Global Health Research, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada. Reza Majdzadeh School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Eshraghian School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran. Mahboubeh Shaneshin National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran. Se Lim Jang Aboriginal and Global Health Research, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada. Abolghasem Djazayery Dept. of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 14 Background: Food security is a multi-dimensional phenomenon. The objective of this study was to identify and prioritize major indices for determining food insecurity in Iran. Methods: Descriptive study using the Delphi method was conducted through an email-delivered questionnaire. Fortythree senior experts at national or provincial level were selected based on their work experience and educational background through study panel consultation and snowballing from Tehran and other cities of Iran. During two rounds of Delphi, participants were asked to identify priority indicators for food security at provincial level in Iran. Results: Sixty five percent of Delphi panel participated in the first round and eighty-nine percent of them participated in the second round of Delphi. Initially, 243 indices were identified through review of literature; after excluding indictors, which was not available or measurable at provincial level in Iran, 103 indictors remained. The results of study showed that experts identified “percentage of individuals receiving less than 70% of daily energy requirement” with a median score of 90, as the most influential index for determining food insecurity. “Food expenses as a proportion of the overall expenses of the family”, “per capita of dietary energy supply”, and “provision of micro-nutrient supply requirement per capita” with median of 80 were in the second rank of food security priority indicators. Conclusion: Out of 243 identified indicators for food security, 38 indicators were selected as the most priority indicators for food security at provincial level in Iran. https://ijph.tums.ac.ir/index.php/ijph/article/view/3684 https://ijph.tums.ac.ir/index.php/ijph/article/download/3684/3358

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 44 2 2015 02 15 254 62 Masoume Pourmohamadreza-Tajrishi Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Parviz Azadfallah Dept. of Psychology, Tarbiat Modares University, Tehran, Iran. Sahel Hemmati Garakani Dept. of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Enayatollah Bakhshi Dept. of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 2015 10 14 Background: Anxiety is one of the most common reactions that parents show while understanding their children’s intellectual disability due to Down syndrome. Anxiety leads parents not to develop appropriate relations with their children, subsequently their psychological health are at risk. The present study was aimed to determine the effect of problem-focused coping strategy training on psychological symptoms of mothers with Down child. Methods: This was an experimental study with pretest and posttest design with case and control group. Sixty-four mothers were selected randomly from Iranian Down Syndrome Charity Society. They completed Symptoms Checklist90-Revised (SCL-90-R). They were assigned to experimental and control groups in equal. Experimental group participated in 12 training sessions (once a week; 60 minutes for each session) and received problem-focused coping strategy program, but control group did not. After 12th session, all subjects completed SCL-90-R again. Analysis of covariance was used for analyzing the data. Results: There was a significant difference (P<0.01) between experimental and control group according to psychological symptoms and its components (phobia, depression, paranoid thoughts, psychosis, somatic complaints,  interpersonal sensitivity, obsession-compulsion, anxiety and aggression) after participation in intervention sessions. Conclusion: There was a significant decrease in psychological symptoms, phobia, depression, paranoid thoughts, psychosis, somatic complaints, interpersonal sensitivity, obsession-compulsion, anxiety and aggression of experimental group. Our findings showed that problem-focused coping strategy-training program led to improve family’s perception towards the child and subsequently promote of mental health of mothers with Down children. https://ijph.tums.ac.ir/index.php/ijph/article/view/3682 https://ijph.tums.ac.ir/index.php/ijph/article/download/3682/3356

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