Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 1 7 Abdullah AM Sarwar Noorhazilah A Manaf Azura Omar 2015 10 03 Background: The need for better healthcare has grown significantly in recent years. In addition, the rising healthcare costs in the U.S. and in many European countries have forced many patients to seek medical treatment abroad, which has created the demand for medical tourism. With little yet known as to the perception of a medical tourist's destination selection, this study aims to explore medical tourist's perception in selecting their destination while going for medical treatment. Methods: Realizing the current need to examine closely the perception of medical tourists, this study had conducted a secondary study to collect data for assessing and identification of the key factors on patient's perception and destination selection criteria. Results: The result confirms the existence of a very strong relationship between cost, service quality, treatment types and availability and marketing impact on the perception of the medical tourists' in selecting their medical tourism destination. Conclusion: This study offers support for the proposed conceptual model and an empirical basis for comparison in future research. https://ijph.tums.ac.ir/index.php/ijph/article/view/2525 https://ijph.tums.ac.ir/index.php/ijph/article/download/2525/2505

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 8 19 P Mirmiran M Golzarand L Serra-Majem F Azizi 2015 10 03 Background: Micronutrient deficiency is one of the major public health problems in the Middle East affecting economic, political and social development of countries. The three commonest micronutrient deficiencies belong to iron, iodine and vitamin A.  Methods: we conducted a systematic review of published English articles in the Middle East countries using databases from PubMed, World Health Organization and Food and Agriculture Organization from 1985 onward. A total of 6050 articles were identified and after evaluation based on eligibility criteria, 81 articles included in this systematic review. Results: Despite implementation of flour fortification other control strategies, the prevalence of iron deficiency is moderate to severe in the Middle Eastern countries, because of ineffective iron fortification program, food interaction and hemoglobin application as anemia indictors in these countries. Mild to severe iodine deficiency disorders exist in many countries of the Middle East, due to lack of effective iodine supplementation program. The prevalence of vitamin A deficiency is mild to severe and there is lack of vitamin A fortification program in many countries in this region. Conclusion: Despite unharmonized efforts to control malnutrition of micronutrients, iron, iodine and vitamin A deficiencies are still exist in some countries of the Middle East. Effective, well controlled and harmonized programs for elimination of micronutrient deficiencies need to be initiated for governments and supported by international organizations in this region. https://ijph.tums.ac.ir/index.php/ijph/article/view/2526 https://ijph.tums.ac.ir/index.php/ijph/article/download/2526/2506

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 20 26 Chang-Ho Ha Wi-Young So 2015 10 03 Background: Metabolic syndrome (MS) is emerging as a serious public health problem in Korea. The purpose of this study was to examine the effects of 12 weeks of combined exercise training on body composition and MS factors in obese Korean female college students. Methods: Subjects were randomly assigned to exercise (n = 7) and control (n = 9) groups. The exercise group trained for 80 min/day, for 3 day/week for 12 weeks. Each exercise session comprised 3 phases: warm-up for 10 min, main exercise for 60 min (consisting of aerobic exercise for 30 min and resistance exercise for 30 min), and cool down for 10 min. Results: The exercise intensity for aerobic exercise was 60-80% of the heart rate reserve (HRR) for 30 min, while the resistance exercises were 10-15 repetitions maximum (RM) for 30 min. Two-way repeated analysis of variance (ANOVA) was used for statistical analysis. There were no interaction effects (time × group) on the MS-related factors of blood lipid composition such as triglycerides (TGs), high-density lipoprotein (HDL), glucose, total cholesterol (TC), and low-density lipoprotein (LDL). However, interaction effects were observed (time × group) on percent body fat (P = 0.006), waist circumference (WC; P < 0.001), systolic blood pressure (SBP; P = 0.010), and diastolic blood pressure (DBP; P = 0.007). Conclusions: A 12-week supervised combined exercise program could effectively reduce percent body fat, WC, SBP, and DBP. However, it was not effective on MS-related factors of blood lipid composition such as TG, HDL, glucose, TC, and LDL in a sample population of obese Korean female college students. https://ijph.tums.ac.ir/index.php/ijph/article/view/2527 https://ijph.tums.ac.ir/index.php/ijph/article/download/2527/2507

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 27 32 Jan Luzny Lubica Jurickova 2015 10 03 Background: Elder abuse and neglect (EAN) comprises emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. Elder abuse and neglect in seniors with psychiatric morbidity was not monitored in the Czech Republic at all, despite the literature shows mental morbidity as one of the important risk factor for developing elder abuse and neglect. Methods: We designed comparative cross sectional study comprising 305 seniors hospitalized in Mental Hospital Kromeriz in June 2011 - group of 202 seniors hospitalized due to mental disorder in psychogeriatric ward and group of 103 seniors hospitalized due to somatic disorder in internal ward. Content analysis of medical records was done in both groups of seniors, with regards to symptoms of elder abuse. Then, we discussed the topic of elder abuse with 30 nurses of psychogeriatric ward in focus group interview. Results: Between two compared groups of seniors we detected statistically higher prevalence of elder abuse in seniors with psychiatric morbidity (48 cases, 23.8% prevalence of EAN), compared to somatically ill seniors (3 cases, 2.9%). As for nursing staff, 5 from 30 nurses (16.7%) have never heard about symptoms of elder abuse and neglect, 10 from 30 nurses (33.3%) had just a partial knowledge about elder abuse and neglect and its symptoms, the rest of nurses (15 from 30 nurses, 50.0%) had good knowledge about elder abuse and neglect and its symptoms. Conclusion: Elder abuse and neglect seems to be a relevant problem in senior population with mental disorders. Development of educational programs for nursing and medical staff about Elder abuse and neglect (symptoms of EAN, early detection of EAN, knowledge how to report cases of EAN) could improve the situation and help mentally ill seniors to better quality of life. https://ijph.tums.ac.ir/index.php/ijph/article/view/2528 https://ijph.tums.ac.ir/index.php/ijph/article/download/2528/2508

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 33 41 Suyan Bian Hongyang Guo Ping Ye Leiming Luo Hongmei Wu Wenkai Xiao 2015 10 03 Background: Both increased arterial stiffness and hyperuricaemia are associated with elevated cardiovascular risks. Little is known about the relations of serum uric acid (UA) level to regional arterial stiffness and wave reflection. The aim of the study was to investigate the gender-specific association of serum UA and indices of arterial function in a community-based investigation in China. Methods: Cross-sectional data from 2374 adults (mean age 58.24 years) who underwent routine laboratory tests, regional pulse wave velocity (PWV) and pulse wave analysis measurements were analyzed in a gender-specific manner. None of the participants had atherosclerotic cardiovascular disease, chronic renal failure, systemic inflammatory disease, gout, or were under treatment which would affect serum UA level. Results: Men had higher serum UA level than women. Subjects with hyperuricaemia had significantly higher carotid-ankle PWV in both genders (P< 0.05), and the carotid-femoral PWV (PWVc-f) was higher in women (P< 0.001) while the augmentation index was marginally lower in men (P = 0.049). Multiple regression analysis showed that serum UA was an independent determinant only for PWVc-f in women (β = 0.104, P = 0.027) when adjusted for atherogenic confounders. No other independent relationship was found between UA level and other surrogates of arterial stiffness. Conclusions: Serum UA levels are associated with alterations in systemic arterial stiffness that differ in men and women. Women might be more susceptible to large vascular damage associated with hyperuricaemia. https://ijph.tums.ac.ir/index.php/ijph/article/view/2529 https://ijph.tums.ac.ir/index.php/ijph/article/download/2529/2509

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 42 49 M Al Momani H Al Korashy 2015 10 03 Background: Examining the quality of nursing care from the patient's perspective is an important element in quality evaluation. The extent to which patients' expectations are met will influence their perceptions and their satisfaction with the quality of care received. Methods:  A cross- sectional survey was conducted among admitted patients at King Khalid Teaching Hospital, Riyadh, Saudi Arabia. Data were collected (from January 2011 to March 2011) from a convenience sample of 448 patients using a 42- items questionnaire assessing six dimensions of the nursing care provided to, during hospitalization.  Results: On a four-point scale (4-higly agree,3-agree, 2-disagree, and 1-higly disagree). The individual items of nursing care showing the lowest means were the information received from the nurses about self-help (2.81), the information about the laboratory results (2.76) and the way the nurse shared the patient's feeling (2.72). A strong correlation existed between the overall perception level and the variables of gender (P=0.01), and the types of department (0.004). Conclusion: The findings of this study demonstrate negative experiences of patients with nursing care in dimensions of information, caring behavior, and nurse competency and technical care. Awareness of the importance of these dimensions of nursing care and ongoing support to investigate patients' perception periodically toward quality of nursing care are critical to success the philosophy of patient centered health care. https://ijph.tums.ac.ir/index.php/ijph/article/view/2530 https://ijph.tums.ac.ir/index.php/ijph/article/download/2530/2510

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 50 55 M Karami D Khalili B Eshrati 2015 10 03 Background: This study aimed at estimating the proportion of diabetes as a risk factor to the attributable burden of cardiovascular diseases in Iran. Methods: Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). To calculate PIF, data on the prevalence of newly diagnosed diabetes mellitus (NDM) and known diabetes mellitus (KDM) were obtained from 3rd Iranian surveillance of risk factors of non- communicable diseases and data on corresponding measures of effect were derived from a cohort study. PIF were estimated on both theoretical minimum and feasible minimum risk. Uncertainty for the attributable burden was estimated by Monte Carlo simulation-modeling techniques incorporating sources of uncertainty. Results: According to multivariate- adjusted hazard ratios, by reducing the prevalence of Iranian women with diabetes from 10.05 percent to the feasible minimum risk level i.e. 5 percent, 6.8% (95% uncertainty intervals: 3.5- 9.8) of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable and the corresponding value for men were 3.1% (95% uncertainty intervals: 1.4- 4.8). Conclusion: Although data on the prevalence of diabetes and corresponding measures of associations were obtained from an updated and country- specific source, but to better priority setting, PIF should be applied to updated and revised burden of CVDs. https://ijph.tums.ac.ir/index.php/ijph/article/view/2531 https://ijph.tums.ac.ir/index.php/ijph/article/download/2531/2511

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 8 2012 08 15 56 60 R Rostami A Beiranvand HR Khakhali S Salary MR Aghasi J Nourooz-Zadeh 2015 10 03 Background: To assess accessibility of iodinated salt and urinary iodine concentrations (UIC) during pregnancy. This cross-sectional study was carried out between October and December, 2009 in Urmia County, West Azerbaijan (WA), Iran. Methods: Data on demographic characteristics and iodinated salt accessibility were gathered through a questionnaire at 1st trimester. Household salt samples and urine samples (1st -and 3rd trimesters) were analyzed for iodine content. Pregnant women (n=490) at 1st trimester were interviewed. Of these, 490 subjects (12 prenatal care centers) were enrolled. Results: All participants declared that they were exclusive users of iodinated salt. Segregation of the household salt samples according to iodine content (0, 8, 15 and 30 ppm) revealed that the respective distributions were 3.3%, 1.4%, 23.7% and 71.6%. Median UIC levels at 1st and 3rd trimesters were 73.5 µg/L and 114µg/L respectively. Accordingly, 86% and 70% of participants exhibited UIC < 150 µg/L. Conclusion: Median UIC during pregnancy in WA is markedly lower than those previously reported for regions with adequate iodine status in the country. Thus, extra iodine is needed to maintain adequate iodine store during gestation. In addition, this preliminary study reveals that a significant proportion (28%) of the household salt samples had low iodine content (≤ 15 ppm) although a level (>20 and <40 ppm) is mandatory in Iran. Further studies are deemed necessary to elucidate the cause(s) for manifestation iodine deficiency among pregnant women despite 20 years after iodine fortification strategy. https://ijph.tums.ac.ir/index.php/ijph/artic> R Hamidian 2015 10 03 Background: The purpose of this research was to determine the relation between negative or positive qualitative troponin I test and the short term prognosis of patients presenting to emergency department with chest pain or angina equivalent symptoms. Methods: we assessed the qualitative rapid troponin I in patients with chest pain or angina equivalent symptoms after at least 4 hours and then we followed the patients in 72 hours after presentation for adverse events such as death, CCU admission, fatal arrhythmias and heart failure. Results: After comparing qualitative troponin I test results and adverse events, we concluded that the troponin I was significantly more positive in patients with adverse events (i.e. CCU admission, fatal arrhythmias and heart failure) (P=0.031). Conclusion: A single measurement of  rapid qualitative troponin I test can be used as a prognostic factor in patients with chest pain or angina equivalent symptoms and also as a device for risk stratification of moderate and high risk patients. https://ijph.tums.ac.ir/index.php/ijph/article/view/2619 https://ijph.tums.ac.ir/index.php/ijph/article/download/2619/2599

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 2 2012 02 15 70 76 MA Kaykhaei M Hashemi B Narouie A Shikhzadeh M Jahantigh E Shirzaei B Rezazehi M Hoseinian S Yousefi S Masoudian A Emamdadi SF Alavi R Mashhadi H Ansari 2015 10 03 Background: The metabolic syndrome (MES) is associated with a high risk of diabetes and cardiovascular disease. The aim of the present study was to determine the prevalence of the metabolic syndrome as well as cut-off points for waist circumference (WC) for diagnosis of MES in Zahedan, southeast Iran. Methods: Totally, 1802 people (735 men and 1067 women) with metabolic syndrome were surveyed according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF) criteria as well as obtained WC cut-off points for IDF criteria.  Results: The prevalence of metabolic syndrome was higher in women than in men. In both sexes the prevalence increased with age. The prevalence of metabolic syndrome among 1802 individuals aged ≥19 years according to NCEP ATP III,  IDF and IDF -AHA/NHLBI were 21.0% (15.4% in male, 24.9% female), 24.8 (20.0% in male, 28.1% in female) and 23.3% (19.7% in male, 25.8% in female), respectively. Low HDL-C (60.6%) and high WC (43.3%) were the most common components of the metabolic syndrome, followed by high triglycerides (32%), elevated glucose (17.1%) and high blood pressure (13%). Conclusion: Our data shows a high prevalence of MES in Zahedan, Southeast Iran, therefore, future health prevention strategies are required for the prevention of MES. https://ijph.tums.ac.ir/index.php/ijph/article/view/2620 https://ijph.tums.ac.ir/index.php/ijph/article/download/2620/2600

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 2 2012 02 15 77 86 K Naddafi MH Sowlat MH Safari 2015 10 03 Background: Air pollution is a major problem in urban"industrial areas, like Tehran, and has several impacts on human health. This study aimed at assessing concentrations of criteria air pollutants (CO, SO2, NO2, O3, PM10) in Tehran, extracting patterns of hourly, daily, weekly, and monthly variations of concentrations, and making comparisons to National Standards and WHO Guidelines. Methods: Air quality data were taken from Air Quality Control Corporation and 5 sampling stations (out of 13) were selected for analysis according to data availability. Microsoft Excel 2003 was used for data analysis and plotting the charts. Results: Patterns of temporal variation (hourly, daily, weekly, and monthly) of air pollutant concentrations were extracted. In some cases extracted patterns matched with the patterns proposed by other researchers. Pollutant concentrations were compared to National Standards and WHO Guidelines and it was observed that in most of the days, we exceeded the limit values. Conclusion: Air pollution in Tehran is quite high and there are many days that we exceed the standards; therefore appropriate control strategies are needed. Although the number of sampling stations is high enough to be representative of whole city, it is proposed that an independent sampling station is setup to check the validity of the measurements. https://ijph.tums.ac.ir/index.php/ijph/article/view/2621 https://ijph.tums.ac.ir/index.php/ijph/article/download/2621/2601

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 2 2012 02 15 87 93 R Vazirinejad N Masoodpour A Puyanfar 2015 10 03 Background: This study aimed to assess the incidence and survival rates of neonates weighing less than 2500g for duration of the first 28 days in an Iranian community. Methods: In this prospective longitudinal study, all neonates with birth weight less than 2500g were selected from the list of all neonates born in the only public-sector referral hospital, for a six months period. The weight of neonates at birth along with some demographic variables was recorded on a checklist. A cohort of neonates with birth weight less than 2500g were followed for 28 days. Mortality within 28 days of birth was used as end point. Continuous variables were summarized using mean and 95% confidence intervals, while categorical variables were presented as ratios and percentages. Results: About 1750 neonates were born of which 168 neonates with birth weights less than 2500g were recorded giving a proportion of 9.6%. Of 168 neonates, 21 (12.5%) had very low birth weights (VLBW) (birth weights<1500g). Survival rates for the groups of LBW (1500<birth weights<2500g) and VLBW neonates were 98.4% and 66.6%, respectively. Regression analysis showed birth weight has, unsurprisingly, the most effect (beta= 0.501) on the survival rate among variables studied in this research. Conclusion: The survival rate among VLBW births in our study is dramatically low (66.6%). Not only attempts must be made to reduce the incidence and prevalence of this problem but also we need to work on the related factors of neonates' survival rate in this community. https://ijph.tums.ac.ir/index.php/ijph/article/view/2622 https://ijph.tums.ac.ir/index.php/ijph/article/download/2622/2602

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 2 2012 02 15 94 99 V Changizi R Nazari S Naseri MZ Zareh 2015 10 03 Background: A few elements of soil are radioactive. Soil can transfer radionuclide into plants feeding human. Sometimes their   levels are as high as to be concern of human healthy. Rice has an important share for Iranian foods especially in north of Iran. Therefore we decided to obtain radionuclides concentration emitting g rays in Lahijan City (Northern Iran) rice fields using g spectroscopy. Methods: Twenty eight samples from rice field's soils and 12 samples from superficial soils were collected at a square of 10*10 m2 to get 2kg weight. To make dry samples were put into oven at 105oC for 24h. Then they were milled and 950 gr of each sample was transferred to Marinelli container with 1000cc volume, sealed and left for 40 days to get secular equilibrium. After measuring Ph, Electric conductivity and organic carbon, g spectroscopy was done to get sample gamma spectrum at 2000-6000 sec using HpGe detector. Results: It was found 226Ra activity in rice fields of 29.273±0.72 Bqkg-1 and city soil of 31.02±1.1 Bqkg-1 and also 232Th activity of 37.47±1.12 Bqkg-1 for rice fields' soils and 40.47±1.68 Bqkg-1 for city soil were in standard mode. Conclusion: 40K activities mean value according to UNSCEAR; 2000 was found a little greater than standard. A little value of 137Cs was found in Lahijan rice fields and city soils that could be as a result of Chernobyl accident. In except of 137Cs, for three other under studied city soil elements, activities were greater than that of rice fields. https://ijph.tums.ac.ir/index.php/ijph/article/view/2623 https://ijph.tums.ac.ir/index.php/ijph/article/download/2623/2603

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 2 2012 02 15 100 104 E Gholami Parizad A Khosravi E Gholami Parizad N Sadeghifard S Ghafourian 2015 10 03 Background: It is estimated that about 370 million people are chronic carriers of HBV worldwide. Apparently 3% of Iranian populations are chronic carriers of this virus. We aimed to evaluate the viral DNA in biological fluids of chronic hepatitis patients compared to a control group. Methods: The current case-control study was designed to evaluate the viral DNA in biological fluids of 70 chronic hepatitis patients compared to a control group using ELISA, PCR and Real Time. Results: All individuals (100%) in case group were HBsAg positive while in control group only 2 individuals (2.8%) were HBsAg positive. Three individuals , in control group were positive using PCR and Real Time PCR indicating that about 7% of those in control  group were chronic carriers of HBV. The interesting point was the copy of viral DNA; (5.49 ×104, 2.162×103and 7.26×106) for 3 chronic carriers using sera while it was about (5.71×103, 1.45×102 and 2.56×105) using ear cerumen confirming the necessity of investigating for the carriers of HBV in different biological fluid and by different methods. Conclusion: It can be concluded chronic carriers of hepatitis B are much more than what is diagnosed by routine diagnostic tests. On the other hand ELISA alone can not be relied on as a complete test for screening of chronic carriers in hepatitis B. PCR and Real Time PCR are more reliable tests for this purpose. https://ijph.tums.ac.ir/index.php/ijph/article/view/2624 https://ijph.tums.ac.ir/index.php/ijph/article/download/2624/2604

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 2 2012 02 15 105 110 P Yazdanpanah S Aramesh