Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 1 6 M Bellavia G Tomasello P Damiani F Damiani A Geraci FM Accardo MC Gioviale AI Lo Monte 2015 10 03 The term Diagnosis-related Group (DRG) refers to a classification system used to assess hospital services with the aim of a better management of health care costs and improving performance. The DRG system focuses on the utilization of resources, and is not concerned with the specific type of care provided to the patient. This system highlights any diseconomies and eventual critical aspects of the hospital system. This article, starting from the history of heath care financing in Italy and pointing out the difficulty to define the "quality" of health care services, describes the variables used to evaluate correctly hospital performance based on the DRG system. These include Average Length of Stay, Average Daily Patient Load, Comparative Performance Index, and Case Mix Index. https://ijph.tums.ac.ir/index.php/ijph/article/view/2539 https://ijph.tums.ac.ir/index.php/ijph/article/download/2539/2519

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 7 13 K Holakouie Naieni H Malekafzali A Rashidian P Vazirian G Moradi A Mirzazadeh M Mirmohammadkhani A Shamshiri 2015 10 03 Background: Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries relation to goal 6 of 3rd Millennium Development Goals (MDGs) which includes have halted by 2015 and begun to reverse the incidence of malaria. Methods: By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. Results: The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases (2,428/100,000) in Afghanistan and 59,284 cases (881/100,000) in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. The main malaria endemic areas of Iran are in southeastern part of the country; consist of less developed provinces that are bordered in the east by Afghanistan and Pakistan. There are little valid information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators. Conclusion: All ECO countries could achieve MDGs malaria indicators by 2015 except Pakistan and Afghanistan, unless preparing urgent intervention programs to fulfill the goals. https://ijph.tums.ac.ir/index.php/ijph/article/view/2540 https://ijph.tums.ac.ir/index.php/ijph/article/download/2540/2520

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 14 23 M Davari A Haycox T Walley 2015 10 03 Background: This paper considers a range of issues related to the financing of health care system and relevant government policies in Iran. Methods: This study used mixed methods. A systematic literature review was undertaken to identify relevant publications. This was supplemented by hand searching in books and journals, including government publications. The issues and uncertainties identified in the literature were explored in detail through semi-structured interviews with key informants. These were triangulated with empirical evidence in the form of the literature, government statistics and independent expert opinions to validate the views expressed in the interviews. Results: The systematic review of published literature showed that no previous publication has addressed issues relating to the financing of healthcare services in Iran. However, a range of opinion pieces outlined issues to be explored further in the interviews. Such issues summarised into four main categories. Conclusion: The health care market in Iran has faced a period in which financial issues have enhanced managerial complexity. Privatization of health care services would appear to be a step too far in assisting the system to confront its challenges at the current time. The most important step toward solving such challenges is to focus on a feasible, relevant and comprehensive policy, which optimises the use of health care resources in Iran. https://ijph.tums.ac.ir/index.php/ijph/article/view/2541 https://ijph.tums.ac.ir/index.php/ijph/article/download/2541/2521

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 24 33 T Sindhu S Rajamanikandan P Srinivasan 2015 10 03 Background: Computational identification of phylogenetic motifs helps to understand the knowledge about known functional features that includes catalytic site, substrate binding epitopes, and protein-protein interfaces. Furthermore, they are strongly conserved among orthologs, indicating their evolutionary importance. The study aimed to analyze five candidate genes involved in type II diabetic nephropathy and to predict phylogenetic motifs from their corresponding orthologous protein sequences. Methods: AKR1B1, APOE, ENPP1, ELMO1 and IGFBP1 are the genes that have been identified as an important target for type II diabetic nephropathy through experimental studies. Their corresponding protein sequences, structures, orthologous sequences were retrieved from UniprotKB, PDB, and PHOG database respectively. Multiple sequence alignments were constructed using ClustalW and phylogenetic motifs were identified using MINER. The occurrence of amino acids in the obtained phylogenetic motifs was generated using WebLogo and false positive expectations were calculated against phylogenetic similarity. Results: In total, 17 phylogenetic motifs were identified from the five proteins and the residues such as glycine, leucine, tryptophan, aspartic acid were found in appreciable frequency whereas arginine identified in all the predicted PMs. The result implies that these residues can be important to the functional and structural role of the proteins and calculated false positive expectations implies that they were generally conserved in traditional sense. Conclusion: The prediction of phylogenetic motifs is an accurate method for detecting functionally important conserved residues. The conserved motifs can be used as a potential drug target for type II diabetic nephropathy. https://ijph.tums.ac.ir/index.php/ijph/article/view/2542 https://ijph.tums.ac.ir/index.php/ijph/article/download/2542/2522

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 34 39 Siti Syairah Mohd Mutalip Ruzianisra Mohamed 2015 10 03 Background: Introduction to sexual education in schools was suggested by the Malaysian government as one of the effort taken in the aim to reduce the sexual-related social problems among Malaysian teenagers nowadays. This study was proposed in the aim to determine the rate of acceptance among adolescents on the implementation of sexual education in schools. Methods: This study was conducted using questionnaires distributed to 152 pre-degree students in Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Kampus Puncak Alam, Selangor, Malaysia. Obtained data were statistically analyzed. Results: Almost half (49.3%) of the respondents agreed that sexual education might help to overcome the social illness among school teenagers. Besides, a large number (77.6%) of respondents also agreed that this module should be incorporated with other core subjects compare to the feedback received on the implementation of this module on its own (28.9%). Conclusion: These results have provided some insight towards the perception of sexual education among the teenagers. Since most of the respondents agreed with this idea, so it might be a sign that the implementation of sexual education is almost accepted by the adolescents. https://ijph.tums.ac.ir/index.php/ijph/article/view/2543 https://ijph.tums.ac.ir/index.php/ijph/article/download/2543/2523

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 40 43 P Ariga A Bridgitte V Rangarajan J M Philip 2015 10 03 Background: The objectives of this study were to evaluate the prevalence of edentulousness, patient's perception on dietary changes resulting from tooth loss and to identify the disparity between actual and patient perceived need to replace missing teeth in an elderly rural population in south India. Methods: A cross sectional study using the systematic cluster sampling method was used to select the study sample of 150 elderly men and women. Data were collected using questionnaires and oral examination. The data were statistically analyzed using chi square test and pearson correlation. Results: 15.6% of the rural elderly were completely edentulous and 54.7% were partially edentulous. Observed differences in distribution between the sampled elderly age groups were found to be statistically significant. Although 70.3% of the evaluated elderly actually required prosthodontic treatment, only 14.4% perceived the need to replace missing teeth. A small percentage of the elderly (18%) perceived a severe change in their diets due to tooth loss. Thirty three percent of them perceived a moderate change and 28% felt that there were no dietary changes because of tooth loss. Conclusions: It is essential to identify feasible strategies to provide primary dental health education and treatment to all rural elderly in the future. We suggest community dental health services as a general health need of the elderly rather than a special health need of the community. https://ijph.tums.ac.ir/index.php/ijph/article/view/2544 https://ijph.tums.ac.ir/index.php/ijph/article/download/2544/2524

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 44 52 Gh Mahdavi Z Izadi 2015 10 03 Background: Existence or non-existence of adverse selection in insurance market is one of the important cases that have always been considered by insurers. Adverse selection is one of the consequences of asymmetric information. Theory of adverse selection states that high-risk individuals demand the insurance service more than low risk individuals do. Methods: The presence of adverse selection in Iran's supplementary health insurance market is tested in this paper. The study group consists of 420 practitioner individuals aged 20 to 59. We estimate two logistic regression models in order to determine the effect of individual's characteristics on decision to purchase health insurance coverage and loss occurrence. Using the correlation between claim occurrence and decision to purchase health insurance, the adverse selection problem in Iranian supplementary health insurance market is examined. Results: Individuals with higher level of education and income level purchase less supplementary health insurance and make fewer claims than others make and there is positive correlation between claim occurrence and decision to purchase supplementary health insurance. Conclusion: Our findings prove the evidence of the presence of adverse selection in Iranian supplementary health insurance market. https://ijph.tums.ac.ir/index.php/ijph/article/view/2545 https://ijph.tums.ac.ir/index.php/ijph/article/download/2545/2525

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 53 58 GR Karami Kh Ahmadi V Nejati M Masumi 2015 10 03 Background: Assessment of quality of life can promote health services. The purpose of this study was evaluation of health related quality of life in lower limbs amputee veterans of Iran. Methods: In the present cross sectional study, we compared 38 lower limbs amputee veterans with 50 normal healthy subjects with SF36 questioner in face-to-face interview. Results: Amputees had significantly lower grade than normal subject did in role physical (P < 0.01) and were better than normal subjects in vitality (P < 0.001) and mental health (P < 0.01). As a whole, amputees have higher in mental summary component of quality of life (P < 0.05) and lower in physical component of quality of life (P < 0.01). Conclusion: Diminishing the demand and improving social support of amputee veterans might be considered as high grade in mental summary component of their quality of life. https://ijph.tums.ac.ir/index.php/ijph/article/view/2546 https://ijph.tums.ac.ir/index.php/ijph/article/download/2546/2526

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 7 2012 07 15 59 63 GA Kardar M Oraei Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 85 96 H Dargahi S Alirezaie G Shaham 2015 10 03 Background: Organizational Citizenship Behavior (OCB) is defined as "individual behavior that is discretionary, not directly or explicitly recognized by the formal reward system, and that in the aggregate, promotes the effective functioning of organization". OCB, enhance job satisfaction among nursing employees. According to several findings, nurses' OCB have a positive and significant influence on job satisfaction. This research is aimed to study OCB among Iranian nurses. Methods: A cross-sectional, descriptive and analytical study was conducted among 510 nurses working in 15 teaching hospitals in Tehran, Iran to be selected by stratified random sampling. The respondents were asked to complete Netemeyer's organizational citizenship behavior questionnaire that encompassed four dimensions of OCB including Sportsmanship, Civil Virtue, Conscientiousness, Altruism and selected each item of OCB dimensions and identified their attitudes about OCB items were observed in hospitals of Tehran. The data was analyzed by T-test, ANOVA and Pearson statistical methods. Results: The results of this research showed that most of the nurses who studied in this study, had OCB behaviors. Also, we found that there was significant correlation between Iranian nurses' marriage status, qualifications and gender with sportsmanship, altruism and civic virtue. Conclusion: This research demonstrates the existence of OCB among Iranian nurses that are essential in developing patient - oriented behavior. The results can be used to develop further nursing management strategies for enhancement of OCB. Finally, the present study indicates new possibilities for future researches such as analysis and comparison of OCB between different hospitals and how nursing policy-makers can enhance these behaviors in Iranian hospitals. https://ijph.tums.ac.ir/index.php/ijph/article/view/2577 https://ijph.tums.ac.ir/index.php/ijph/article/download/2577/2557

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 91 96 M Karami H Soori A Bahadori Monfared 2015 10 03 Background: Knowledge of the magnitude of avoidable burden by risk factors is needed for health policy, priority setting, and preventing stroke. The aim of this study was to estimate the contribution of selected risk factors including hypertension, overweight, obesity, tobacco use, and physical inactivity to the attributable burden of stroke in Iran. Methods: The World Health Organization Comparative Risk Assessment (CRA) methodology was employed to calculate the Potential Impact Fraction (PIF) and percentage of avoidable burden of stroke, which attributed to its risk factors among Iranian adults in 2009. Prevalence of risk factors was obtained from the 5th STEPS survey of chronic disease risk factors which conducted in 2009. PIF was estimated on both theoretical minimum and feasible minimum risk. A simulation procedure incorporating sources of uncertainty was used to estimate the uncertainties for the attributable burden. Results: About 15.7% (95% uncertainty intervals: 5.8- 23.5) of attributable Disability Adjusted Life Years (DALYs) to stroke in adult males and 15.8% (95% uncertainty intervals: 5.8- 23.5) in adult females are avoidable after changing the current prevalence (16.0% and 16.1% for males and females, respectively) of hypertension to 10% in both sexes. Conclusion: This work highlighted the important role of hypertension and overweight. Accordingly, policy makers are advised to consider these risk factors once implementing interventional program in Iran. https://ijph.tums.ac.ir/index.php/ijph/article/view/2578 https://ijph.tums.ac.ir/index.php/ijph/article/download/2578/2558

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 97 104 A Haghighatnia S Vallian J Mowla Z Fazeli 2015 10 03 Background: Genetic diversity of three polymorphic markers in the phenylalanine hydroxylase (PAH) gene region including PvuII (a), PAHSTR and MspI were investigated. Methods: Unrelated individuals (n=139) from the Iranian populations were genotyped using primers specific to PAH gene markers including PvuII(a), MspI and PAHSTR. The amplified products for PvuII(a), MspI were digested using the appropriate restriction enzymes and separated on 1.5% agarose. The PAHSTR alleles were identified using polyacrylamide gel electrophoresis followed by silver staining. The exact size of the STR alleles was determined by sequencing. The allele frequency and population status of the alleles were estimated using PHASE, FBAT and GENEPOP software. Results: The estimated degree of heterozygosity for PAHSTR, MspI and PvuII (a) was 66%, 56% and 58%, respectively. The haplotype estimation analysis of the markers resulted in nine informative haplotypes with frequencies ≥5%. Moreover, the results obtained from Ewens-Watterson test for neutrality suggested that the markers were under balancing selection in the Iranian population. Conclusion: These findings suggested the presence of genetic diversity at these three markers in the PAH gene region. Therefore, the markers could be considered as functional markers for linkage analysis of the PAH gene mutations in the Iranian families with the PKU disease. https://ijph.tums.ac.ir/index.php/ijph/article/view/2579 https://ijph.tums.ac.ir/index.php/ijph/article/download/2579/2559

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 105 109 MH Javanbakht M Daneshpazhooh C Chams-Davatchi MR Eshraghian M Zarei M Chamari M Djalali 2015 10 03 Background: Pemphigus vulgaris is a life threatening, blistering skin disease. It is an autoimmune abnormality. Due to involvement of oral cavity and pharynx, patients are at risk of nutrients deficiency. The aim of this study was to evaluate the status of selenium, copper, and zinc in these patients. Methods: In a case-control study, 43 newly diagnosed pemphigus vulgaris patients were compared with 58 healthy people from 2009 to 2010. The severity of the disease was estimated according to Harman's scores. Serum selenium was measured with atomic absorption but serum zinc and copper concentrations were determined spectrophotometrically. Data were compared with independent t test. Correlations were evaluated by Pearson correlation test. Results: Both groups were the same based on sex, age, and weight and body mass index. The mean duration of disease was 5.6 month. The oral and skin severities were 1.79 and 2.3 respectively, based on Harman's scores. Serum selenium of pemphigus patients was significantly less than that of healthy people (P<0.001). Serum copper was negatively correlated with duration of disease in males (P=0.02, r=-0.5). Conclusions: Pemphigus vulgaris negatively affects on serum selenium, copper and zinc. It seems that serum selenium, copper and zinc decrease as the disease lasts longer. https://ijph.tums.ac.ir/index.php/ijph/article/view/2580 https://ijph.tums.ac.ir/index.php/ijph/article/download/2580/2560

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 110 115 MR Baneshi A Talei 2015 10 03 Background: Prognostic models have clinical appeal to aid therapeutic decision making. Two main practical challenges in development of such models are assessment of validity of models and imputation of missing data. In this study, importance of imputation of missing data and application of bootstrap technique in development, simplification, and assessment of internal validity of a prognostic model is highlighted. Methods: Overall, 310 breast cancer patients were recruited. Missing data were imputed 10 times. Then to deal with sensitivity of the model due to small changes in the data (internal validity), 100 bootstrap samples were drawn from each of 10 imputed data sets leading to 1000 samples. A Cox regression model was fitted to each of 1000 samples. Only variables retained in more than 50% of samples were used in development of final model. Results: Four variables retained significant in more than 50% (i.e. 500 samples) of bootstrap samples; tumour size (91%), tumour grade (64%), history of benign breast disease (77%), and age at diagnosis (59%). Tumour size was the strongest predictor with inclusion frequency exceeding 90%. Number of deliveries was correlated with age at diagnosis (r=0.35, P<0.001). These two variables together retained significant in more than 90% of samples. Conclusion: We addressed two important methodological issues using a cohort of breast cancer patients. The algorithm combines multiple imputation of missing data and bootstrapping and has the potential to be applied in all kind of regression modelling exercises so as to address internal validity of models.   https://ijph.tums.ac.ir/index.php/ijph/article/view/2581 https://ijph.tums.ac.ir/index.php/ijph/article/download/2581/2561

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 116 121 MA Goreishizadeh A Mohagheghi S Farhang L Alizadeh 2015 10 03 Background: This study aimed at revaluating the psychosocial disabilities in schizophrenic patients. Methods: In an analytic-descriptive setting, schizophrenic patients were evaluated in Razi University Hospital during a one-year period (2009-10). The study group consisted of male and female patients aged 18-65 years, with the onset of disease for a minimum of 2 years and at least one psychological hospitalization in their medical record. The demographic data, as well as the results of the SANS, SAPS, GARF and SOFAS questionnaires were determined in each patient. Results: Two hundred and eight patients, 53 females, and 155 males with the mean age of 36.96±11.55 (18-65) years were enrolled. Vocational, educational, social, familial, and self-hygiene related disabilities were seen in 63.5%, 21.2%, 93.8%, 13.9%, and 48.1% of the patients, respectively. Totally, psychosocial disabilities were reported in 98.1% of these patients. The mean age of the patients with educational or social disabilities was lower. Vocational problems were more common in male patients. Familial and social disabilities were positively related to the severity of positive and negative symptoms, with the predominance of the latter. Positive and negative symptoms were more frequent in patients with social and self-care related disabilities, respectively. The duration of the disease was significantly correlated with the positive symptoms and familial-social disabilities. Conclusion: The current study described the high prevalence of psychosocial disabilities in patients with schizophrenia and may have implications for public health interventions. https://ijph.tums.ac.ir/index.php/ijph/article/view/2582 https://ijph.tums.ac.ir/index.php/ijph/article/download/2582/2562

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 41 5 2012 05 15 123 123 W-J