Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 481 488 Leejin KIM Dept. of Child Studies, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, South Korea Sungmin MYOUNG Dept. of Health Administration, Jungwon University, 85 Munmu-ro Goesan-eup Goesan-gun, Chungbuk, South Korea 2018 04 22 2018 04 22 Background: The aim of this study was to explore the comorbidity of Attention-Deficit Hyperactivity Disorder (ADHD) for the Korean national health insurance data (NHID) by using association rule mining (ARM). Methods: We used data categorized mental disorder according to the international classification of disease, 10th revision (ICD-10) diagnosis system from NHID from 2011 to 2013 in youths aged 18 yr or younger. Overall, 211420 subjects, comorbid cases with ADHD were present in 105784. ARM was applied to the Apriori algorithm to examine the strengths of associations among those diagnosed, and logistic regression was used to evaluate the relations among rules. Results: The most prevalent comorbid psychiatric disorder of ADHD youths was mood/affective disorders. From results of ARM, nine association rules (support≥1%, confidnce≥50%) were produced. The highest association was found between specific developmental disorders of scholastic skills and ADHD. Among association of three comorbid diseases, tic disorder was an important role in the association between ADHD and other comorbid diseases through results of ARM and logistic regression. Conclusion: The practical application of ARM for discovering the comorbidity of ADHD in large amount real-data such as the Korean NHID was mostly confirmed by past studies. The results of this study will be helpful to researchers evaluating the stability of their diagnosis in ADHD.   https://ijph.tums.ac.ir/index.php/ijph/article/view/13142 https://ijph.tums.ac.ir/index.php/ijph/article/download/13142/5945

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 466 472 Ji WANG Dept. of Infection, Ningbo Fenghua People’s Hospital, Zhejiang, China Malong FENG Dept. of Respiratory Disease, Ningbo Fenghua People’s Hospital, Zhejiang, China Shidong YING Dept. of Tuberculosis and AIDS, Ningbo Fenghua Disease Control and Prevention Center, Zhejiang, China Jianfang ZHOU Dept. of Infection, Ningbo Fenghua People’s Hospital, Zhejiang, China Xiaoqing LI Dept. of Hepatic Disease, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China 2018 04 22 2018 04 22 Background: Vitamin D might be promising to serve as an adjunctive therapy for pulmonary tuberculosis (TB). However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of vitamin D in patients with pulmonary TB. Methods: Medline, SCOPUS, Google Scholar, EMBASE, Springer, and Science Direct were searched electronically from inception to Oct 2016. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effect of vitamin D plus anti-tuberculosis treatment (ATT) versus placebo plus ATT on the treatment of pulmonary TB were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Data were analyzed using RevMan 5.3 software. Results: Five studies were included in this meta-analysis. Overall, compared with placebo intervention, vitamin D supplementation was found to have no significant effect on sputum smear negative conversion rates (RR=0.99; 95% CI=0.91 to 1.07; P=0.77), BMI (MD=0.11; 95% CI=-0.85 to 1.07; P=0.82) and ESR (MD=-2.29; 95% CI=-8.87 to 4.30; P=0.50). Conclusion: Vitamin D supplementation showed no influence on the improvement of sputum smear-negative conversion rates and BMI, as well as the decrease in ESR.   https://ijph.tums.ac.ir/index.php/ijph/article/view/13140 https://ijph.tums.ac.ir/index.php/ijph/article/download/13140/5943

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 597 602 Mengxue YANG Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Biao LONG Dept. of Pediatrics, Qiandongnan People’s Hospital, Kaili, Guizhou, China Jie XU School of Public Health, Zunyi Medical University, Zunyi, China Jie YU School of Public Health, Zunyi Medical University, Zunyi, China Xianwen LI Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Fanhao YE Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Bo YANG Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Yulan LIAO Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Sicheng LI Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Ya LI Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China Xue ZHOU Dept. of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China 2018 04 23 2018 04 23 Carney complex (CNC) is a rare genetic disease. Here, we report a case of CNC and explore clinical manifestations and gene mutation studies of CNC. A male patient with CNC at the age of 16 yr was admitted to Affiliated Hospital of Zunyi Medical University in July, 2015. Although the patient had typical signs of Cushing's syndrome, he also presented with certain rare signs of Cushing's syndrome, such as "freckle-like" scattered spots of pigmentation on the face and around the lips. In addition, concomitant severe osteoporosis led to flattened vertebrae and the compression of corresponding levels of the spinal cord. Radiographic findings revealed adrenal nodular hyperplasia. Based on sequencing, 2 novel heterozygous mutations of the PRKAR1A gene were found. CNC was eventually diagnosed via pathologic biopsy. After 1 year of follow-up, the patient exhibited weight loss, relief of low back pain, normal blood biochemical indicators and cortisol levels at the lower limit of the normal range.   https://ijph.tums.ac.ir/index.php/ijph/article/view/13163 https://ijph.tums.ac.ir/index.php/ijph/article/download/13163/5959

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 603 605 Józef BERGIER Dept. of Tourism and Recreation, Pope John Paul II State School of Higher Education, Biała Podlaska, Poland Pongrác ÁCS Institute of Physiotherapy and Sport Sciences, University of Pécs, Pécs, Hungary Ferdinand SALONNA Faculty of Physical Culture, Palacký University of Olomouc, Olomouc, Czech Republic Ján JUNGER Dept. of Physical Education, Pavol Jozef Šafárik University in Košice, Košice, Slovakia 2018 04 23 2018 04 23 No Abstract### https://ijph.tums.ac.ir/index.php/ijph/article/view/13164 https://ijph.tums.ac.ir/index.php/ijph/article/download/13164/5960

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 591 596 Young Saing KIM Dept. of Internal Medicine, Gil Medical Center, Gachon University, Incheon, South Korea Dong Kyun PARK Dept. of Internal Medicine, Gil Medical Center, Gachon University, Incheon, South Korea In Cheol HWANG Dept. of Family Medicine, Gil Medical Center, Gachon University, Incheon, South Korea Hong Yup AHN Dept. of Statistics, Dongguk University, Seoul, South Korea 2018 04 23 2018 04 23 Background: The effect of weather conditions on human health has been documented. However, the role of daily weather on anticipated death remains unclear. This study aimed to evaluate the relationship between daily weather conditions and death in terminally ill cancer patients. Methods: We retrospectively searched a medical database of 935 consecutive terminally ill cancer patients who passed away in the palliative care unit from Oct 2009 to Sep 2013. We used Poisson regression to assess the relative risk (RR) of anticipated death based on various weather variables, using mean values calculated from the 10 d around the time of death. Results: The final study population consisted of 745 patients with a mean age of 65.9 ± 12.2 yr. The mean palliative prognostic index (PPI) score in the last week of life was 8.0 ± 3.8. After adjustment for age, sex, cancer type, and PPI score, RRs were 1.69 (95% CI, 1.17–2.46) for low temperature, 2.57 (1.77–3.77) for high diurnal temperature variation, 2.35 (1.61–3.36) for low humidity, and 1.75 (1.22–2.53) for high levels of sunlight. Conclusion: Weather conditions may be a predictor of death in terminally ill cancer patients.     https://ijph.tums.ac.ir/index.php/ijph/article/view/13162 https://ijph.tums.ac.ir/index.php/ijph/article/download/13162/5958

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 489 498 Hongpu HU Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China Yanli XU Medical College of Hebei Engineering University, Handan, Hebei, China Qingkun CHEN Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China Juan LI Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China Chenliu YANG Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China Yanli WAN Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China 2018 04 22 2018 04 22 Background: We presented the running state of rural basic medical insurance system in Henan and discussed the enforcements and development experiences of underdeveloped areas. We provided data evidence to support the improvement and development of a basic rural medical insurance system. Methods: We selected Henan Province, China as a sample, using the method of cluster sampling, from policy documents published in the national and provincial level of the new rural cooperative medical policy and work documents, data from 2004 to 2014, the National Health Statistical Yearbook of health statistics yearbook of Henan Province and relevant statistical data of the province. Results: The new rural cooperative policy has covered the whole population in Henan Province. The number of individual received benefits is increasing. In 2013, the number of persons counted has reached to 270 million, funds raised and expenditures reached 38.5 billion and 26 billion, respectively. The operational task force has been developed rapidly. In 2013, on average each staff managed the cases for 16.4 thousand rural residents. Conclusion: The major implementation and development experience from the new rural cooperative policy of Henan province include: education of related knowledge, optimization of compensation plan, development of operational system and framework, improvement of management rules, reinforcement of information system development and financial supervision and increment of investment in rural medical healthcare.     https://ijph.tums.ac.ir/index.php/ijph/article/view/13143 https://ijph.tums.ac.ir/index.php/ijph/article/download/13143/5946

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 2018 04 23 473 480 Saeideh MAZLOOMZADEH Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Zahra RASHIDI KHAZAGHI Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Nouraddin MOUSAVINASAB Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran 2018 04 22 2018 04 22 Background: Metabolic syndrome (MS)is a collection of metabolic disorders which leads to early cardiovascular disease and diabetes type II. Regarding the wide range of its prevalence in Iran, this systematic review and meta-analysis determined the overall prevalence of the metabolic syndrome in Iran. Methods: In this systematic review and meta-analysis, the Medline, ISI, IranMedex, and SID were searched using "metabolic syndrome", "syndrome X", "prevalence", and "Iran" keywords from 2002 to 2012. A total of 223 articles were found in which 14 studies were considered for meta-analysis. Data were analyzed using fixed and random model and meta-regression in STATA. Results: The prevalence of MS for those who were 20 yr and older was 23. 8% (95%CI: 18. 99-28. 67) and in under 20 was 10. 98% (95%CI: 7. 75-14. 2). Metabolic syndrome was more frequent in women (25. 5%) than in men (17. 16%) and was increased with increasing age. The most frequent component of metabolic syndrome was low HDL cholesterol (59. 7%) followed by hypertriglyceridemia (39. 5%). Conclusion: Regarding a high prevalence of metabolic syndrome and some of its components such as low HDL and high triglyceride in our country, implementation of programs for metabolic syndrome prevention is necessary.   https://ijph.tums.ac.ir/index.php/ijph/article/view/13141 https://ijph.tums.ac.ir/index.php/ijph/article/download/13141/5944

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 4 a Dongming WU China Institute of Sport Science, Beijing, China Huan WANG China Institute of Sport Science, Beijing, China Xiaoming HAN Qianjiang College, Hangzhou Normal University, Hangzhou, China Botong XU Qianjiang College, Hangzhou Normal University, Hangzhou, China 2019 09 03 Background: We aimed to establish a reference standard of Body Mass Index (BMI) for the growth of preschool children in China. Methods: We monitored and obtained the height and weight of 50702 children aged 3-6 yr in 31 provinces in mainland China in 2014. The reference standard and percentile curve of BMI preschool children aged 3-6 yr old were formulated by using Lambda-Median-Sigma (LMS) method in China. Results: The common grounds of the male and female children were as follows: the percentile maps were similar in shape; the graphs of children aged 4-6 were approximately horn shaped. The differences between male and female children were as follows: the BMI values of male children in the same age group and the same percentile were higher than those of the female children. The change pattern of male children was larger than that of female children. BMI of 3 yr old and 6 yr old children was larger than those of 4 yr old and 5 yr old. During the change from low percentile to high percentile, the BMI values of Chinese male children exceeded WHO to a larger extent, and the BMI values of Chinese female children were substantially consistent with WHO, but the high percentile greater than P95 exceeded WHO. Conclusion: The BMI growth chart developed can be applied in monitoring the growth and nutrition of preschool children in China. We recommend the promotion of the results in the field of preventive health care.     https://ijph.tums.ac.ir/index.php/ijph/article/view/18248 https://ijph.tums.ac.ir/index.php/ijph/article/download/18248/6500

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1627 1635 Yerbol BEKMUKHAMBETOV Administration, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Arstan MAMYRBAYEV Department of Hygiene and Occupational Diseases, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Timur JARKENOV Administration, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Talgar ABILOV Department of Molecular Biology and Medical Genetics, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Gulnar SULTANOVA Department of Children and Surgical Dentistry, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Gulnar ISAEVA Department of Children and Surgical Dentistry, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Mukhtar ZHAILYBAYEV Department of Clinical Anatomy with Operational Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan Raisa URAZ Department of Therapeutic and Prosthetic Dentistry, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan 2019 09 03 Background: The health status of the population of different ages was examined. Since children are very vulnerable to environmental factors, our goal was to examine their health status and compare them with those of the older population. Also one of the important tasks of our study was the installation of carcinogenic and non-carcinogenic risks for children and adults of different sexes. Methods: During our research, we calculated the air pollution index, investigated the incidence statistics of the population, and calculated the lifetime average daily dose (LADD). We investigated the content of sulfur dioxide, hydrogen sulfide, nitrogen oxide, ammonium and hydrogen carbonates and compared it with safe level of exposure. Results: In Aktobe, the Republic of Kazakhstan the external environment is polluted with boron and chromium, and in Aktau - with organic hydrocarbons. High morbidity rates in adolescents were found for endocrine disorders, digestive system diseases, and musculoskeletal system disorders. Estimating the prevalence and incidence of newly diagnosed diseases among women in Aktau showed that the overall incidence rate, as well as the incidence of respiratory and skin diseases, declines with age. The incidence of the genitourinary system and the number of nervous disorders increase, and the number of neoplasms increases in men population. A study of carcinogenic risks showed that children with Aktau, especially boys, have the greatest risk of cancer. Conclusion: The conducted research shows that environmental factors have a big impact on the health of the population.     https://ijph.tums.ac.ir/index.php/ijph/article/view/18249 https://ijph.tums.ac.ir/index.php/ijph/article/download/18249/6501

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1636 1646 Huanchun HUANG Department of Urban Planning, School of Landscape Architecture, Nanjing Forestry University, Nanjing, China Hailin YANG Department of Urban Planning, School of Landscape Architecture, Nanjing Forestry University, Nanjing, China Xin DENG Department of Urban Planning, School of Landscape Architecture, Nanjing Forestry University, Nanjing, China Peng ZENG Department of Urban Planning, School of Architecture, Tianjin University, Tianjin, China Yong LI People’s Hospital of Jiangsu Province, Nanjing Medical University, Nanjing, China Luning ZHANG Department of University Foreign Language Teaching Section, School of foreign Studies, Nanjing Forestry University, Nanjing, China Lei ZHU Center for Educational Research, Seoul National University, Seoul, South Korea 2019 09 03 Background: Urban heat island (UHI) is being intensified with the progress of urbanization. Meanwhile, respiratory diseases caused by high temperature become common. This study explores the influences of UHI on respiratory diseases (J00-J99) and the evolutionary characteristics of the spatial pattern of such influences. Methods: The pattern–process–function and the influencing mechanism of UHI on respiratory diseases were evaluated through landscape pattern indexes from 1992 to 2018 in Tianjin, China. The basis was on data from Landsat TM/OLI/TIRS remote-sensing images, meteorological stations, and mortality of respiratory diseases. Results: The fluctuating influence of UHI on the respiratory diseases in Tianjin has increased from 1992 to 2018, showing a significant phase-based characteristic. During 2011-2018, the influence has soared greatly, and mortality risk has increased by 101%, and the influenced area has reached 349 km². Furthermore, the regional space clustered, and the influenced patches are in irregular shape, and the highly influenced area is enlarged. Moreover, the indexes of the landscape level of the influenced areas all decrease. The patches at all levels are fragmented and distributed discontinuously. Spatially, the influenced areas gradually extend from the urban center to the suburbs. Conclusion: UHI causes a higher mortality of respiratory diseases because it increases daily average air temperature in summer. With respect to landscape pattern, the influenced areas at low level is highly interconnected and relatively concentrated, whereas the influenced area at high level is distributed in clusters. In general, the influenced area is fragmented and discontinuously distributed in urban center.     https://ijph.tums.ac.ir/index.php/ijph/article/view/18250 https://ijph.tums.ac.ir/index.php/ijph/article/download/18250/6502

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1647 1653 Sulistyawati SULISTYAWATI Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia Isnah FITRIANI Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia 2019 09 03 Background: In 2015, Indonesia government targeted to eliminate malaria in Java Island. Nevertheless, until now malaria still occurs, including in Samigaluh, Kulon Progo District although many malaria programs has been run. Complexity and dynamic of the population also limited budget may become the reason of malaria combat difficulties. Subsequently, a method to direct the policymaker on how to provide program effectively and efficiently was needed.  We examined malaria risk factor using statistical and cluster analysis. Methods: A quantitative study with case-control approach was conducted during Spring 2017 in Samigaluh II Public Health Centre, Indonesia. The structured questioner was used to collect the information from both of case and control which were people who had blood examination regarding malaria diagnosed during January-December 2016. Global Positioning System was used to record the geographical position of house participant which was used in cluster analysis. Results: Occupation was recognized as the significant risk factor to malaria. One most likely cluster was detected and translated as the source of transmission because of its fall in malaria hotspot. Conclusion: Satscan be able to detect a spatial cluster of malaria case and a promising method for supporting malaria control.    https://ijph.tums.ac.ir/index.php/ijph/article/view/18251 https://ijph.tums.ac.ir/index.php/ijph/article/download/18251/6503

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1654 1662 Yu HUANG Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China Min LUO Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China Junqing HUANG Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China Shaoxin HUANG Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China Liuxia WEI Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China Yumei ZHANG Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China Zhiming ZHANG Department of Medical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P.R. China 2019 09 03 Background: We aimed to investigate the expression level of breast cancer susceptibility gene 2 (BRCA2) and its changes during chemotherapy in patients with different pathological types of mammary cancer (MC). Methods: Overall, 102 patients treated in Affiliated Tumor Hospital of Guangxi Medical University, China from April 2013 to August 2017 were enrolled as experimental group, including 58 patients with noninvasive MC (group A) and 44 with invasive MC (group B). Fifty healthy volunteers at the same time were enrolled as control group. The relative expression of BRCA2 in the blood of MC patients was detected by real-time fluorescence quantitative PCR (FQ-PCR). Results: In the experimental group, the expression level of BRCA2 in group A was higher than that in group B before chemotherapy (P<0.001); the expression level in group A and group B 1 month after chemotherapy was higher than that before chemotherapy (P<0.001); the expression level in the both groups 3 months after chemotherapy was higher than that 1 month after chemotherapy (P<0.001); the expression level of BRCA2 in blood of group A increased gradually before, 1 month and 3 months after chemotherapy (P<0.001). The expression level of BRCA2 in blood of group B increased gradually at the same time points (P<0.001). Conclusion: BRCA2 is over-expressed in noninvasive MC patient and under-expressed in invasive MC patient. And it can be used as an index for monitoring the condition of MC patients with different pathological types during chemotherapy.     https://ijph.tums.ac.ir/index.php/ijph/article/view/18252 https://ijph.tums.ac.ir/index.php/ijph/article/download/18252/6504

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1663 1670 Jie GU Zhongshan Hospital of Fudan University, Shanghai 200032, P.R. China Haiying CHEN Xidu Community Health Center of the Fengxian District, Shanghai 201400, P.R. China Xiaoqing GU Xidu Community Health Center of the Fengxian District, Shanghai 201400, P.R. China Xiaomin SUN Health Development Institute of Pudong, Shanghai 201208, P.R. China Zhigang PAN Zhongshan Hospital of Fudan University, Shanghai 200032, P.R. China Shanzhu ZHU Zhongshan Hospital of Fudan University, Shanghai 200032, P.R. China Doris YOUNG Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia 2019 09 03 Background: Frailty is a common syndrome in elderly people, but has not been fully studied in China. We aimed to investigate the epidemiological characteristics of frailty and analyze its risk factors in elderly people in rural areas of China. Methods: This cross-sectional study was conducted between September and October 2016. Overall, 4323 elderly people over 60 yr were enrolled by cluster random sampling method from the Fengxian District of Shanghai, China. These subjects voluntarily participated in the health examination of the 2016 National Basic Public Health Service Program. In addition to regular examination items, frailty assessment was performed on the basis of Fried frailty phenotype criteria. Results: The prevalence of pre-frailty and frailty was 49.4% and 6.8%, respectively. Advanced age (OR=1.44 for pre-frailty and OR=2.01 for frailty, 65-74 years old; OR=3.02 for pre-frailty and OR=14.13 for frailty,75-84 years old; OR=8.17 for pre-frailty and OR=71.71 for frailty, ≥85 years old), female (OR=1.32 for pre-frailty and OR=1.97 for frailty), stroke history (OR=1.75 for pre-frailty and OR=2.43 for frailty), vision decrease (OR=1.98 for pre-frailty and OR=2.70 for frailty), and anemia (OR=1.95 for pre-frailty and OR=3.64 for frailty) were common risk factors for both pre-frailty and frailty. Conclusion: Healthy elderly people in the rural areas of Shanghai have relatively high prevalence of pre-frailty and frailty. Advanced age, female, stroke history, decreased vision, and anemia are the risk factors for pre-frailty and frailty.   https://ijph.tums.ac.ir/index.php/ijph/article/view/18253 https://ijph.tums.ac.ir/index.php/ijph/article/download/18253/6505

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1671 1680 Enayat DARABI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Elahe MOTEVASELI Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza KHORRAMIZADEH Biosensor Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Mehdi MOHEBALI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Bagher ROKNI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Farzaneh ZAHABIUN Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Eshrat Beigom KIA Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2019 09 03 Background: Cystic echinococcosis (CE), larval stage of Echinococcus granulosus, immunodiagnostics is still a challenge due to asymptomatic nature of CE during the early phase of infection and imperfection of diagnostic antigens. In silico design and assessments of hydatid cyst antigens provide preeminent information for novel and favorable diagnostic methods. Methods: This study was performed at the Tehran University of Medical Sciences, Tehran, Iran in 2018. The sequences of B2, EPC1, B1 and B4 antigens were collected and analyzed for sequence conservancy by protein BLAST search and CLUSTALW multiple sequence alignment. The secondary and 3D structures were predicted using ab initio and threading methods. The antigens were analyzed for their B cell epitopic content using linear and conformational B cell epitope prediction tools. The final diagnostic antigen was designed by fusing the selected epitopic determinants form each antigen. Results: Given the conservancy results and B cell epitope predictions, the whole B2 antigen along with amino acids spanning 1-50, 1-30, and 30-81 regions of EPC1, B1 and B4 antigens were selected to design the final antigen. High surface accessibility (75%), protein stability, low free energy and high number of amino acids involved in B cell epitopes were desirable properties for the final antigen to interact with antibodies against CE. Conclusion: In silico design of such antigens is useful for better diagnosis of CE, decrease the cost and the time required for antigen design, while avoiding the ethical aspects of in vivo studies.     https://ijph.tums.ac.ir/index.php/ijph/article/view/18254 https://ijph.tums.ac.ir/index.php/ijph/article/download/18254/6506

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1681 1689 Edris KAKEMAM Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medi-cal Sciences, Tabriz, Iran Hossein DARGAHI Department of Management Sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ANDHealth Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran 2019 09 03 Background: Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of public hospitals during before and after the implementation of Health Sector Evolution Plan (HSEP) and to determine whether, and how, efficiency is affected by various factors. Methods: Forty-two public hospitals were selected in Tehran, Iran, from 2012 to 2016. Data envelopment analysis was employed to estimate the technical and scale efficiency sample hospitals. Tobit regression was used to relate the technical efficiency scores to seven explanatory variables in 2016, the last year. Results: Overall, 24 (57.1%), 26 (61.9%), 26 (61.9%), 24 (57.1%) and 21 (50%) of the 42 sample hospitals ran inefficiently in 2012 to 2016, with average technical efficiency of 0.859, 0.836, 0.845, 0.905 and 0.934, respectively. The average pure technical efficiency in sample hospitals increased from 0.860 in 2010 (before the HSEP) to 0.944 in 2012 (after the HSEP). Tobit regression showed that average length of stay had a negative impact on technical efficiency of hospitals. In addition, bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. Conclusion: Despite government support, public hospitals operated relatively inefficien. Managers can enhance technical efficiency by increasing bed occupancy rate through shortening the average length of stay, proportioning the number of doctors, nurses, and beds along with service quality assurance.   https://ijph.tums.ac.ir/index.php/ijph/article/view/18255 https://ijph.tums.ac.ir/index.php/ijph/article/download/18255/6507

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 9 2019 09 03 1690 1696 Ali Akbar HAGHDOOST Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Mohammad Reza 2019 06 03 1189 1190 Reza SHOKOOHI Department of Environmental Health Engineering, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Mohammad Taghi SAMADI Department of Environmental Health Engineering, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Manoochehr KARAMI Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Razieh KHAMUTIAN Department of Environmental Health Engineering, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran 2019 06 03 The Necessity of Monitoring Pesticide Residues in Vegetables and Fruits Using Hazard Index among Consumers https://ijph.tums.ac.ir/index.php/ijph/article/view/17375 https://ijph.tums.ac.ir/index.php/ijph/article/download/17375/6433

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 02 1074 1081 Fatemeh TOORANG Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medi-cal Sciences, Tehran, Iran Bahareh SASANFAR Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Soodeh RAZEGHI JAHROMI Department of Clinical Nutrition and Dietetics, School of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Soraiya EBRAHIMPOUR KOUJAN Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medi-cal Sciences, Tehran, Iran Saba NARMCHESHM Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medi-cal Sciences, Tehran, Iran Ali RAFEI Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Kazem ZENDEHDEL Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran AND Breast Diseases Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran 2019 06 02 Background: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population. Methods: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based on Iranian food habits and cooking methods. We recruited 244 healthy adults with a mean age of 42.83 ± 0.75 yrs. from healthy individuals who were friends or relatives of patients in the Cancer Institute of Iran from April 2011 to February 2012. We used the DHQ to assess dietary intakes through interviews as well as at least four 24-h recalls one in every season. Reliability was estimated by comparing data of DHQ with mean intake from 24-hour recalls using deattenuated and energy-adjusted Spearman correlation coefficients. We classified dietary intakes of two methods into three groups to probe if DHQ correctly allocates subjects into different intake groups compared to reference method. The results are reported as percent of disagreement, adjacent agreement, and complete agreement. Results: Deattenuated spearman correlation ranged from 0.18 for vitamin B12 and fat to 0.60 for sugar. It ranged from 0.13 for pantothenic acid to 0.60 for sugar in men and from 0.07 for fat to 0.58 for sugar in females. The complete agreement of methods ranged from 51% for selenium to 36% for carotene in the entire sample, from 50% for energy to 31% for niacin in males and from 49% for sugar to 27% for vitamin B12 in females. Conclusion: The DHQ is a valid tool for assessing most nutrients intake among Iranian population. In addition, it is a proper instrument in categorizing individuals based on their dietary intakes.   https://ijph.tums.ac.ir/index.php/ijph/article/view/17344 https://ijph.tums.ac.ir/index.php/ijph/article/download/17344/6412

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 02 1082 1090 Mostafa ENAYATRAD Department of Epidemiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran Parvin YAVARI Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Department of Health and Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Koorosh ETEMAD Department of Epidemiology, Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sohila KHODAKARIM Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sepideh MAHDAVI Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran 2019 06 02 Background: In this study, we used a variety of factors that affect urbanization in Iran to evaluate different provinces in Iran in terms of the level of urbanization. Methods: Using information from census 2011, we collected data on 33 indicators related to urbanization in 31 provinces in Iran. To rank the provinces we used density-based hierarchical clustering scheme. To determine similarities or differences between the provinces, the square of the Euclidean distance dissimilarity coefficient; Ward’s algorithm was used to merge the provinces to minimize intra-cluster variance. One-way analysis of variance (ANOVA) was used to determine the variance between the variables used to rank the provinces in terms of different levels of urbanization. Statistical analysis was performed using SPSS. Results: The provinces in Iran were combined with each other in 30 stages and classified into four levels. Taking into account the variables used to rank the level of urbanization, Tehran, and Alborz provinces were at the highest level of urbanization. On the other hand, the provinces of Sistan and Baluchistan, Kerman, North Khorasan, South Khorasan, Hormozgan, and Bushehr were at the lowest level of urbanization. Conclusion: Identification of provinces at the same level of urbanization can help us to discover the strengths and weaknesses in the infrastructures of each of them. Given the differences between various levels of urbanization, the identification of factors that are effective in the process of urbanization can help to access more information required for designing plans for the years to come.   https://ijph.tums.ac.ir/index.php/ijph/article/view/17345 https://ijph.tums.ac.ir/index.php/ijph/article/download/17345/6413

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 02 1091 1098 Reza ZEIDABADINEZHAD Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Hassan VATANDOOST Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Department of Environmental Chemical Pollutants and Pesticides, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza ABAI Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Navid DINPARAST DJADID Malaria and Vector Research Group, Biotechnology Research Center, Pasteur Institute, Tehran, Iran Abbasali RAZ Malaria and Vector Research Group, Biotechnology Research Center, Pasteur Institute, Tehran, Iran Mohammad Mahdi SEDAGHAT Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohamad Ali OSHAGHI Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Ahmad RAEISI Malaria Control Unit, Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran Neda ADIBI Malaria Control Unit, Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran 2019 06 02 Background: Some mosquito species which belong to the Culex. pipiens complex are primary vectors for West Nile virus, Sindbis, Dirofilaria immitis, and many arboviruses. Knockdown resistance (kdr) mutations in the voltage-gated sodium channel (VGSC) gene of Cx. pipiens that is inherited, is one of the important threats for the efficacy of pyrethroids insecticides. Knockdown resistance (kdr) mutation, L1014F, is a well-defined mechanism of resistance to pyrethroids and DDT in many insect species. The aim of study was to determine the mechanisms of Insecticide resistance in this species Methods: Specimens of Cx. pipiens, the major vector of West Nile virus, were obtained in Tehran, Iran by collecting larvae from polluted wastewater in Qarchak of Tehran. In 2016 Insecticide susceptibility tests were performed according to WHO methods with deltamethrin 0.05%. We focused on determination of this point mutation in the VGSC gene of Cx. pipiens by Real-time PCR. Results: Our results revealed high levels of resistance to deltamethrin 0.05%. The lethal times i.e. LT50 and LT90 for deltamethrin were 2.1530 and 8.5117 h respectively. The result of Real-time PCR confirmed the presence of resistant genotype in all the members of tested population. This study is the first report on kdr genotyping of Cx. pipiens from Tehran and our results on the VGSC gene in position L1014F confirmed the TTA to TTT nucleotide change. Conclusion: This finding will provide a clue for management of insecticide resistance in mosquito which are vectors of arboviruses and decision for replacement of novel approach for vector control.     https://ijph.tums.ac.ir/index.php/ijph/article/view/17346 https://ijph.tums.ac.ir/index.php/ijph/article/download/17346/6414

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 02 1099 1105 Farzaneh AMINHARATI Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Hassan EHRAMPOUSH Department of Environmental Health Engineering, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Mehdi SOLTAN DALLAL Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran Mehdi YASERI Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Abbas Ali DEHGHANI TAFTI Department of Disaster and Emergency Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Zahra RAJABI Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran 2019 06 02 Background: The aim of this study was to assess associations of Citrobacter freundii foodborne outbreaks with environmental factors in various regions of Yazd Province, Iran, 2012–2016. Methods: The public health surveillance data were used for one period of five years reported foodborne disease outbreaks in various regions of the Province. Multilevel regression statistical method was used to analyze associations of climatic and demographic variables with outbreaks. Significant associations were tested using likelihood ratio tests. Results: Results showed a significant association between C. freundii outbreaks and air dust conditions, age groups and various regional cities. Conclusion: The current study revealed necessity of etiologic agent identification for use in foodborne disease outbreak guidance in future outbreaks. Systemic surveillance schemes can help prevent and control similar scenarios using reports of environmental effects on foodborne disease outbreaks.   https://ijph.tums.ac.ir/index.php/ijph/article/view/17347 https://ijph.tums.ac.ir/index.php/ijph/article/download/17347/6415

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 02 1106 1115 Somaye YOSAEE Department of Nutrition, School of Health, Larestan University of Medical Sciences, Larestan, Iran AND Department of Nutrition, Emam Reza Teaching Hospital, Larestan University of Medical Sciences, Larestan, Iran Mahmoud KHODADOST Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Gerash University of Medical Sciences, Gerash, Iran Alireza ESTEGHAMATI Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran John R. SPEAKMAN State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China AND Institute of Biological and Environmental Sciences, University of Aberdeen, Scotland, UK Kurosh DJAFARIAN Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran Vida BITARAFAN Adelaide Medical School and National Health and Medical Research Council of Australia (NHMRC), Center of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Farzad SHIDFAR Department of Nutritional Sciences, School of Public Health, Iran University of Medical Sciences, Tehran, Iran 2019 06 02 Background: Metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, consider as a manifestation of obesity. However, a proportion of obese patients do not develop MetS. The aim of our study was to determine whether concentration of plasma adiponectin and leptin differ between metabolic unhealthy obese (MUO) patients and comparable age- and sex-matched control groups. Methods: In this case-control study, we assigned 51 obese patients with MetS (MUO) in cases group and 102 metabolic healthy obese (MHO) and normal weight metabolic healthy subjects matched for age and gender to cases in control groups. The study was conducted between December 2014 and February 2016 in the Endocrinology Research Center of Tehran University of Medical Sciences , Tehran , Iran.  We measured serum adiponectin, leptin, their ratio, and body composition in all subjects. Results: No significant differences were observed between MHO and MUO in term of total fat mass and trunk fat (P>0.05). Compared to MHO and normal weight metabolic healthy subjects, MUO subjects had lower levels of plasma adiponectin (P<0.001) and lower plasma adiponectin to leptin ratio (P<0.001) and a higher level of plasma leptin (P<0.002). A Receiver Operator Characteristic curve was used to identify the ability of adiponectin and leptin level to predict the MetS. The area under the Receiver Operator Characteristic curve was 0.66 (P<0.01), 0.73 (P<0.001) and 0.75 (P<0.001) for leptin, adiponectin, and adiponectin/leptin ratio levels respectively. Conclusion: Our study introduced adiponectin and leptin as indicator of MetS and obesity respectively.   https://ijph.tums.ac.ir/index.php/ijph/article/view/17349 https://ijph.tums.ac.ir/index.php/ijph/article/download/17349/6416

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 02 1116 1123 Nahid RAMEZANGHORBANI Department of Development and Cooperation of Information and Scientific Publications, Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran Mehrnaz HAJIABEDIN RANGRAZ Department of Development and Cooperation of Information and Scientific Publications, Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran Rosemarie NOOT HEIDARI Department of Development and Cooperation of Information and Scientific Publications, Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran 2019 06 02 Background: Web is considered an important tool for formal and informal communication and cooperation among members of the community including researchers. Universities’ websites played a significant role in the development of social structure through the creation of cyberspace. We aimed to evaluate the growth and Webometrics rankings of the country’s medical universities web sites base on interventional approach. Methods: This interventional study assessed Iranian universities of medical sciences’ websites from the periods of Jan 2015, Jul 2015 and Jan 2016. Medical universities websites were ranked based on four Webometrics indicators; PRESENCE, VISIBILITY, OPENNESS, and EXCELLENCE. To enhance the ranking of websites, 4 strategies were introduced in 3 seminars conducted from Jan to Jul 2015. Information needed from these 30 medical universities were obtained from Webometrics Ranking of World Universities based on 4 indicators and were collected in 2 steps (before and after introduction of strategies) Results: About 21% to 70% of the country’s medical universities have increased ranking after the interventions while 9% to 30% obtained a downward trend in their rankings, Tehran University of Medical Sciences obtained the highest rank followed by Shahid Beheshti University of Medical Sciences and the third rank was obtained by Shiraz University of Medical Sciences. Conclusion: The presence of websites play a vital role in the academic community. Doubtlessly, the idea of designing and launching a website without any knowledge of the principles and standards would be problematic and impossible.     https://ijph.tums.ac.ir/index.php/ijph/article/view/17350 https://ijph.tums.ac.ir/index.php/ijph/article/download/17350/6417

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 6 2019 06 03