Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 7 2018 07 16 944 951 Seyed Mehdi SAJJADI Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran Ali Akbar POURFATHOLLAH Iranian Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran Saeed MOHAMMADI Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran Bijan NOURI Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Rostam HASSANZADEH Iranian Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran Fariba RAD Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran 2018 07 16 2018 07 16   Background: Transfusion transmissible infections (TTIs) are a common complication of blood transfusion. Evaluation and monitoring the prevalence rate of TTIs in blood donors is a valuable indicator of donor selection and blood safety. We analyzed the trends of these infections among blood donors at Kohgiluyeh and Boyer-Ahmad transfusion service (KBTC) during 10 years. Methods: Viral screening and confirmatory tests were carried out on 180304 voluntary donations from 2005-2014. The annual prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infections per 100000 donations and 95% confidence interval were calculated. Chi-square test was applied to obtain the P-value. Results: The overall prevalence was 0.13% for HBV and 0.06% for HCV while there were only three positive cases for HIV. The annual trend fluctuated during the time period studied. Compared to first-time donors, regular and repeat donors were significantly less likely to be positive for these infections. Outstandingly, this study provides first data in TTIs seropositivity rates among blood donors in our region; surprisingly were lower compared to other reports of Iran. Conclusion: The trends of TTIs prevalence in this study provide additional evidence that safety measures employed by the KBTC have been effective in maintaining a safe blood supply. The lower prevalence of TTIs in our study compared with other Iranian studies and also the general population reflects the efficacy of donor selection and education procedures in KBTC.     https://ijph.tums.ac.ir/index.php/ijph/article/view/14035 https://ijph.tums.ac.ir/index.php/ijph/article/download/14035/6034

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 7 2018 07 16 936 943 Niloofar PEYKARI Iranian Non Communicable Diseases Committee (INCDC), Ministry of Health and Medical Education, Tehran, Iran Hassan HASHEMI Iranian Non Communicable Diseases Committee (INCDC), Ministry of Health and Medical Education, Tehran, Iran Gholamreza ASGHARI Food and Drug Organization, INCDC, Ministry of Health and Medical Education, Tehran, Iran Mohammadhadi AYAZI Social Health Deputy, INCDC, Ministry of Health and Medical Education, Tehran, Iran Ghasem JANBABAEI Curative Affairs Deputy, INCDC, Ministry of Health and Medical Education, Tehran, Iran Reza MALEKZADEH Research and Technology Deputy, INCDC, Ministry of Health and Medical Education, Tehran, Iran Alireza RAEISI Public Health Deputy, INCDC, Ministry of Health and Medical Education, Tehran, Iran Ali SADROLSADAT Development Deputy, Management, and Resources, INCDC, Ministry of Health and Medical Education, Tehran, Iran Mohsen ASADI-LARI International Affairs, INCDC, Ministry of Health and Medical Education, Tehran, Iran Aliasghar FARSHAD Occupational Health Research Center, Iran University of Medical Sciences, Tehran, Iran Farshad FARZADFAR Non Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran Mostafa GHANEI Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Ali Akbar HAGHDOOST Planning and Coordination Deputy, INCDC, Ministry of Health and Medical Education, Tehran, Iran Ramin HESHMAT Chronic Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran Hamidreza JAMSHIDI Dept. of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Afshin OSTOVAR Osteoporosis Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran Amirhossein TAKIAN Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran Bagher LARIJANI Iranian Non Communicable Diseases Committee (INCDC), Ministry of Health and Medical Education, Tehran, Iran 2018 07 16 2018 07 16 Background: Non-Communicable disease (NCDs) is a killer of people that needs to urgent actions across the world. Scientific evidence is the critical arm for effective interventions. Therefore, we aimed to quantify the trend of four main NCDs’ scientific publication in a 17-yr period, and reflect international collaboration. Methods: This scientometric study on four main NCDs; cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases were carried out through the narrative review in international databases of Scopus from 2000 to 2016. In this way, the number of articles, citations, and international collaboration were assessed, and the frequently used terms on non-communicable diseases were mapped by VOSviewer software. Results: Over the 17 years, 25827 articles about four main NCDs by Iran indexed in Scopus have increasing trend steadily. However, chronic obstructive respiratory publications have slow trend. The number of articles, citations, and h index of cancer-related publications was higher than the others. Diabetes, cardiovascular diseases, and chronic respiratory diseases scientometrics indicators state in next positions, respectively. The most collaborative country was USA in the four areas, and there was not seen region countries’ collaboration in top ten levels. The frequently used terms in NCDs’ articles in order were diabetes, cardiovascular diseases, and breast cancer. Conclusion: Iran provides appropriate face of cancer, diabetes, and cardiovascular diseases publications in the mirror of NCDs’ scientometry. However, there is need for more effort in chronic respiratory diseases researches, and strengthen collaboration with regional countries.   https://ijph.tums.ac.ir/index.php/ijph/article/view/14034 https://ijph.tums.ac.ir/index.php/ijph/article/download/14034/6033

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 7 2018 07 16 1034 1036 Bili ZHANG Dept. of Obstetrics, Xiamen Maternity and Child Health Care Hospital, Xiamen 361003, China Xueqin ZHANG Dept. of Obstetrics, Xiamen Maternity and Child Health Care Hospital, Xiamen 361003, China Yijing WANG Dept. of Obstetrics, Xiamen Maternity and Child Health Care Hospital, Xiamen 361003, China 2018 07 16 2018 07 16   Idiopathic chylous ascites in pregnancy is extremely rare. Here, we report a 24-yr-old patient with idiopathic chylous ascites in pregnancy. The patient was hospitalized in Xiamen Maternity and Child Health Care Hospital, Xiamen China in 2014 due to G1P0 intrauterine pregnancy 39+2 week, LOA, and time of labor. The patient gave birth to a live baby boy (3.6 kg) by spontaneous vaginal delivery, with complete delivery of placenta. Three hours after delivery, the patient reported abdominal distension and pain, as well as asthma. Later, milky white liquid was drawn from left lower abdomen by puncture. Exploratory laparotomy was performed, and 800 ml milky white liquid was drawn from the abdominal cavity. Subsequently, drainage tube was placed in the abdominal cavity, and the abdomen was closed. After the surgery, the patient was given low-fat diet, supplemented with parenteral nutrition support and intravenous injection of antibiotics. Extubation was performed on day 3. On day 7 after surgery, the mother and baby left the hospital without any health problems. No abnormality was observed during six months of follow-ups. Idiopathic chylous ascites in pregnancy may be related to congenital lymphatic system dysplasia, and directly caused by chylous flow from ducts into abdominal cavity induced by progesterone during pregnancy or pressure from enlarged uterus during late pregnancy. After pregnancy, the disease is cured by the release of disease cause and the reduction of thoracic duct pressure.     https://ijph.tums.ac.ir/index.php/ijph/article/view/14051 https://ijph.tums.ac.ir/index.php/ijph/article/download/14051/6046

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 7 2018 07 16 1037 1038 Wi-Young SO Sports and Health Care Major, College of Humanities and Arts, Korea National University of Transportation, Chungju-si 27469, Korea Taikyeong Ted. J EONG Dept. of Business Intelligence, CHA University, Pocheon, Gyeonggi-do, Korea 2018 07 16 2018 07 16 Resistance Training Data Analysis on Blood and Personal Pro-files for Customized Healthcare https://ijph.tums.ac.ir/index.php/ijph/article/view/14052 https://ijph.tums.ac.ir/index.php/ijph/article/download/14052/6047

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 7 2018 07 16 952 957 Bin YANG Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Chunyan ZHENG Medical Consultation Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Haichu YU Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Rui ZHANG Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Shan LI Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Lijuan TAN Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Min LENG Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China Shanglang CAI Dept. of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003 China 2018 07 16 2018 07 16 Background: We compared treatments with the antiplatelets ticagrelor and clopidogrel used in patients with acute myocardial infarction (AMI) during the perioperative period for emergency percutaneous coronary intervention (PCI). Methods: A total of 120 patients were selected and randomly divided into control and observation groups (60 patients in each) from 2014- 2016 at The Affiliated Hospital of Qingdao University. The patients in the control group received 300 mg clopidogrel and 300 mg aspirin for oral administration, while those in the observation group were given 180 mg ticagrelor and 300 mg aspirin orally prior to the PCI. During the operation, heparinization and a tirofiban micro-pump were used continuously. Results: Coronary artery and peripheral venous blood were extracted from each patient to obtain various parameters of thrombelastogram (TEG), and the maximum platelet aggregation rates in order to compare antiplatelet effects. Major adverse cardiac events (MACE) were recorded during the following 6-month follow-up. Analysis of the data showed no differences in terms of the time span between medication intake and stent implantation, or the dosage of heparin and tirofiban used between the two groups. Before stent implantation, and 24 and 48 h after the procedure the average R and K values of TEG in coronary artery blood and peripheral venous blood samples in the observation group were longer than those in the control group, while the α angle, MA, CI, MARAA and MARADP values were lower (P<0.05). Conclusion: Ticagrelor can improve antiplatelet treatment for patients with AMI during the perioperative period of emergency PCI.   https://ijph.tums.ac.ir/index.php/ijph/article/view/14036 https://ijph.tums.ac.ir/index.php/ijph/article/download/14036/6035

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 7 2018 07 16 1030 1033 Majid EMTIAZY Dep. of Traditional Medicine‚ Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd , Iran AND The Research Center of the Iranian Traditional Medicine‚ Shahid Sadoughi University of Medical Sciences‚ Yazd‚ Iran Elham ZAREIE Dep. of Traditional Medicine‚ Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran Laila SHIRBEIGI Dep. of Iranian Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran Omid SADEGHPOUR Dept. of Herbal Medicine, Research Institute for Islamic & Complementary Medicine‚ Iran University of Medical Sciences‚ Tehran, Iran Parvin MANSOURI Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran 2018 07 16 2018 07 16 A 32-yr-old man with a 10-yr history of scalp seborrhea referred le> 673 683 Junjing ZHAO Medical Department, Binzhou Central Hospital, Bingzhou 251700, P.R. China Jianping ZHANG Ward 1, Department of Neurology, Gaotang People's Hospital, Gaotang 252800, China Yongxia BU Central Sterile Supply Department, Binzhou People's Hospital, Bingzhou 251700, P.R. China Wei LU Cerebrovascular and Neurological Severe Cases, Linzi District People's Hospital, Zibo 255400, P.R. China Gejin ZHAO Department of Neurosurgery for Professional Clinical Medicine, Linzi District People's Hospital, Zibo 255400, P.R. China 2019 11 23 2020 07 20 Background: We aimed to explore the treatment and safety of subarachnoid hemorrhage. Methods: A retrospective analysis was applied on 137 patients with subarachnoid hemorrhage treated in Binzhou Central Hospital, Bingzhou, China from March 2015 to October 2018.  Seventy cases with interventional embolization of intracranial aneurysms were divided as the observation group, and 67 cases with craniotomy for aneurysm clipping were divided as the control group. The changes of immune globulins before and after surgery, CD4+, CD8+, NIHSS scores, BI scores, the total effective rate of subarachnoid hemorrhage, the total length of postoperative hospital stay and conditions of postoperative complications as well as 30-day survival were compared between the two groups. Results: The levels of Ig G, Ig M, Ig A, and CD4+ after surgery in the observation group were significantly lower than those before surgery (P<0.05), but significantly higher than those in the control group (P<0.05); the total time of postoperative hospitalization in the observation group was shorter than that in the control group (P<0.05). The incidence of intracranial infection and cerebral vasospasm in the observation group was significantly lower than that in the control group (P<0.05). The NIHSS score of the observation group was significantly lower than that of the control group (P<0.05), and the BI score was significantly higher than that of the control group (P<0.05). Conclusion: Patients with subarachnoid hemorrhage undergoing interventional embolization of aneurysms can reduce the impact on immune function, decrease the adverse reactions caused by treatments, shorten the length of hospital stay and fully improve the efficacy. https://ijph.tums.ac.ir/index.php/ijph/article/view/18975 https://ijph.tums.ac.ir/index.php/ijph/article/download/18975/6881

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 684 692 Qingyuan SHEN College of Information & Business, Zhongyuan University of Technology, Zhengzhou, China Binbin CHANG College of Information & Business, Zhongyuan University of Technology, Zhengzhou, China Guoyu YIN Pingdingshan Branch of Henan Rural Credit Union, Pingdingshan, China Wendong WANG School of Law, Anqing Normal University, Anqing, China 2020 02 14 2020 03 09 Background: Currently, China is carrying forward “Healthy China” construction. Thus, health investment has gradually become an important issue concerned by the Chinese government. Exploring the influence of health investment on economic growth under this background is of great theoretical and realistic significance for realizing economic transformation and upgrading in China. Methods: Thirty-one provincial regions in China were selected as research objects. Based on the panel data during 2000-2017, difference-generalized method of moment (D-GMM) and system-generalized method of moment (S-GMM) were comprehensively used to estimate the dynamic panel model from the national perspective, combining the fixed effects model (FE) estimation method to estimate the static panel model from the regional perspective, so as to investigate the relationships among governmental, residential health investment, and economic growth. Results: First, the governmental and residential health investments have positive effects on economic growth. Second, from the perspective of different regions, the governmental and residential health investments present positive correlations with economic growth, but the correlations present a progressively decreasing trend from the east to west. Conclusion: The Chinese government needs to steadily increase governmental health investment, elevate the level of residents' health expenditure, promote the development of the health industry, and finally facilitate sustainable economic growth in China. https://ijph.tums.ac.ir/index.php/ijph/article/view/19736 https://ijph.tums.ac.ir/index.php/ijph/article/download/19736/6882

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 693 700 EN Jinchang YANG School of Safety Science and Emergency Management, Wuhan University of Technology, Wuhan, Hubei, China Wei YAN Department of Finance, Guangxi Financial Vocational College, Nanning, Guangxi, China 2020 01 21 2020 03 09 Background: Incidents of violence, such as school bullying, are mainly caused by excessive mental stress of students, which will also lead to all kinds of psychologically unsafe behaviors. The emotion regulation ability of students and the safety atmosphere level of campus will be considerably conducive to relieving the mental stress of students. This study aims to analyze the relationships of mental stress and regulatory emotional self-efficacy (RES) among students and campus safety atmosphere with their psychosocial safety behaviors (PSB). Methods: A total of 120 class teachers and 365 students from three junior high schools in Henan Province, China were selected as the study objects in 2019. Then, middle school students and RES, campus safety atmosphere, and PSB scales were assessed through a mental stress scale. Results: Mental stress (r=–0.8) of middle school students and campus safety atmosphere (r=0.86) had a significant negative and positive influence on their PSB, respectively. RES played a mediating role in the negative correlation between the mental stress of middle school students and their PSB (r=–0.57). Campus safety atmosphere could moderate the relationship between mental stress and RES (r=0.12). Campus safety atmosphere could moderate the mediating effect on the relationship between mental stress of middle school students and their PSB. Conclusion: Mental stress of middle school students will give rise to the occurrence of their psychologically unsafe behaviors. The improvement of the campus safety atmosphere level can effectively mitigate the mental stress of students to reduce the occurrence of unsafe behaviors. https://ijph.tums.ac.ir/index.php/ijph/article/view/19504 https://ijph.tums.ac.ir/index.php/ijph/article/download/19504/6883

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 701 710 EN Zahra HOSSEINKHANI Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Saharnaz NEDJAT Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mahboubeh PARSAEIAN Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Fatemeh VEISI HAMPA Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran Hamidreza HASSANABADI Department of Educational Psychology, Kharazmi University, Tehran, Iran 2018 07 30 2018 09 01 Background: Academic stress is one of the factors affecting the health of adolescents. The aim of present study was to design an academic stress questionnaire for Iranian adolescents with regard to the cultural and educational system of the country. Methods: After reviewing the literature and identifying available tools in 2018, Iranian adolescents' views on academic stress were extracted. Similar questions have been used in other tools. According to expert opinion, the results were overviewed and the initial version was designed. The steps of content validity and instrument reliability were carried out. Internal consistency was investigated with Cronbach's alpha (α) and repeatability with Intra Class Correlation (ICC). After dividing the data into two randomized samples, exploratory factor analysis (EFA) with 899 subjects and confirmatory factor analysis (CFA) with 717 subjects were performed. The association between this tool and the Morgan and Jink’s Self Efficacy Scale and the Strengths and Difficulties Questionnaire questionnaires was investigated. Data were analyzed using SPSS and Mplus softwares. Results: The Iranian Adolescent Academic Stress Questionnaire (IAASQ) was designed with 57 questions. Relevancy and clarity of the whole tool were obtained as 0.81 and 0.83, respectively. In different domains, Cronbach's alpha was in the range (0.58-0.85) and ICC (0.80 (95% CI:0.66-0.90)). In the EFA, 9 factors were extracted. CFA confirmed the suitability of the model in another sample. Discriminant and convergent validity tool was approved. Conclusion: The IAASQ questionnaire has acceptable reliability and validity. This tool is recommended for use in related studies in the Iranian community. https://ijph.tums.ac.ir/index.php/ijph/article/view/14253 https://ijph.tums.ac.ir/index.php/ijph/article/download/14253/6884

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 711 717 EN Arezoo FADAVI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Kayhan ASHRAFI Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Hamid HASSANPOUR Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohamad Bagher ROKNI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Seyyed Mostafa HOSSEINI Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Arezoo BOZORGOMID Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Leila HOSSEINPOUR Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Faezeh NAJAFI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Gholamreza MOWLAVI Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2019 08 07 2019 12 09 Background: Efforts to find a reliable non-molecular means of identification has been the main purpose of the current work that always is persuaded by researchers interested in the field of parasitology. Methods: Adult fasciolids were obtained from the slaughterhouses in different parts of Iran in 2017, and investigated using the classical old fashion morphological appearances of the worms implementing a camera lucida equipped microscope. Histological procedure was subsequently performed for almost the entire collected adult worms followed by Hematoxylin and Eosin (H&E) staining technique. DNA extraction and RFLP-PCR technique were carried out for the entire fasciolid liver flukes. To attain more comparable morphological conclusions, Scanning Electron Micrographs were also implemented for two molecularly identified fasciolids.  Results: Based on spine morphology observed in worm’s tissue sections two types of tegumental spines, “pointed” and “molar” shapes have been identified addressing to distinguish F. hepatica and F. gigantica species respectively. The present identification has been also supported by Molecular analysis using RFLP-PCR technique.  Conclusion: There are some hidden morphological characters implemented in species identification for certain helminths. Meanwhile, the emergence of computer image analysis system (CIAS) on the scene of taxonomy, has revolutionized the accuracy of measurement in morphology by employing detailed parameters that have not been regarded before. The current study has illustrated the tegumental spines of two Fasciola species in tissue sections which has not been enough considered in helminthological publications so far. https://ijph.tums.ac.ir/index.php/ijph/article/view/18015 https://ijph.tums.ac.ir/index.php/ijph/article/download/18015/6885

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 718 726 EN Payam ROSHANFEKR Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Mohammad-Reza KHODAIE-ARDAKANI Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran AND Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Homeira SAJJADI Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Hossein MALEK AFZALI ARDAKANI Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2018 05 02 2020 07 20 Background: Despite many efforts, Iran continues to have a high rate of traffic accidents and poor health outcomes. This study aimed to measure income-related inequality for traffic accident health outcomes in Iran, a country with one of the highest rates of traffic accidents and related health problems. Methods: The source of data was a national representative survey named the Iranian Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010). Monthly household income is obtained through self-report in different quarters. Disparity rate ratio (DRR), slop index of inequality (SII) and the population attributable risk percentage measure (PAR%) were calculated. The concentration index (CI) of RTIs was used as our measure of socioeconomic inequality and decomposed into its determining factors. Results: Using the DRR index, in the lowest income group, the risk of death from an accident was 2.3 times, greater and the risk of accidental disability was 11.7 times greater than for the third income quartet. The slope index also shows that the rate of road traffic deaths, disability and injury per 100,000 individuals decreased by 28, 82, and 392 moving from lower to higher incomes. This decrease in injury was about 581 for motorcyclists. CI was -0.04078643 (SE=.01424828, P-value 0.004). Male sex (68.9%), 15-29 yr old age (9.4%), employed activity status (20.8%) has a positive contribution in the RTIs concentration index. Conclusion: In addition to intervention related to the road safety and vehicles and reducing human errors, prevention of the road traffic ill health outcomes requires attention to reduction of inequality in society. https://ijph.tums.ac.ir/index.php/ijph/article/view/13257 https://ijph.tums.ac.ir/index.php/ijph/article/download/13257/6886

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 727 735 EN Firoozeh BAIRAMI Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Amirhossein TAKIAN Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran Ali AKBARI SARI Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Iraj HARIRCHI Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran Minoo Alipouri Sakha Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2017 11 19 2018 04 18 Background: Healthcare systems are always facing increasing public demands to provide better services. Therefore, countries always need more resources and are constantly seeking more fiscal space for health. Freeing up resources through improving efficiency can be a practical option for all settings, particularly countries with low resources. This study aimed to identify feasible options for expanding fiscal space through efficiency within Iran’s healthcare system. Methods: This was a qualitative study. We conducted 29 semi-structured in-depth interviews with stakeholders at various levels of healthcare system in 2017 and 2018. We used mixed method (deductive and inductive) qualitative content analysis. Pre-defined themes extracted from literature and meanwhile new subthemes were developed and added to the initial framework. Results: We identified three main themes that affect the efficiency of healthcare system in Iran: administration, implementation, and monitoring. Problematic administration, inappropriate implementation and lack of good monitoring in healthcare initiatives may lead to inefficiencies and wasting resources. Recognizing these leakages in every healthcare system can free up some resources. Conclusion: Irrespective of their economic development, all countries may, to some extent, face limited resources to address ever-increasing needs in their healthcare systems. While generating new resources is not always possible, enhancing efficiency to expand fiscal space might be a feasible option. Healthcare systems should identify the leakages and respond to wastages with appropriate planning. Getting the most out of current resources is possible through proper administration, good implementation and a well-established monitoring system for healthcare initiatives. https://ijph.tums.ac.ir/index.php/ijph/article/view/11666 https://ijph.tums.ac.ir/index.php/ijph/article/download/11666/6887

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 736 743 EN Zahra AZADMANJIR Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran AND Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran AND National Inistitue for Medical Research Development (NIMAD), Tehran, Iran Zahra MOHTASHAM-AMIRI Guilan Road Trauma Research Center (GRTRC), Guilan University of Medical Sciences, Rasht, Iran Seyed-Mahdi ZIABARI Guilan Road Trauma Research Center (GRTRC), Guilan University of Medical Sciences, Rasht, Iran Leila KOCHAKINEJAD Guilan Road Trauma Research Center (GRTRC), Guilan University of Medical Sciences, Rasht, Iran Hamid HAIDARI Guilan Road Trauma Research Center (GRTRC), Guilan University of Medical Sciences, Rasht, Iran Mina MOHSENI Guilan Road Trauma Research Center (GRTRC), Guilan University of Medical Sciences, Rasht, Iran Hadis SABOUR Brain and Spinal Cord Injury Research Center, Neurosciences Institute, Tehran University of Medical Sciences, Tehran, Iran Zahra KHAZAEIPOUR Brain and Spinal Cord Injury Research Center, Neurosciences Institute, Tehran University of Medical Sciences, Tehran, Iran Mahdi SHARIF-ALHOSEINI Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Zahra GHODSI Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Abbas AMIRJAMSHIDI Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Farshad AKBARZADEH Guilan Road Trauma Research Center (GRTRC), Guilan University of Medical Sciences, Rasht, Iran Kazem ZENDEHDEL Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran Amir AZARHOMAYOUN Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Khatereh NAGHDI Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Gerard OREILLY Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Ellen MERETE 1. Autonomic Unit, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK 2. Institute of Neurology, University College London, London, UK Alexander R Vaccaro Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, USA Edward C BENZEL Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, Ohio, USA Seyed Behzad JAZAYERI Department of Urology, University of Florida, Jacksonville, FL, USA Vafa RAHIMI-MOVAGHAR Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran AND Brain and Spinal Cord Injury Research Center, Neurosciences Institute, Tehran University of Medical Sciences, Tehran, Iran 2018 06 11 2018 10 08 Background: The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center. Methods: This was a mixed-methods study. For the quantitative analysis, a retrospective observational design was used to measure case capture or case identification rate, mapping cases in the registry against those eligible for registry inclusion amongst the register of hospital admissions. For the qualitative component, data was collected using focus group discussions and semi-structured interviews, followed by thematic analysis. Results: From 19 Jun 2016 to 24 Jan 2018, the proportion of case capture (case identification rate) was 17%. The median time between case identification and data entry to the system was 30.5 d (range: 2 to 193 d). Thematic analysis identified a lack of trained human resources as the most important cause of low case identification rate and delay in data completion. Conclusion: Recruitment and education to increase trained human resources are needed to improve case capture, the timeliness of data input and registry sustainability in a regional participating site. https://ijph.tums.ac.ir/index.php/ijph/article/view/13682 https://ijph.tums.ac.ir/index.php/ijph/article/download/13682/6888

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 744 752 EN Younes MOHAMMADI Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran AND Social Determinants of Health Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Manoochehr KARAMI Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran AND Modelling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Nasrin DERAKHSHANZADEH Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran AND Students Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran 2018 04 05 2018 08 27 Background: To estimate under-five mortality rate (U5MR), as one of the sustainable development goals, in rural and urban areas of Iran from 1990 to 2015. Methods: We used the data collected through two censuses and one Demographic and Health Surveys (DHS). We analyzed the Summary Birth History (SBH) data via 2 approaches including Maternal Age Cohort (MAC) and Maternal Age Period (MAP) methods, and then, Gaussian Process Regression (GPR) was used to combine the three trends and with 95% uncertainty. Finally, Ratio of U5MR in rural to urban was calculated. Results: At the national level and in urban areas, U5MR in 1990, 2000, 2010, and 2015 was 66, 34, 18, and 13 per 1000 live births, respectively. Corresponding values in rural areas in 1990, 2000, 2010, and 2015 was 129, 64, 31, and 21 per 1000 live births, respectively. Accordingly, the ratio of U5MR in rural to urban at the national level was 1.93, 1.86, 1.72 and 1.63 in the same years. At the sub-national level, U5MR in urban areas ranged from 11.2 per 1000 live births in Isfahan to 18.2 per 1000 live births in Hormuzagn. U5MR in rural areas ranged from 14.1 per 1000 live births in Isfahan to 29.5 per 1000 live births in Sistan and Baluchistan Conclusion: There is still a gap between rural and urban areas, although it has decreased during the 25 years of the study. To alleviate this gap, health system authorities are advised to plan appropriate actions using multi-sectoral capacities. https://ijph.tums.ac.ir/index.php/ijph/article/view/12967 https://ijph.tums.ac.ir/index.php/ijph/article/download/12967/6889

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 753 762 EN Narges AHANI Department of Biology, Faculty of Sciences, University of Sistan and Baluchestan, Zahedan, Iran Mohammad Hossein SANGTARASH Department of Biology, Faculty of Sciences, University of Sistan and Baluchestan, Zahedan, Iran Majid ALIPOUR ESKANDANI Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, University of Zabol, Zabol, Iran Massoud HOUSHMAND Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran AND Research Center, Knowledge University, Erbil, Kurdistan Region, Iraq 2018 01 29 2018 08 27 Background: Zataria multiflora Boiss. is known by the common Persian name “Avishan-e-Shirazi”, is one of the best-known medicinal herbs belonging to the Labiatae (Lamiaceae) family. The aim of this study was to evaluate the anticancer effects and the underlying mechanisms of how Z. multiflora Boiss., essential oil induced apoptosis in the human colorectal tumor cell lines (HCT116 & SW48). Methods: This study was conducted in National Institute of Genetic Engineering and Biotechnology (NIGEB) (Tehran, Iran) from 2017 to 2019.  The cytotoxicity of this essential oil was assessed by 3- (4,5-di-methylthiazol-2-yl)- 2,5-diphenyltetra-zolium bromide (MTT) assay, trypan blue exclusion, and colony formation assays. We assessed apoptosis and measure intracellular reactive oxygen species (ROS) by flow cytometry. Then gene expression was analyzed by Quantitative Real-Time RT-PCR. Results: Z. multiflora Boiss., essential oil time- and dose-dependently inhibits cell proliferation and also induced apoptosis in both cell lines via UCP2-related mitochondrial pathway by the induction of intracellular ROS. Conclusion: Z. multiflora Boiss., essential oil could be a good candidate for use as an inhibitor of the growth of colorectal tumor cells. https://ijph.tums.ac.ir/index.php/ijph/article/view/12366 https://ijph.tums.ac.ir/index.php/ijph/article/download/12366/6890

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 07 20 763 772 Mostafa EGHBALIAN Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Abbas MOGHIMBEIGI Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran AND Modeling of Noncommunicable Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Marzieh MAHMOODI Department of Biostatistics, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran Iraj MOHAMADFAM Department of Occupational Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Razieh Sadat MIRMOEINI Disease Control & Prevention Center, Deputy of Health Services, Hamadan University of Medical Sciences, Hamadan, Iran 2020 03 28 Background: Accidents were just one of the general health problems. According to WHO forecasts (2013), deaths from road accidents will become the fifth-highest cause of death in the world by 2030. Therefore, we have attempted the application of non-parametric count models for modeling female’s accident rates. Methods: All accidents in Hamadan Province, western Iran are referred to as one of the emergency centers located in the hospitals. Data regarding the accidents were obtained from 21 emergency centers across Hamadan for the period 2009-2016. To assess the trend and pattern of the accidents, the Generalized Additive Model for the accident rate has been utilized. Results: The Mean±SD age of the females in study was 31.23±12.88 yr old. For each of the three kinds of road accidents (car accidents, motor accidents and pedestrian crashes), the accident rates in the “residential urban” areas are lesser than in the “non-residential” area (P=<0.001) and in "public and sports grounds" and "great roads, avenues and streets" are more than in "others". For the three kinds of accidents, the functional effect in the monthly trend of the accidents was signification (P=<0.001). Conclusion: The rates for all three kinds of accidents decreased. The increase in accident rates from the beginning of 2014 to Mar 2016 maybe due to the generalization of insurances in Iran and the increase in the number of accident victims being referred to the hospitals, which was the same with the results of other studies.   https://ijph.tums.ac.ir/index.php/ijph/article/view/20169 https://ijph.tums.ac.ir/index.php/ijph/article/download/20169/6738

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 773 781 EN Hamid Reza TABATABAEE Research Center for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran Atefeh ZAHEDI Department of Public Health, School of Health, Abadan School of Medical Sciences, Abadan, 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 Tannaz VALADBEIGI Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran Sepideh MAHDAVI Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran Mostafa ENAYATRAD Department of Epidemiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran Seideh Zeinab ALMASI Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Halime YAGHOOBI Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Fatemeh ZOLFIZADEH Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Mahmoud HAJIPOUR Department of Epidemiology, Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2018 03 03 2018 08 04 Background: Both Gestational diabetes and hypertension almost affect 10.5% of the pregnancies. This study was conducted to investigate and compare the pregnancy outcomes in women with gestational diabetes or high blood pressure with outcomes belonging to healthy mothers. Methods: This population-based case-control study was conducted in 8 provinces and two cities of Iran on women referred to the public health centers during 2015 to 2018. Descriptive statistics for variables presented by percentages and frequencies and logistic regression analysis was used to analyze data at a significance level of less than 0.05. Results: Some variables such as ethnicity, maternal education and age, gestational diabetes, high blood pressure and previous pregnancy outcome were significantly associated with stillbirth. Maternal age greater than 35 yr (OR=1.78, CI: 1.29-2.48), maternal illiteracy (OR=3.67, CI: 2.25-5.98), a previous stillbirth (OR=9.92, CI: 4.98-19.78), gestational diabetes among women who had never had a screening test (OR =3.91, CI: 2.96-5.18) and high blood pressure (OR =1.95, CI: 1.38-2.77) were important factors associated with stillbirth. Maternal and paternal occupation, paternal education and age, place of residence, smoking and maternal BMI were significantly associated with stillbirth. Conclusion: Gestational diabetes, hypertension, a previous miscarriage, stillbirth, first pregnancy, low education level, advanced maternal age and ethnicity were associated with an increased risk of stillbirth. It is necessary to provide high-quality healthcare services before and during pregnancy particularly for those at heightened risk and improve knowledge of mothers on the side effects of each of the mentioned risk factors in order to control these factors more effectively and thus reducing the risk of stillbirth. https://ijph.tums.ac.ir/index.php/ijph/article/view/12674 https://ijph.tums.ac.ir/index.php/ijph/article/download/12674/6891

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 782 790 EN Kolsoum AHMADI Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran Azam SOLEIMANI Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran Shadi SOLEIMANI MOTLAGH Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran Shahram BAHARVAND AHMADI Department of Internal Medicine, Artesh University of Medical Sciences, Tehran, Iran Mohammad ALMASIAN School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran Ali Asghar KIANI Department of Hematology and Blood Transfusion, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran 2018 04 30 2018 10 08 Background: The present research is a case-control study to analyze the influence of pre-miRNA-146a rs2910164 and pre‑miRNA-499 rs3746444 polymorphisms as candidate susceptibility factors for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Methods: Polymorphism in miR146 and miR499 using ARMS-PCR was genotyped on 139 autoimmune disease (AD) patients (89 RA and 50 SLE) referred to Educational Hospitals of Khorramabad, Lorestan Province, west of Iran in 2018–2019 and 237 healthy control subjects. Results: A significant increase in the likelihood of carrying the GC vs. GG of pre-miR146-rs2910164 and T vs C allele of pre-miR499- rs3746444 in patients with RA was found. On the contrary, patients with RA were less likely to carry the TC + CC vs TT genotype and the C vs T allele of pre-miR499- rs374644. In females with the GC vs GG and GC+ CC vs GG genotypes, a significant association was found with the increased risk of RA. Interestingly, the genotypic combination of TC of the pre-miR499-rs374644 with GG of pre-miR146-rs2910164 more strongly decreased the risk of RA. In patients with SLE, no notable associations were found between both pre-miRNA-146a rs2910164 and pre‑miRNA-499 rs3746444 with risk of disease. Conclusion: Genetic polymorphisms of miR146 rs2910164 is associated with RA susceptibility especially in females. Interestingly, there is a potential in miR499 to reduce the risk with the protective effect of gene-gene interactions on miR146 in RA disease. https://ijph.tums.ac.ir/index.php/ijph/article/view/13240 https://ijph.tums.ac.ir/index.php/ijph/article/download/13240/6892

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 791 799 EN Nasrollah SALEH-GOHARI Department of Medical Genetics, Kerman University of Medical Sciences, Kerman, Iran AND Laboratory of Medical Genetics, Afzalipour Hospital, Kerman, Iran Kolsoum SAEIDI Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran Sima ZIAADINI-DASHTKHAKI Laboratory of Medical Genetics, Afzalipour Hospital, Kerman, Iran 2017 12 20 2018 07 29 Background: β-thalassemia is characterized by reduced synthesis of the hemoglobin beta chain that results in microcytic hypochromic anemia and reduced amounts of hemoglobin A (HbA) on hemoglobin analysis. β-thalassemias are caused by mutations in the β-globin gene, inherited in an autosomal recessive manner. Determining molecular defects in couples carrying β-thalassemia is a prerequisite for prenatal diagnosis of the disease. In this regards, database of β-globin gene haplotypes facilitates mutation detection of the gene and helps genetic counselors to reach the goals of β-thalassemia prevention program. Methods: In this cross-sectional study, 255 couples attended genetic counseling between December 2017 and January 2019 in Afzalipour Hospital, Kerman University of Medical Scinces, Kerman, Iran as suspicious of β-thalassemia carriers. Furthermore, they were investigated using amplification refractory mutations system-polymerase chain reaction and restriction fragment length polymorphism methods for mutation screening and haplotype analysis of polymorphic sites in β-globin gene cluster, respectively. Results: We identified 20 different types of β-globin gene mutation in 449 β-thalassemia carriers. Analysis of the pattern of Hind III/Gγ, Hinf I/5′β, Hinc II/3′Ψβ, Rsa I/5′β, AvaII/β and Hind III/Aγ polymorphic sites in 257 alleles of informative families revealed 17 different haplotypes. Haplotype 1 (77.24%) showed strong linkage with the most common mutation IVSI-5 while haplotype 5 (66.67%) was associated with the second frequent mutation IVSII-1. Conclusion: To our knowledge, these β-globin haplotypes are reported for the first time which are different with those found in other parts of Iran. The current haplotypes pattern data makes the counseling of β-thalassemia carriers more straightforward and the process of mutation screening faster and more accurate. https://ijph.tums.ac.ir/index.php/ijph/article/view/11924 https://ijph.tums.ac.ir/index.php/ijph/article/download/11924/6893

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 800 801 EN Mojtaba MEHTARPOUR Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Ebrahim JAAFARIPOOYAN Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2018 08 07 2018 08 27 Letters to the Editor: no abstract https://ijph.tums.ac.ir/index.php/ijph/article/view/14382 https://ijph.tums.ac.ir/index.php/ijph/article/download/14382/6894

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 802 804 EN Salman KHAZAEI Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran Saeid BASHIRIAN Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Ensiyeh JENABI Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 2018 08 10 2018 08 27 No Abstract https://ijph.tums.ac.ir/index.php/ijph/article/view/14403 https://ijph.tums.ac.ir/index.php/ijph/article/download/14403/6895

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 49 4 2020 04 01 805 807 EN Yanli MA Department of Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China AND Beijing Children's Key Laboratory of Chronic Kidney Disease and Blood Purification, Beijing, China Ying SHEN Department of Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China AND Beijing Children's Key Laboratory of Chronic Kidney Disease and Blood Purification, Beijing, China Xiaomei LIU Beijing Children's Ke