Showing papers in "Iranian Journal of Public Health in 2016"

Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article.

Abstract: Background: Hyperbilirubinemia, or jaundice, is a life threatening disorder in newborns. It is a multifactorial disorder with many symptoms. Generally, the physiological jaundice is the most prevalent type however in some regions pathological jaundice is also common. This review article focuses on a brief introduction to jaundice, its types and causes, measuring the bilirubin level, clinical approaches towards hyperbilirubinemia, different precautionary measures for the parents of babies suffering from hyperbilirubinemia and different remedial therapeutic measures for its treatment. Methods : The main databases including Scopus, Pubmed, MEDLINE, Google scholar and Science Direct were researched to obtain the original papers related to the newborns’ hyperbilirubinemia. The main terms used to literature search were “ newborns’ hyperbilirubinemia”, “newborns’ jaundice”, “Physiological Jaundice” and “Patholigical Jaundice”. The timeframe included the obtained articles was from 1952 to 2015. Results : Neonatal jaundice due to breast milk feeding is also sometimes observed. Hemolytic jaundice occurs because of the incompatibility of blood groups with ABO and Rh factors, when the fetus and mother blood groups are not compatible and the fetus blood crosses the barrier of the umbilical cord before birth causing fetus blood hemolysis owing to severe immune response. Conclusion : Jaundice is easily diagnosable however require quick and on the spot treatment. If not treated properly, it leads to many complications. Currently the treatment options for jaundice include photo therapy, chemotherapy, and vaccinations.

Characterization of Staphylococcus aureus Biofilm Formation in Urinary Tract Infection.

Abstract: Background: The aim of this study was to investigate the antibiotic susceptibility pattern as well as the phenotypic and genotypic biofilm formation ability of Staphylococcus aureus isolates from patients with urinary tract infection (UTI). Methods : A total of 39 isolates of S. aureus were collected from patients with UTI. The antibiotic susceptibility patterns of the isolates were determined by the Kirby-Bauer disk-diffusion. We used the Modified Congo red agar (MCRA) and Microtiter plate methods to assess the ability of biofilm formation. All isolates were examined for determination of biofilm related genes, icaA , fnbA , clfA and bap using PCR method. Results : Linezolid, quinupristin/dalfopristin and chloramphenicol were the most effective agents against S. aureus isolates. Overall, 69.2% of S. aureus isolates were biofilm producers. Resistance to four antibiotics such as nitrofurantoin (71.4% vs. 28.6%, P =0.001), tetracycline (57.7% vs. 42.3%, P =0.028), erythromycin and ciprofloxacin (56% vs. 44%, P =0.017) was higher among biofilm producers than non-biofilm producers. The icaA , fnbA and clfA genes were present in all S. aureus isolates. However, bap gene was not detected in any of the isolates. Conclusion : Our findings reinforce the role of biofilm formation in resistance to antimicrobial agents. Trimethoprim-sulfamethoxazole and doxycycline may be used as an effective treatment for UTI caused by biofilm producers S. aureus . Our results suggest that biofilm formation is not dependent to just icaA , fnbA , clfA and bap genes harbor in S. aureus strains.

Physical Activity and Colorectal Cancer

Abstract: Colorectal cancer is one of the most common cancers in the world. In developed countries 60% of the populations are at risk of this cancer, and colorectal cancer is considered as 10% and 11% of newly diagnosed cancers among men and women, respectively (1). The Europe Society of Gastroenterology declared that colorectal cancer is the most common cancer in 2000. The incidence of colorectal cancer varies in different parts of the world, so that the highest incidence is visible in developed countries such as America, Australia, West Europe and New Zealand and lowest in countries such as South of America, Africa and Asia (2, 3). Colorectal cancer is a multifactorial disease with a set of genetic and environmental factors. In this disease a series of factors such as lifestyle, nutrition and physical activity play a key role in susceptibility to cancer. The role of physical activity in susceptibility to colorectal cancer has received special attention; so that the findings resulted out of most of these studies indicate the effect of physical activity in reducing the risk of suscptibility to colorectal cancer (4, 5). In fact, there is a reverse relationship between physical activity and colorectal cancer, in such a way that the risk of colorectal cancer in people with physical activity in their free time is 27% less than people without physical activity are (6). Severe physical activity is associated with the reduced risk of colon cancer, so that the relative risk of proximal and distal colon cancer in severe physical activity group compared with no physical activity group was 0.73(95% CI, 0.66–0.81), and 0.74 (95% CI, 0.68–0.80), respectively (7). People who have a history of continuous physical activity during the past 20 yr have more benefits from the protective effects of exercise in reducing the risk of occurrence of colon cancer (4). In men and women with high physical activity, incidence of colorectal cancer compared to those with little or no physical activity reduced by 40%–50% (8). In people that during their leisure time had at least 60 min of daily physical activity compared to those who had physically active for 10 min or less, the hazard ratio of colorectal cancer was 0.57 (95% CI, 0.41–0.79). Hazard ratio for colon cancer was 0.56 (95% CI, 0.37–0.83) and for rectal cancer was 0.59 (95% CI, 0.34–1.02) (9). In recent years, mechanisms by which physical activity reduces the risk of colorectal cancer, were not entirely clear, albeit assumptions such as changes in the material in gastrointestinal transmit time, changes in immune function as well as changes in prostaglandin levels, insulin, insulin-like growth factors, bile acid secretion, serum cholesterol as well as pancreatic and gastrointestinal hormone profiles are presented. There is currently limited empirical data in epidemiologic studies on humans and animals in order to approve each of these mechanisms in reducing the risk of colorectal cancer; therefore, it is probable that beneficial effect of physical activity in reducing colorectal cancer has been due to the combined effects of these factors and other unknown factors (10). Doctors recommend physical activity for the general population with the aim of reducing the burden related to colorectal cancer. However, doctors do not need a full understanding of this mechanism. Therefore, in health education programs and medical advice for reducing the risk of colorectal cancer, physicians must pay particular attention to the protective effect of exercise and physical activity, and at the same time conduct scientific and biological surveys to achieve a clearer understanding of the beneficial mechanisms of physical activity in reducing risk of colorectal cancer.

Mosquito Surveillance and the First Record of the Invasive Mosquito Species Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) in Southern Iran.

Abstract: Background: Epidemics of mosquito-borne viral infections such as dengue, chikungunya, West Nile and Rift Valley fevers in neighbouring countries and risk of introduction of exotic vectors into Iran have placed this country at a significant risk for these mosquito-borne diseases. Methods: After the first dengue case reported in Iran in 2008, active entomological surveillance of Aedes albopictus (Skuse) and Ae. aegypti (Linnaeus) were conducted in May/Jun, Sep, and Oct/Nov, 2008-2014. Based on occurrence of dengue cases and the presence of potential entry sides including ports and boarder gates, 121 sites in eight provinces were monitored for mosquito vectors. Larval collections were carried out using droppers or dippers and adult collections with CDC light traps, human landing catches, aspirator and Pyrethrum spray space catches. Results: A total of 8,186 larvae and 3,734 adult mosquitoes were collected belonging to 23 Culicinae species, including 13 of the genus Culex , 1 Culiseta , 1 Uranotaenia , and 8 of the genus Aedes . Five Aedes albopictus larvae were identified from the Sistan & Baluchestan province bordering Pakistan in 2009. In 2013, seven Ae. albopictus adult mosquitoes were also collected in a coastal locality near the city of Chabahar in the same province. Conclusion: The detection of larvae and adults of this species in different parts of this province reveal its probable establishment in southeast Iran, which has implications for public health and requires active entomological surveillance as well as the implementation of vector control to prevent the further spread of this critical vector. Keywords: Aedes albopictus , Dengue, Introduction, DNA barcoding, Iran

Evaluating the High Risk Groups for Suicide: A Comparison of Logistic Regression, Support Vector Machine, Decision Tree and Artificial Neural Network.

Abstract: Background: We aimed to assess the high-risk group for suicide using different classification methods includinglogistic regression (LR), decision tree (DT), artificial neural network (ANN), and support vector machine (SVM). Methods: We used the dataset of a study conducted to predict risk factors of completed suicide in Hamadan Province, the west of Iran, in 2010. To evaluate the high-risk groups for suicide, LR, SVM, DT and ANNwere performed. The applied methods were compared using sensitivity, specificity, positive predicted value, negative predicted value, accuracy and the area under curve. Cochran-Q test was implied to check differences in proportion among methods. To assess the association between the observed and predicted values, O coefficient, contingency coefficient, and Kendall tau-b were calculated. Results: Gender, age, and job were the most important risk factors for fatal suicide attempts in common for four methods. SVM method showed the highest accuracy 0.68 and 0.67 for training and testing sample, respectively. However, this method resulted in the highest specificity (0.67 for training and 0.68 for testing sample) and the highest sensitivity for training sample (0.85), but the lowest sensitivity for the testing sample (0.53). Cochran-Q test resulted in differences between proportions in different methods ( P <0.001). The association of SVM predictions and observed values, O coefficient, contingency coefficient, and Kendall tau-b were 0.239, 0.232 and 0.239, respectively. Conclusion: SVM had the best performance to classify fatal suicide attempts comparing to DT, LR and ANN.

Identifying Important Risk Factors for Survival in Kidney Graft Failure Patients Using Random Survival Forests

Abstract: Background: Kidney transplantation is the best alternative treatment for end-stage renal disease. Several studies have been devoted to investigate predisposing factors of graft rejection. However, there is inconsistency between the results. The objective of the present study was to utilize an intuitive and robust approach for variable selection, random survival forests (RSF), and to identify important risk factors in kidney transplantation patients. Methods: The data set included 378 patients with kidney transplantation obtained through a historical cohort study in Hamadan, western Iran, from 1994 to 2011. The event of interest was chronic nonreversible graft rejection and the duration between kidney transplantation and rejection was considered as the survival time. RSF method was used to identify important risk factors for survival of the patients among the potential predictors of graft rejection. Results: The mean survival time was 7.35±4.62 yr. Thirty-seven episodes of rejection were occurred. The most important predictors of survival were cold ischemic time, recipient's age, creatinine level at discharge, donors’ age and duration of hospitalization. RSF method predicted survival better than the conventional Cox-proportional hazards model (out-of-bag C-index of 0.965 for RSF vs. 0.766 for Cox model and integrated Brier score of 0.081 for RSF vs. 0.088 for Cox model). Conclusion: A RSF model in the kidney transplantation patients outperformed traditional Cox-proportional hazard model. RSF is a promising method that may serve as a more intuitive approach to identify important risk factors for graft rejection.

Prevalence of Posttraumatic Stress Disorder among Breast Cancer Patients: A Meta-analysis.

Abstract: Background: Prevalence estimates of Posttraumatic Stress Disorder (PTSD) among breast cancer patients varied widely in existing studies. This study aimed to provide an overall prevalence estimate of PTSD among breast cancer patients, and the prevalence estimates related to specific PTSD diagnosis tools. Methods: Systematic search of relevant articles was made from seven databases. Freeman-Tukey Double Arcsine Transformation was used to estimate the overall prevalence of PTSD. Sub-group and meta-regression analyses were used to investigate the between-study sources of heterogeneity. Publication bias was examined using Egger’s funnel plot and Begg test. Results: The pooled prevalence of PTSD among breast cancer patients was [9.6%, 95% confidence intervals (95% CI )=7.9-11.5%]. Studies that used Clinician Administered PTSD Scale-Form (CAPS) method alone yielded much higher prevalence (19.0%, 95% CI =13.1-25.5%, n=5) than three or fourth edition Structured Clinical Interview for Diagnostic and Statistical Manual (SCID) method alone (3.0%, 95% CI = 2.2-3.9%, n=11). Prevalence estimates for studies that used the methods: PTSD Checklist—Civilian Version (PCL-C) cut-off, PCL-C cluster, and Impact of Event Scale (IES) cut-off were (7.0%, 95% CI = 3.9-10.8%, n=10), (11.5%, 95% CI = 8.6-15.6%, n=11) and (15.1%, 95% CI = 12.3-18.2%, n=4), respectively. Heterogeneity between-study was substantial ( I 2 =44.9–92.3%). Conclusion: About 9.6% of the breast cancer patients would develop the PTSD symptoms. Those who were younger, non-Caucasian and recently completed treatment would be at a greater risk of developing PTSD.

Adropin- A Novel Biomarker of Heart Disease: A Systematic Review Article

Abstract: Background: Heart disease is one of the most common chronic disease and leading cause of morbidity and mortality worldwide. Adropin, a newly identified protein, is important for energy homeostasis and maintaining insulin sensitivity, and has been referred to as a novel regulator of endothelial cells. Endothelial dysfunction is a key early event in atherogenesis and onset of HD. Therefore, this review gives a systematic overview of studies investigating plasma adropin level in patient with heart disease. Methods: Data carried out in PubMed, Scopus, Web of Science, Embase, Google scholar and MEDLINE, from the earliest available online indexing year through 2015. The search restricted to studies conducted in humans. The keyword search was adropin to apply in title, abstract and keywords. References lists of all original published articles were scanned to find additional eligible studies. Results: Heart failure (HF), coronary atherosclerosis acute myocardial infarction and Cardiac Syndrome X (CSX) were type of heart disease acknowledged in this study. Majority of evidences introduced low adropin as an independent risk factor of heart disease. In a case-control study, the plasma level of adropin increased with the severity of HF. Conclusion: Adropinmay be a potential serum biomarker for early diagnosis of HD.

Assessing Predictive Validity of Pressure Ulcer Risk Scales- A Systematic Review and Meta-Analysis.

Abstract: Background: The purpose of this study was to present a scientific reason for pressure ulcer risk scales: Cubbin& Jackson modified Braden, Norton, and Waterlow, as a nursing diagnosis tool by utilizing predictive validity of pressure sores. Methods: Articles published between 1966 and 2013 from periodicals indexed in the Ovid Medline, Embase, CINAHL, KoreaMed, NDSL, and other databases were selected using the key word “pressure ulcer”. QUADAS-Ⅱ was applied for assessment for internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4. Results: Seventeen diagnostic studies with high methodological quality, involving 5,185 patients, were included. In the results of the meta-analysis, sROC AUC of Braden, Norton, and Waterflow scale was over 0.7, showing moderate predictive validity, but they have limited interpretation due to significant differences between studies. In addition, Waterlow scale is insufficient as a screening tool owing to low sensitivity compared with other scales. Conclusion: The contemporary pressure ulcer risk scale is not suitable for uninform practice on patients under standardized criteria. Therefore, in order to provide more effective nursing care for bedsores, a new or modified pressure ulcer risk scale should be developed upon strength and weaknesses of existing tools.

Providing Healthcare Services at Home-A Necessity in Iran: A Narrative Review Article.

Abstract: Background: Increasing hospital costs and its social and cultural problems has led to the idea of providing healthcare services at home. Because of infrastructural and implementation problems, providing healthcare at home in Iran has not been initiated yet. Therefore, this study set out to elaborate the need for a comprehensive system in order to provide this service in Iran. Methods : All articles published in indexing sites with the defined keywords in English or Farsi were gathered. The indexing websites included Iran Medex, PubMed Central, Elsevier journals, WHO publications and Google scholar from 1985 to 2014 were surveyed. Other documents included the related books and regulations. Results : Despite of having dominant religious values and constitution laws related to stability of family relations and establishment of clinical services and health care at home in Iran, providing health care services faces some harsh challenges including ignoring entrepreneurship and lack of required infrastructures such as lack of required insurance regulations, the inappropriate and indifferent performance of some activists home services and absence of registration and identification system in this domain. Conclusion : Because of the increasing number of elderly people in Iran and healthcare costs becoming more and more expensive, establishing a system for providing healthcare at home is inevitable.

Prevalence of Virulence Factors and Vancomycin-resistant Genes among Enterococcus faecalis and E. faecium Isolated from Clinical Specimens.

Abstract: Background: The aim of this study was to determine the occurrence of virulence determinants and vancomycin- resistant genes among Enterococcus faecalis and E. faecium obtained from various clinical sources. Methods: The study was performed on the 280 enterococcal isolated from clinical specimens in Hamadan hospitals, western Iran in 2012-14. Antibiotic susceptibility testing was performed using disk diffusion and Minimal Inhibitory Concentration (MIC) methods. The presence of vancomycin-resistant genes and virulence genes was investigated using PCR. Results: Totally 280 enterococcal isolates were identified as follows: E. faecalis (62.5%) , E. faecium (24%) and Enterococcus spp (13.5%). The results of antibiotic susceptibility testing showed that resistance rates to vancomycin and teicoplanin in E. faecalis and E. faecium isolates were 5% and 73%, respectively. Of Sixty vancomycin-resistant Enterococci strains, fifty-one isolates were identified as E. faecium ( VREfm ) and nine as E. faecalis ( VREfs ). Prevalence of esp, hyl, and asa 1 genes were determined as 82%, 71.6%, and 100%, respectively in E. faecium strains; and 78%, 56/6%, and 97%, respectively in E. faecalis strains. Conclusion: The increased frequency of VREF, as seen with rapid rise in the number of vanA isolates should be considered in infection control practices.

Psychiatric Disorders Are Associated with an Increased Risk of Injuries: Data from the Iranian Mental Health Survey (IranMHS).

Abstract: BACKGROUND: Injuries and psychiatric disorders, notably both major public health concerns, are associated with a high burden and are believed to be bi-directionally correlated. Those inflicted with injuries face increased risks of mental illnesses. Psychiatric disorders may make the individual prone to injuries. The objective of the study was to assess the correlation of mental disorders with non-fatal injuries. METHODS: A total of 7886 participants aged 15 to 64 yr were interviewed in a national household survey in 2011 in Iran. Composite International Diagnostic Interview (CIDI v2.1) was implemented to assess the prevalence of psychiatric disorders in the past twelve months. Injuries were assessed using Short Form Injury Questionnaire (SFIQ-7). RESULTS: Injury was reported in 35.9% and 22.8% of participants in the past twelve and past three months, respectively. Using multivariate logistic regression analysis, mental disorders were significantly associated with injuries in the past three months (OR=1.6, 95% CI:1.36-1.87), recurrent injuries (OR=1.7, 95% CI: 1.21-2.41) and road/traffic accidents (OR=2.4, 95% CI: 1.28-4.49). CONCLUSION: Psychiatric disorders were found to be associated with an increased risk of injuries. Early detection and treatment of mental illnesses can contribute to injury prevention. Language: en

Impact of Article Page Count and Number of Authors on Citations in Disability Related Fields: A Systematic Review Article

Abstract: Background: Citation metrics and total publications in a field has become the gold standard for rating researchers and viability of a field. Hence, stimulating demand for citation has led to a search for useful strategies to improve performance metric index. Meanwhile, title, abstract and morphologic qualities of the articles attract researchers to scientific publications. Yet, there is relatively little understanding of the citation trend in disability related fields. We aimed to provide an insight into the factors associated with citation increase in this field. Additionally, we tried to know at what page number an article might appear attractive to disability researchers needs. Thus, our focus is placed on the article page count and the number of authors contributing to the fields per article. Methods: To this end, we evaluated the quantitative characteristics of top cited articles in the fields with a total citation (³50) in the Web of Science (WoS) database. Using one-way independent ANOVA, data extracted spanning a period of 1980-2015 were analyzed, while the non-parametric data analysis uses Kruskal-Walis test. Results: Articles with 11 to 20 pages attract more citations followed by those within the range of zero to 10. Articles with upward 21 pages are the least cited. Surprisingly, articles with more than two authors are significantly ( P <0.05) less cited and the citation decreases as the number of authors increased. Conclusion: Collaborative studies enjoy wider utilization and more citation, yet discounted merit of additional pages and limited collaborative research in disability field is revealed in this study.

Construct Validity of Symptom Checklist-90-Revised (SCL-90-R) and General Health Questionnaire-28 (GHQ-28) in Patients with Drug Addiction and Diabetes, and Normal Population

Abstract: Background: Given that validity is the baseline of psychological assessments, there is a need to provide evidence-based data for construct validity of such scales to advance the clinicians for evaluating psychiatric morbidity in psychiatric and psychosomatic setting. Methods : This comparative cross-sectional study aimed to investigate the construct validity of the Malaysian version of the GHQ-28 and the SCL-90-R. The sample comprised 660 individuals including diabetics, drug dependents, and normal population. The research scales were administered to the participants. Convergent and discriminant validity of both scales were investigated by Confirmatory Factor Analysis (CFA) using AMOS. The Pearson correlation coefficient was utilized to obtain the relationship between the two scales. Results : The internal consistency of the GHQ-28 and SCL-90-R were highly acceptable, and confirmatory factor analysis confirmed the convergent validity of both scales. The results of this study revealed that the construct validity of GHQ-28 was acceptable, whereas discriminant validity of SCL-90-R was not adequate. According to Pearson correlation coefficient the relationships between three common subscales of the GHQ-28 and SCL-90-R were significantly positive; somatization (r=0.671, P <0.01), Anxiety (r=0.728, P <0.01), and Depression (r=0.660, P <0.01). Conclusions : This study replicated the construct of the Malaysian version of GHQ-28, yet failed to support the nine-factor structure of the SCL-90-R. Therefore, multidimensionality of the SCL-90-R as clinical purposes is questionable, and it may be a better unitary measure for assessing and screening mental disorders. Further research need to be carried out to prove this finding.

Berberine Induced Apoptosis of Human Osteosarcoma Cells by Inhibiting Phosphoinositide 3 Kinase/Protein Kinase B (PI3K/Akt) Signal Pathway Activation

Abstract: Background: Osteosarcoma is a malignant tumor with high mortality but effective therapy has not yet been developed. Berberine, an isoquinoline alkaloid component in several Chinese herbs including Huanglian, has been shown to induce growth inhibition and the apoptosis of certain cancer cells. The aim of this study was to determine the role of berberine on human osteosarcoma cell lines U2OS and its potential mechanism. Methods : The proliferation effect of U20S was exanimed by 3- (4,5)-dimethylthiahiazo (-z-y1)-3,5-di- phenytetrazoliumromide (MTT) and the percentage of apoptotic cells were determined by flow cytometric analysis. The expression of PI3K, p-Akt, Bax, Bcl-2, cleavage-PARP and Caspase3 were detected by Western blott. Results : Berberine treatment caused dose- dependent inhibiting proliferation and inducing apoptosis of U20S cell. Mechanistically, berberine inhibits PI3K/AKT activation that, in turn, results in up-regulating the expression of Bax, and PARP and down-regulating the expression of Bcl-2 and caspase3. In all, berberine can suppress the proliferation and induce the apoptosis of U2OS cell through inhibiting the PI3K/Akt signaling pathway activation. Conclusion : Berberine can suppress the proliferation and induce the apoptosis of U2OS cell through inhibiting the PI3K/Akt signaling pathway activation.

The Evaluation of Hospital Performance in Iran: A Systematic Review Article.

Abstract: Background: This research aimed to systematically study and outline the methods of hospital performance evaluation used in Iran. Methods: In this systematic review, all Persian and English-language articles published in the Iranian and non-Iranian scientific journals indexed from Sep 2004 to Sep 2014 were studied. For finding the related articles, the researchers searched the Iranian electronic databases, including SID, IranMedex, IranDoc, Magiran, as well as the non-Iranian electronic databases, including Medline, Embase, Scopus, and Google Scholar. For reviewing the selected articles, a data extraction form, developed by the researchers was used. Results: The entire review process led to the selection of 51 articles. The publication of articles on the hospital performance evaluation in Iran has increased considerably in the recent years. Besides, among these 51 articles, 38 articles (74.51%) had been published in Persian language and 13 articles (25.49%) in English language. Eight models were recognized as evaluation model for Iranian hospitals. Totally, in 15 studies, the data envelopment analysis model had been used to evaluate the hospital performance. Conclusion: Using a combination of model to integrate indicators in the hospital evaluation process is inevitable. Therefore, the Ministry of Health and Medical Education should use a set of indicators such as the balanced scorecard in the process of hospital evaluation and accreditation and encourage the hospital managers to use them.

Determination of Pesticides Residues in Cucumbers Grown in Greenhouse and the Effect of Some Procedures on Their Residues.

Abstract: Background: The objective of this study was to determine the residual concentrations of ethion and imidacloprid in cucumbers grown in greenhouse. The effect of some simple processing procedures on both ethion and imidacloprid residues were also studied. Methods: Ten active greenhouses that produce cucumber were randomly selected. Ethion and imidacloprid as the most widely used pesticides were measured in cucumber samples of studied greenhouses. Moreover, the effect of storing, washing, and peeling as simple processing procedures on both ethion and imidacloprid residues were investigated. Results: One hour after pesticide application; the maximum residue levels (MRLs) of ethion and imidacloprid were higher than that of Codex standard level. One day after pesticide application, the levels of pesticides were decreased about 35 and 31% for ethion and imidacloprid, respectively, which still were higher than the MRL. Washing procedure led to about 51 and 42.5% loss in ethion and imidacloprid residues, respectively. Peeling procedure also led to highest loss of 93.4 and 63.7% in ethion and imidacloprid residues, respectively. The recovery for both target analytes was in the range between 88 and 102%. Conclusion: The residue values in collected samples one hour after pesticides application were higher than standard value. The storing, washing, and peeling procedures lead to the decrease of pesticide residues in greenhouse cucumbers. Among them, the peeling procedure has the greatest impact on residual reduction. Therefore, these procedures can be used as simple and effective processing techniques for reducing and removing pesticides from greenhouse products before their consumption.

Factors Associated with the Social Support of Hemodialysis Patients.

Abstract: Background: Support has been gradually acknowledged as a significant factor that exerts a positive influence on hemodialysis patients' lives as well as on the outcome of the disease The purpose was to explore factors associated with social support of hemodialysis patients Methods: The sample studied consisted of 258 patients undergoing hemodialysis in public hospitals in Athens, Greece during 2015 Data collection was performed by the method of the interview using a specially designed questionnaire, which included the Multidimensional Scale of Perceived Social Support for the assessment of social support from significant others, family and friends as well as patients’ socio-demographic, clinical and other characteristics Results: Of the 258 participants, 539% were male and 65% were over 60 yr Regard to social support, patients felt highly supported by their significant others and their family (median 6 for both subscales) and less by their friends (median 45 neutral support levels) In terms of patients' characteristics, statistically significant association of support from significant others and family was observed with marital status ( P <0001 and P <0001 respectively), place of residence ( P <0001 and P <0001 respectively) and the number of children ( P =0002 and P =0007 respectively) Furthermore, statistically significant association of support from friends was observed with age ( P <0001), marital status ( P =0002), and place of residence ( P =0017) Conclusion: Socio-demographic, clinical characteristics and patients' perceptions are associated with perceived Social Support Provision of holistic individualized care to hemodialysis patients demands assessment of social support in the daily clinical practice

Prevalence of Urogenital Mycoplasmas in Iran and Their Effects on Fertility Potential: A Systematic Review and Meta-Analysis

Abstract: Background : Urogenital mycoplasmas are potentially pathogenic species causing genitourinary tract infections that may be initially asymptomatic but can progress and lead to severe complications and threaten reproductive health However, the overall prevalence rate of this bacterium and its probable impacts on fertility potential have yet to be determined Methods : We searched both English and Persian electronic databases using key words such as " Mycoplasma ," " Ureaplasma ," " M hominis ," " M genitalium ," " U urealyticum ," " U parvum ," "prevalence," and "Iran" Finally, after some exclusion, 29 studies from different regions of Iran were included in our study, and a meta-analysis was performed on collected data Results : Urogenital mycoplasmas prevalence for women and men was high and ranged from 2%–405% and 2%–443%, respectively The pooled prevalence in the male population was 111% (95% CI, 74%–164%) and in female was 128% (95% CI, 98%–165%) The prevalence of these bacteria was significantly higher in infertile men compared with that in fertile men A high level of heterogeneity was observed for both men (I 2 = 924%; P <0001) and women (I 2 = 933%; P <0001) Some evidence for publication bias was observed in both men [Egger’s test (two-tailed P =00007), and Begg’s test (two-tailed P =00151)] and women [Egger’s test (two-tailed P =00006), and Begg’s test (two-tailed P =00086)] analysis Conclusion : Since urogenital mycoplasmas may play a role in male infertility, screening strategies, particularly for asymptomatic individuals, and treatment of infected ones, which can reduce consequent complications, looks to be necessary

Correlation Assessment of Climate and Geographic Distribution of Tuberculosis Using Geographical Information System (GIS)

Abstract: Background: Tuberculosis (TB) spread pattern is influenced by geographic and social factors. Nowadays Geographic Information System (GIS) is one of the most important epidemiological instrumentation identifying high-risk population groups and geographic areas of TB. The aim of this study was to determine the correlation between climate and geographic distribution of TB in Khuzestan Province using GIS during 2005-2012. Methods: Through an ecological study, all 6363 patients with definite diagnosis of TB from 2005 until the end of September 2012 in Khuzestan Province, southern Iran were diagnosed. Data were recorded using TB- Register software. Tuberculosis incidence based on the climate and the average of annual rain was evaluated using GIS. Data were analyzed through SPSS software. Independent t -test, ANOVA, Linear regression, Pearson and Eta correlation coefficient with a significance level of less than 5% were used for the statistical analysis. Results: The TB incidence was different in various geographic conditions. The highest mean of TB cumulative incidence rate was observed in extra dry areas ( P = 0.017). There was a significant inverse correlation between annual rain rate and TB incidence rate (R= -0.45, P = 0.001). The lowest TB incidence rate (0-100 cases per 100,000) was in areas with the average of annual rain more than 1000 mm ( P = 0.003). Conclusion: The risk of TB has a strong relationship with climate and the average of annual rain, so that the risk of TB in areas with low annual rainfall and extra dry climate is more than other regions. Services and special cares to high-risk regions of TB are recommended.

Technical Efficiency of Hospitals in Tehran, Iran

Abstract: Background: Nowadays, restriction on access and optimum use of resources is the main challenge of development in all organizations. Therefore, the aim of this study was to determine the technical efficiency and its factors, influencing hospitals of Tehran. Methods : This research was a descriptive-analytical and retrospective study conducted in 2014-2015. Fifty two hospitals with public, private, and social security ownership type were selected for this study. The required data was collected by a researcher-made check list in 3 sections of background data, inputs and outputs. The data was analyzed by DEAP 1.0.2, and STATA-13 technique. Results : Seventeen (31/48) of hospitals had the efficiency score of 1 as the highest technical efficiency. The highest average score of efficiency was related to social security hospitals as 84.32, and then the public and private hospitals with the average of 84.29 and 79.64 respectively. Tobit regression results showed that the size, type of practice, and ownership of hospitals were effective on the degree of their technical efficiency. However, there was no significant correlation between teaching / non-teaching hospitals with technical efficiency. Conclusion : Establishment of competition system among hospitals, constitution of medium size hospitals and allocation of budget to hospitals based on national accreditation system are recommended.

A Stochastic Model for the Ethanol Pharmacokinetics.

Abstract: Background: The aim of this study was to propose a new stochastic model to study the time course of ethanol elimination in human bodies. Methods: The times and amount of alcohol ingested are assumed to be random in controllable intervals. Constant elimination rate follows zero order kinetics and is replaced by first order kinetics when the effects of alcohol increase due to alcohol ingestion. Simulation studies of three different models were made to compare the statistical characteristics of the ethanol effects obtained using analytical expressions. For each model, three cases were considered depending on the drinking pattern and by classifying the drinker as heavy, normal or sparse. Results: From the model formulation, we noted that as the rate of drinking increases for a given elimination rate, the expected time between overflows goes towards zero. Furthermore, as the average amount of alcohol in each drink increases, the corresponding time between overflows decreases. Conclusion: Variations in times of alcohol intakes as well as the amount of alcohol consumption can be accounted through the final created formula. The model proves that overflows occur when alcohol is ingested before the adverse effects of alcohol from the previous drink are completely eliminated. Being the first stochastic model of such a kind, we do hope that it will throw more light on interpreting experimental data of alcohol abuse. Keywords: Alcohol ingestion, Elimination rate, Overflow, Multiple doses, Zero order kinetics, First order kinetics

Cardiac Hydatid Cyst: A Case Report

Abstract: Hydatid disease commonly involves liver but in rare cases, it can involve cardiac structures. A 75-yr-old farmer from Parsabad-Moghan, northwestern Iran was presented to the Emergency Room of Tehran Imam Khomeini Hospital, Tehran, Iran with dyspnea and without chest pain in 2014. A lesion compatible with hydatid cyst was found in echocardiography and confirmed by serology and MRI. Surgical treatment was done but the patient was died in recovery room because of cardiac arrhythmia. In endemic areas, hydatid cyst should be considered in differential diagnosis of heterogeneous echogenic lesions even if the serologic tests are negative. Physician can use cardiac MRI to earn valuable information about the lesion and its relation to other structures. However, with all of these assessments, surgical removal of cardiac cysts may have some complications.

Physician Dual Practice: A Descriptive Mapping Review of Literature.

Abstract: Background: Physician dual practice is a common phenomenon in almost all countries throughout the world, which could potential impacts on access, equity and quality of services. This paper aims to review studies in physician dual practice and categorize them in order to their main objectives and purposes. Methods: Comprehensive literature searches were undertaken in order to obtain main papers and documents in the field of physician dual practice. Systematic searches in Medline and Embase from 1960 to 2013, and general searches in some popular search engines were carried out in this way. After that, descriptive mapping review methods were utilized to categorize eligible studies in this area. Results: The searches obtained 404 titles, of which 81 full texts were assessed. Finally, 24 studies were eligible for inclusion in our review. These studies were categorized into four groups - "motivation and forces behind dual practice", "consequences of dual practice", "dual practice Policies and their impacts", and "other studies" - based on their main objectives. Our findings showed a dearth of scientifically reliable literature in some areas of dual practice, like the prevalence of the phenomenon, the real consequences of it, and the impacts of the implemented policy measures. Conclusion: Rigorous empirical and evaluative studies should be designed to detect the real consequences of DP and assess the effects of interventions and regulations, which governments have implemented in this field.

Are Women of East Kazakhstan Satisfied with the Quality of Maternity Care? Implementing the WHO Tool to Assess the Quality of Hospital Services.

Abstract: Background: To evaluate the satisfaction of mothers with the quality of care provided by maternity institutions in East Kazakhstan on the basis of the “Quality of hospital Care for mothers and newborn babies, assessment tool” (WHO, 2009). Methods: This cross-sectional study took place in 2013 and covered five maternity hospitals in East Kazakhstan (one referral, two urban and two rural). To obtain information, interviews with 872 patients were conducted. The standard tool covered 12 areas ranging from pregnancy to childcare. A score was assigned to each area of care (from 0 to 3). The assessment provided the semi-quantitative data on the quality of hospital care for women and newborns from the perception of mothers. Results: The average satisfaction score was 2.48 with a range from 2.2 to 2.7. The mean age of women was 27.4 yr. Forty-two percent were primiparas. Mean birth weight was 3455.4 g. All infants had ‘skin to skin’ contact with their mothers immediately after birth. Mean number of antenatal visits to family clinics was 8.6. Only 42.1 % of the respondents used contraceptives while the rest were not aware of contraception, never applied it and could not distinguish between different methods and devices. Conclusions: The quality of care was substandard in all institutions. To improve the quality of care, WHO technologies in perinatal care could be applied.

Breastfeeding Education: Where Are We Going? A Systematic Review Article.

Abstract: Background: UNICEF (United Nations International Children's Emergency Fund) and WHO estimate that if all babies were breastfed for at least the first six months of their lives, the rate of morbidity and malnutrition would significantly decrease all over the world. In this view, these two organizations promoted a worldwide campaign for breastfeeding, creating the Baby Friendly Hospital Initiative (BFHI) that encourages good practices for the promotion of breastfeeding in hospitals. The aim of our study was to review the available evidence regarding the positive effects of breastfeeding, in order to suggest to most appropriate strategy to support it. Methods: The main databases including Scopus, PubMed, MEDLINE, Google scholar and Science Direct were researched to obtain the original papers related to breastfeeding education. The main terms used to literature search were "Breastfeeding education", Breastfeeding support", and “Breastfeeding healthcare policy”. The timeframe included the obtained articles was from 1980 to 2015. Results: Our analysis confirms that healthcare providers play a pivotal role in education and encouraging mothers to begin and continue breastfeeding. In this view, the adequate training of healthcare providers seems to be mandatory in order to support this practice. Moreover, adequate facilities are needed in order to promote and support breastfeeding. Conclusion: Considering the available evidence, breastfeeding should be supported among all the mothers. Based on the positive data emerging from the public awareness campaign in different Countries of the world, we strongly encourage an accurate training for doctors and midwives and the implementation of adequate facilities in order to support breastfeeding.

Antifungal susceptibility analysis of clinical isolates of Candida parapsilosis in Iran.

Abstract: Background: Candida parapsilosis is an emergent agent of invasive fungal infections. This yeast is one of the five most widespread yeasts concerned in invasive candidiasis. C. parapsilosis stands out as the second most common yeast species isolated from patients with bloodstream infections especially in neonates with catheter. Recently several reports suggested that its reduced susceptibility to azoles and polyene might become a cause for clinical concern, although C. parapsilosis is not believed to be intensely prone to the development of antifungal resistance. Methods: In the present report, One hundred and twenty clinical isolates of C. parapsilosis complex were identified and differentiated by using PCR-RFLP analysis. The isolates were then analyzed to determine their susceptibility profile to fluconazole (FLU), itraconazole (ITC) and amphotericin B. The minimum inhibitory concentration (MIC) results were analyzed according to the standard CLSI guide. Results: All of isolates were identified as C. parapsilosis. No C. metapsilosis and C. orthopsilosis strains were found. Evaluation of the antifungal susceptibility profile showed that only three (2.5%) C. parapsilosis were resistant to fluconazole, three (2.5%) C. parapsilosis were resistant to itraconazole and two (1.7%) C. parapsilosis were amphotericin B resistant. Conclusion: Profiles in clinical isolates of C. parapsilosis can provide important information for the control of antifungal resistance as well as distribution and susceptibility profiles in populations.

Work task and job satisfaction predicting low back pain among secondary school teachers in Putrajaya

Abstract: IntroductionMusculoskeletal Disorders (MSDs) is a global issue and is considered as one of the most common and expensive occupational health problem (1). MSDs can be divided into eight body parts, which are one or both thighs, one or both hands, one or both legs, shoulder, elbow, neck, upper back pain and LBP. Almost half of the adult population suffers from low back pain, which lasts for more than two days in a year (2). Those who have low back pain were observed to develop other psychological, social and physical health problems (3). MSDs among workers increase financial loss due to work absences, medical treatment, early retirement and poor work performances (4-6).School teachers have been indicated in previous studies to report high prevalence of MSDs (7). This prevalence ranges between 39% and 95% (8). MSDs is also reported as one of the main causes of poor health among retired school teachers (4). Some researchers believed that several work factors were significant in predicting musculoskeletal disorders among school teachers such as lifting of heavy load, prolonged sitting, improper posture, walking up and down stairs, writing on board and prolonged computer use (9-11). Other significant factors were gender, age, psychological framework of teachers including anxiety and low job satisfaction as well as psychosocial work factors such as lack of social support and high psychologically work demand (9-13).Teachers form the majority of the government workforce in Malaysia, thus their health and performance are vital for the overall productivity of the Malaysian government education service. Good teachers' performance encourages the production of good students as well as increases the education standard among Malaysian schoolchildren. Although many studies have dealt with MSDs among occupational groups in other countries, data on the exact nature and prevalence of this important health problem is limited in Malaysia especially among teachers. A previous study on low back pain was conducted only among primary school teachers (9). Identifying the potential causes of MSDs among school teachers is therefore important to assist in improving productivity among teachers. Knowledge on the prevalence of LBP and associated risk factors are important basic information that can provide practical guidance for minimizing teachers' exposure and in preventing LBP among them.This study aims to determine the prevalence of LBP among secondary school teachers in Putrajaya and its potential factors; a) socio-demographic factors b) teachers' work factors c) teachers' satisfac - tion d) knowledge and awareness on LBP. Findings of this study may help in identifying the main factors for MSDs among school teachers which may enhance the current preventive measures, if available, to be more efficient and cost effective. Prevention strategies against LBP can only be successful if its contributory and associated risk factors are identified and better understood.MethodsStudy Location and Study PopulationThe selected locations were secondary schools in Wilayah Persekutuan, Putrajaya. In Putrajaya from February to March 2015, there were 11 secondary schools of which two were boarding and religious schools (14). Four schools in Putrajaya were selected randomly from a list obtained from the Ministry of Education's website. Thirty teachers were selected randomly from the teachers' name list obtained for each selected school. One hundred and twenty secondary school teachers participated in this study with the inclusion criteria of full time/permanent posts and minimum of one-year teaching experience. This study location was chosen because of the school facilities available, proximity to town and their location in an urban area. Urban schools normally have large number of pupils. As a result, there is an increase in job demand with extra responsibility and additional workload among the teachers. The study population was secondary school teachers who have suffered and who have not suffered LBP throughout their job career from four secondary schools in Putrajaya. …

Carcinogen Risk Assessment of Polycyclic Aromatic Hydrocarbons in Drinking Water, Using Probabilistic Approaches.

Abstract: Background: This study was focused on the probability of carcinogen risk of low-level ingestion and dermal exposure with polycyclic aromatic hydrocarbons (PAHs) from drinking water in Tehran, capital of Iran. Methods: Concentrations of 16 PAHs were measured in the tap, bottled and heated tap water in four different seasons. Using a questionnaire-based survey, exposure with PAHs from drinking water was evaluated via direct ingestion, swimming, washing and showering. Finally, a comprehensive risk assessment was performed in four age groups. Rank correlation was used to represent variability in risk analysis and obtained coefficients were used for sensitivity analysis. In addition, Monte Carlo simulation was implemented to determine risk probability distributions and to calculate cumulative probability of the total risks in different age groups. Results: The lifetime average daily dose and the dermal absorbed dose were 0.69E-06 and 1.33E-05 mg/kg/day, respectively. The total estimated excess lifetime cancer risk (ELCR) of ingestion and dermal exposure were 1.57E-05 and 17.24E-05. Conclusion: Sum of estimated ingestion and dermal ELCR was 18.81E-05, which was higher than the acceptable value recommended by WHO. It means a total of 1504 lifetime cancer cases in residents of Tehran. Monte Carlo simulation indicated that risk probability above the acceptable level was 96.2% in dermal exposure. Moreover, sensitivity analysis indicated that tap water consumption (P spearman >0.92) and washing activities (P spearman >0.95) had the greatest correlation on the cancer risk.

Can Opium Use Contribute to a Higher Risk of Colorectal Cancers? A Matched Case-control Study in Iran

Abstract: Background: Colorectal cancers (CRCs) including colon, rectum and anal cancers are the third most prevalent cancers in the world There are strong evidence showing the risk of the cigarette smoking, alcohol use, low physical activity and some types of diets in CRCs; however, few studies explored the relationship between opium use and CRCs This study aimed to investigate the association between opioid use and the incidence of CRCs Methods: In a population-based matched case-control study in Kerman, Iran, 175 patients with colorectal cancers and 350 healthy controls (matched for age, sex, and place of residence) were interviewed from Sep 2014 to Nov 2014 Opium and its derivatives, cigarette, alcohol, and diet use were collected using a valid and reliable questionnaire Conditional logistic regression was used to estimate odds ratios with 95% confidence intervals Results: The use of opioids was associated with an increased risk of CRCs (adjusted odds ratio= 4 5, 95% CI: 2 4-8 7) In addition, a dose-response relationship was observed between the cumulative use of opioids and the incidence of CRCs (with low use OR=3 7; 95% CI: 1 5-8 6 and high use OR= 8 0; 95% CI: 2 9-21 7) This dose-response relationship was also strong in patients with colon cancers, with OR= 3 9 (95% CI: 1 5-9 9) and 9 4 (95% CI: 3 3-27 0) for the low and high uses of opioids, respectively Conclusion: Opioid use can lead to an increased risk of CRCs Therefore, it is necessary to implement preventive policies to control the use of opioids