Background

This study sought to determine the level of adherence to Coartem© in the routine treatment of uncomplicated malaria among children under the age of five years in Nyando district, Kenya.

Methods:

Seventy-three children below the age of five years with microscopically confirmed uncomplicated Plasmodium falciparum malaria and prescribed Coartem® during the normal outpatient department hours were included into the study on 27th of April to 15th of May 2009. Adherence was assessed through a semi-structured interviewer administered questionnaire; pill count and blister pack recovery. Patients were then classified into three categories of adherence. Patients who had tablets remaining in the blister pack were classified as definitely non-adherent. Those who had blister pack missing or empty and the caretaker did not report administering all the doses at the correct time and amount were considered probably non-adherent or as probably adherent when the caretaker reported administering all doses at the correct time and amount.

Results:

Nine (14.5%) patients were definitely non-adherent, 6 (9.7%) probably non-adherent and 47 (75.8%) probably adherent. The most significantly left tablet was the sixth doses (P = 0.029).

Conclusion:

Caretakers should be made much aware that non-adherence might not only be dangerous to child’s health but also dramatically increase the financial cost for public-health services.

Background:

In the recent years, advances in medical technologies for end stage cancer patients’ care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists’ viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.

Methods:

In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.

Results:

During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.

Conclusion:

Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians’ communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.

Background:

The objective of this study was to assess the magnitude of the cutaneous leishmaniasis (CL) disease and identification of the causative agent by nested-PCR for current control strategy.

Methods:

This study was carried out as descriptive house-to-house visits in Orzoieh district in Kerman Province, south–east Iran, during 2011–2012. A questionnaire was completed for each individual consisting of demographic and clinical data. Suspected individuals were examined by direct smear microscopy and subsequent identification by nested-PCR. X2-test was used for any significance (P<0.05).

Results:

A total of 18308 inhabitants (mean age; 22.7 yr) consisting of 9011 males (49.2%) and 9297 females (50.8%) were examined for the presence of active or chronic lesions. The overall prevalence was 4.7%, including 30 cases of active and 839 cases of scar, distributed more significantly (P<0.01) in females (5.2%) than males (4.3%). Individuals <10 years of age showed the highest (6.3%) and >50 years the lowest rate of CL disease, respectively (P<0.001). The proportion of infection was the highest in Soltanabad (14.7%), followed by Vakilabad (6.8%), Dolatabad (3.2%) and Shahmaran (2.8%). The majority of cases had 2 lesions (mean; 2.1 lesions). Hand was the most common site of involvement (35%), and then face (26%), and multiple locations (39%). Nested-PCR displayed 29 isolates as Leishmania major and one isolate L. tropica. The CL disease first emerged in 1998 as epidemic in the area and appeared endemics, thereafter.

Conclusion:

L. major was the sole species caused ZCL. These findings are necessary for future control programs and strategic planning.

Background

Human Development Index (HDI) is a composite indicator that can show the impact of economic strategies on human life standards. The index is calculated by three main factors of income, education and health. This research studies the status of HDI across the Iranian provinces, its changes over time and the efficiency of provinces in using resources.

Methods:

The data for 2001 and 2009 was obtained from the Iranian Center of Statistics. Data envelopment analysis technique was used to analyze the data. To calculate the efficiency, Banker, Charnes and Cooper’s model was used.

Results:

The national mean for the HDI in 2001 was 0.717 while it grew to 0.747 in 2009. Except for one province, all others had an improved human development index. Low ranked provinces such as Sistan & Baluchistan and Kurdistan stayed at the bottom in 2009 as well. Some provinces such as Bushehr with developing oil industries, or those purposively benefited from national oil income showed good growth. In some provinces, such as Hormozgan, out-migration of manpower to its neighboring province, Bushehr, was associated with decrease of the provincial income level. The number of efficient provinces increased from 5 to 13 in 2009.

Conclusion:

Iran falls among countries with high human development index based on the 2009 data. However, the distribution of HDI status across provinces was highly varied and the difference between high- and low-developed provinces increased in 2009. The government needs to revise policies concerning distribution of resources among the provinces.

Background

The science and technology health plan has defined the outline of health research to the national vision of Iran by 2025. The aim of this study was to focus on the process of needs assessment of health research projects also health research priority setting in Iran.

Methods:

The project management life cycle has four phases: Initiation, Planning, Execution and Closure. Based on abovementioned points we conducted the study.

Results:

Focusing on the needs assessment led to systematic implementation of needs assessment of health project in all of the medical sciences universities. Parallel with this achieved strategies health research priority setting was followed through specific process from empowerment to implementation.

Conclusion:

We should adopt with more systematic progressive methods of health project managements for both our national convenience as well as our international health research programs.

An earthquake was happened on 23 October 2011 in Van, Turkey (Mw7.2) at the eastern most area of Anatolian plateau and in the neighborhood of Iranian border (West Azerbaijan Province). The study was performed based on field and office observations and has been focused on the process of disaster management in Turkey after the 23 October 2011 earthquake. We surveyed the quake from the view point of disaster management, and study the relief process during and after the catastrophe. The day-to-day disaster management procedure in seventeen days after the event has been scrutinized as well. The number of victims and extent of damage in Van earthquake was relatively limited according to the national experiences and recent modernization of infrastructures in Turkey. The Van earthquake caused 644 deaths and demolishing of several buildings in the cities of Van and Erciş in Van Province. The performance of the government organizations is however criticized based on their response to the event.

Background:

The purpose of this study was to examine whether lifestyle-related factors, such as frequency of drinking and smoking, mental stress, sleep duration, economic status, and education level, are associated with obesity (as defined given by the WHO report on Asia) in a selected sample of Korean adults.

Methods:

The subjects were 1,566 adults (505 men, 1,061 women) aged over 20 years who visited a public health center for medical checkups in Seoul, Korea, between November 1, 2010, and October 30, 2011. The association between lifestyle-related factors and obesity was assessed by using multivariate logistic regression analysis after adjusting for gender, age, frequency of drinking and smoking, mental stress, sleep duration, economic status, and education level.

Results:

Only economic status and education level significantly predicted obesity; very rich people and people who completed high school, college, or higher were less likely to be obese.

Conclusion:

Therefore, frequency of smoking and drinking, sleep duration, and level of stress were not associated with obesity but economic status and educational level significantly predicted obesity.

Background:

This is a cross-sectional study aiming at analyzing the relation between falling and domestic environmental –risk factors in community-dwelling elderly.

Methods:

The study consisted of 243 randomly chosen community-dwelling elderly over 65 years of age living around a health care center in Central Selcuklu, Konya. Data were collected with a questionnaire form including socio-demographic and other characteristics, with the Rivermead Mobility Index for evaluating mobility condition and an Evaluation Form of Domestic Environmental Risk Factors of Falling (EFDERF), which is developed by the researcher to assess domestic environmental risk factors of falling.

Results:

Based on (EFDERF) high number of problems lived in bathroom/restroom, kitchen, bedroom, sitting room/saloon and in all other areas was a risk factor in terms of domestic falling characteristics while the number of problems lived in hall and stairs was not a significant risk factor.

Conclusion:

EFDERF may be used by the nurses and health professionals to evaluate risk of falling and collecting data after visits in primary-care of elderly.

Background

Geographic Tongue is a benign disorder involving the dorsal surface of the tongue characterized by depapillated areas with leading and folded edges in yellowish or grayish white color and sometimes with unclear borders. Many studies have reported a relationship between such condition and different risk factors. This study aimed to investigate the prevalence rate and the risk factors of geographic tongue in the patients referring to the Department of Oral Medicine of Zahedan Dental School, in 2012.

Methods:

Using Poisson regression model, 2000 patients referred to the Department were selected for this cross-sectional study. Data collection method included an investigation into the medical history as well as doing intraoral examinations. Using SPSS 17 software and Chi-square statistical test, the collected data were analyzed.

Result:

Among the 2000 patients selected, 7.8% (156 persons) suffered from geographic tongue. The results of our study show that there is a significant relationship between the occurrence of geographic tongue and a history of allergy and fissured tongue (P<0.001). There was no significant statistical relationship between the occurrence of geographic tongue and gender, smoking and medication.

Conclusion:

The geographic tongue is more frequently in the patients suffering from atopy or allergy as well as the patients with fissured tongue.

Background:

Preparing long term reformatory plan for the health system, like other macro plans, requires guiding principles which is according to the values, and as a bridge, connect the ideals and values to the goals. This study was designed with the purpose of explaining the values and principles of health system, and as a pre-requisite to compilation of Iran’s health system reform plan at 2025.

Method:

The document of values and principles of health system reform plan for 2025 was developed by reviewing the literature and receiving the opinions of senior experts of health system, and was criticized in focus group discussion sessions of experts and decision makers.

Results:

The values of Iran are: dignity of human, the right to maximum attainable level of health, comprehensive health, equity and social cohesion. The principles of this health system include: institutionalizing the ethical values, responsiveness and accountability, equitable access (utilization), prevention and health promotion, community participation, inter-sectoral collaboration, integrated stewardship, benefit from innovation and desired technology, human resources promotion and excellence and harmony.

Conclusion:

Based on the perception of cultural and religious teachings in Iran, protecting of human dignity and human prosperity are the ultimate social goal. In this sense, health and healthy humans, in its holistic concept (physical, mental, social health and spiritual) are the center and development in any form should lead to the human prosperity in a way that each of the individuals could enjoy the maximum attainable level of health in its holistic meaning and in a faire manner.

Background:

High cholesterol levels are associated with increased risk of coronary heart disease and stroke. Understanding the distribution of serum cholesterol levels in each country is valuable index for use in public health planning. This study aimed to construct nomograms of total cholesterol (TC) levels and establish the cut-points specific to Iranian population.

Methods:

Data on serum TC levels of 19,630 non-institutionalized individuals aged 25–64 years from third national survey on non-communicable diseases (SuRFNCD) in 2007 were used to construct cholesterol nomograms. We proposed cutoff values for borderline and high TC levels based on rounded 75th and 90th percentiles in three age groups (25–34, 35–44 and 45–64) respectively.

Results:

Average yearly increase of TC for males up to the age of 45 and females up to 64 were 1.15 and 1.03 mg/dl, respectively. TC levels were higher in females. In males, cutoff values for “borderline and high” TC levels were 195 and 220 mg/dl in 25–34, 210 and 240 mg/d in 35–44 and 215 and 245 mg/dl in 45–64 years old individuals. In women, these values were 200 and 225 mg/dl in 25–34,215 and 240 mg/dl in 35–44 and 235 and 265 mg/dl in 45–64 years old individuals respectively.

Conclusion:

Since TC levels are different in two sexes and change with age, we proposed different cutoffs for sex and age group. We think these cutoffs could be used in national public health planning.

Background

Drug abuse is a problem that causes a wide array of social, emotional, and physical problems and involves both patients and the society. Helping the addicted has always been a priority for physicians and especially psychiatrists. The purpose of this prospective study was to compare the effects of methadone and naltrexone in general well-being of patients undergoing these treatments.

Methods:

Forty-six patients who were taking either methadone or naltrexone were selected and evaluated for a period of 5 months using a 28-item questionnaire about their general health.

Results:

In spite of the fact that patients undergoing methadone treatment had more severe symptoms and prognoses regarding their age, duration of drug abuse, and number of treatment attempts, these patients showed better general health and social functioning comparing to patients undergoing naltrexone treatment during the 6-month period of this study (P<0.000).

Conclusion:

Methadone might be regarded as an effective and useful medicine in treatment of addiction.

Background:

Healthy lifestyle habits during adolescence can prevent many of the diseases and disabilities in adulthood and later. The aim of the study was to examine the role of education in improving lifestyles among Iranian adolescents.

Methods:

This group randomized controlled trial was conducted during October 2010 until January 2011 in Tehran. Participants for this study were selected through a random sampling method and divided into intervention and control groups. The intervention group received a six session course on healthy lifestyles and the control group received no intervention. The Adolescent Lifestyle Questionnaire (ALQ) was used for collecting data. Data were collected before the intervention, at a two week after participation time point, and a three month follow-up was conducted.

Results:

Overall, 365 (male: 173, female: 192) adolescents participated in the study. There were significant differences between boys and girls in terms of physical activity and social support (P<0.001). The boys had higher levels of physical activity than girls. Girls received more social support than boys. There were significant differences in the lifestyle scores between the intervention and control groups at follow-up (P<0.001). The educational intervention indicated an improved total lifestyle score (from 123.7(SD.16.1) at baseline to 131.8 (SD.16.7) at two weeks and to 130.5(16.5) at 3 months after education) among the intervention group.

Conclusions:

Adolescents’ behaviors may be different in some dimensions among boys and girls. Unhealthy lifestyle habits are prevalent among adolescents. Therefore sex-specified lifestyle education can bring promising results. Further research in the field can reveal the importance of lifestyle intervention programs.

Background:

As social health is a condition-driven, dynamic and fluid concept, it seems necessary to construct and obtain a national and relevant concept of it for every society. Providing an empirical back up for Iran’s concept of social health was the aim of the present study.

Methods:

This study is an ecologic study in which available data for 30 provinces of Iran in 2007 were analyzed. In order to prove construct validity and obtain a social health index, an exploratory factor analysis was conducted on six indicators of population growth, willful murder, poverty, unemployment, insurance coverage and literacy.

Results:

Following the factor analysis, two factors of Diathesis (made up of high population growth, poverty, low insurance coverage and illiteracy) and Problem (made up of unemployment and willful murder) were extracted. The diathesis and problem explained 48.6 and 19.6% of social health variance respectively. From provinces, Sistan & Baluchistan had the highest rate of poverty and violence and the lowest rate of literacy and insurance coverage. In terms of social health index, Tehran, Semnan, Isfahan, Bushehr and Mazandaran had the highest ranks while Sistan and Baluchistan, Lurestan, Kohkiloyeh and Kermanshah occupied the lowest ones.

Conclusion:

There are some differences and similarities between Iranian concept of social health and that of other societies. However, a matter that makes our concept special and different is its attention to population. The increase in literacy rate and insurance coverage along with reduction of poverty, violence and unemployment rates can be the main intervention strategies to improve social health status in Iran.

Background:

Clinical Trial Committee (CTC) has been established in Food and Drug Organization (FDO), in 2003 to assure efficacy and safety of all types of medicinal products which are meant to be registered in Iran Drug List and/or obtain market authorization.

Methods:

All clinical trial files, meeting minutes and databases in CTC secretariat in FDO were reviewed. Relevant information and data extracted, analyzed and reported.

Results:

Total number of clinical trial (CT) files received by CTC, in 2011, was 76 cases: 21 CT protocols, 45 CT reports and 10 requests for importation of investigational new medicinal products (IMPs). Number of CT files received for herbal and natural products was 8 cases while CT files reviewed for vaccines and biological products was 50; 66% of all CT files received. Local industries sponsored 28 CT studies while 47 studies were supported by multinational/foreign companies. Of all CT files reviewed, 54 cases accounted for phase III CTs and 20 cases for phase IV and periodic safety updated reports (PSUR). With respect to the decisions made by CTC in 2011, 23 out of 45 CT reports were approved and the number of clinical trial authorizations (CTA) issued were 11; 52% of all CT protocols reviewed.

Conclusion:

Results presented in this report are indicative of a positive trend in compliance of pharmaceutical industries and clinical research groups to national regulations of CTs and IR-GCP. Effective communication with different parties involved in regulatory and industry sides of CTs will further enhance conducting quality CTs.

Background:

Research background approved weight loss would result in improvement of lipid profile. Nowadays, weight management is attained by modifying psychological mediators, as well as dieting and making individuals do more physical activity. Hence, This research was performed to compare effectiveness of different psychological interventions on lipid profile improvement among individuals with overweight and obesity.

Methods:

Using quasi-experimental design, 68 participants with mean age 26 years and 9 months (ranged from 20 to 43) were randomly assigned into 4 groups (including LEARN, CBT, CT, and MCT), and eventually 61 participants completed the treatment protocols. BMI was calculated by Omron digital body composition instrument, and blood lipids and glucose concentrations were measured prior to and after all interventions.

Results:

Data analysis by using t-test for dependent groups analysis revealed lipid profile, FBS, and BMI were significantly modified after applying 4 interventions comparing baseline and post treatment mean differences(P<0.05). Furthermore, repeated measure design analysis showed there were significant mean differences (P<0.05) in HDL cholesterol, TG levels and FBS levels among 4 groups. Scheffe test revealed more detailed significant differences among four groups in HDL cholesterol, and FBS concentration varieties (P<0.05).

Conclusions:

Adding psychological interventions to dietary plans and regular physical activities in overweight management would consider as a valuable step in optimizing physiological outcomes and that’s because of correcting mind-body interactional pathways among obese and overweight individuals.

Background

Location-allocation is a combinatorial optimization problem, and is defined as Non deterministic Polynomial Hard (NP) hard optimization. Therefore, solution of such a problem should be shifted from exact to heuristic or Meta heuristic due to the complexity of the problem. Locating medical centers and allocating injuries of an earthquake to them has high importance in earthquake disaster management so that developing a proper method will reduce the time of relief operation and will consequently decrease the number of fatalities.

Methods:

This paper presents the development of a heuristic method based on two nested genetic algorithms to optimize this location allocation problem by using the abilities of Geographic Information System (GIS). In the proposed method, outer genetic algorithm is applied to the location part of the problem and inner genetic algorithm is used to optimize the resource allocation.

Results:

The final outcome of implemented method includes the spatial location of new required medical centers. The method also calculates that how many of the injuries at each demanding point should be taken to any of the existing and new medical centers as well.

Conclusions:

The results of proposed method showed high performance of designed structure to solve a capacitated location-allocation problem that may arise in a disaster situation when injured people has to be taken to medical centers in a reasonable time.

Background

The purpose of this study was to examine whether the frequency of breakfast consumption was related to academic performance in healthy Korean adolescents.

Methods:

We analyzed data from the seventh Korea Youth Risk Behavior Web-based Survey conducted in 2011, in which 75,643 adolescents from school grades 7–12 participated. We assessed the association between the frequency of breakfast consumption (per week) and academic performance using multivariate logistic regression analysis after adjusting for covariates such as age, body mass index, frequency of smoking, frequency of drinking, parents’ education level, family economic status, frequency of vigorous physical activity (PA), frequency of moderate PA, frequency of muscular strength exercises, and level of mental stress.

Results:

For male adolescents, the odds ratios (ORs) for achieving average or higher academic performance according to the breakfast frequency per week were once per week, 1.004 (P=0.945); twice per week, 0.915 (P=0.153); 3 days per week, 0.928 (P=0.237); 4 days per week, 1.087 (P=0.176); 5 days per week, 1.258 (P<0.001); 6 days per week, 1.473 (P<0.001); and every day, 1.700 (P<0.001), compared to no breakfast per week. For female adolescents, the ORs for achieving average or higher academic performance according to the breakfast frequency were once per week, 1.068 (P=0.320); twice per week, 1.140 (P=0.031); 3 days per week, 1.179 (P=0.004); 4 days per week, 1.339 (P<0.001); 5 days per week, 1.449 (P<0.001); 6 days per week, 1.768 (P<0.001); and every day, 1.922 (P<0.001), compared to no breakfast per week.

Conclusion:

The frequency of breakfast consumption is positively correlated with academic performance in both male and female healthy adolescents in Korea.

Background:

Human papilloma virus causes benign and malignant abnormalities in different part of the body. The link between high risk types of HPV and some anogenital and aerodigestive tract cancer is well established. Oral HPV infection plays a role in developing oropharyngeal squamous cell carcinoma. We studied the prevalence of oral HPV in healthy individuals and its relative risk factors.

Methods:

Saliva samples of 114 healthy subjects were collected for HPV DNA analysis. Volunteers completed questionnaires and signed a written consent. For data analysis descriptive statistic, chi square test and odds ratio was used.

Results:

The frequency of oral HPV in healthy individuals was 6.1 %(seven participant).The most frequent type was HPV-18 in five of them. HPV-6 and HPV-66 each was detected in one case. Relation of oral HPV positivity to demographic features and risk factors was not statistically significant.

Conclusions:

The prevalence of oral HPV infection in our community is the same as many other communities of developing countries, stressing that HPV-18 were the dominant type.

In September 2007 national standard manual was finalized and officially announced as the minimal quality requirements for all medical laboratories in the country. Apart from auditing laboratories, Reference Health Laboratory has performed benchmarking auditing of medical laboratory network (surveys) in provinces. 12th benchmarks performed in Tehran and Alborz provinces, Iran in 2010 in three stages. We tried to compare different processes, their quality and accordance with national standard measures between public and private hospital laboratories. The assessment tool was a standardized checklist consists of 164 questions. Analyzing process show although in most cases implementing the standard requirements are more prominent in private laboratories, there is still a long way to complete fulfillment of requirements, and it takes a lot of effort. Differences between laboratories in public and private sectors especially in laboratory personnel and management process are significant. Probably lack of motivation, plays a key role in obtaining less desirable results in laboratories in public sectors.

Background:

The cognitive behavioral interventions based on the transdiagnostic approach for emotional disorders have received useful empirical supports in recent years. Most of the researches on this area have been conducted without any control group. Moreover, little information about comparative effectiveness has reported. The current study was compared transdiagnostic group therapy with classical cognitive group therapy.

Methods:

Thirty three collages students with anxiety and depressive symptoms participated in eight two-hour sessions in Akhavan Hospital, Tehran, Iran during May and June 2011. The results were analyzed by The Depression, Anxiety, and Stress Scale, and Work and Social Adjustment Scale in pre and post intervention.

Results:

Both groups showed the significant difference in research variables pre and post test. However, there was no significant difference in the results analysis using ACOVAs except for anxiety symptoms.

Conclusions:

The effectiveness of transdiagnostic group therapy was confirmed in reducing anxiety and depressive symptoms. Implications of the study are discussed.

The evolution of human blood groups, without doubt, has a history as old as man himself. There are at least three hypotheses about the emergence and mutation of human blood groups. Global distribution pattern of blood groups depends on various environmental factors, such as disease, climate, altitude, humidity etc. In this survey, the collection of main blood groups ABO and Rh, along with some minor groups, are presented. Several investigations of blood groups from Iran, particularly a large sampling on 291857 individuals from Iran, including the main blood groups ABO and Rh, as well as minor blood groups such as Duffy, Lutheran, Kell, KP, Kidd, and Xg, have been reviewed.