Information about Chronic obstructive pulmonary diseases (COPD)-related health resources allocation in China is very limited. The aim of the study was to explore the distribution of COPD-related health resources allocation among different levels public hospitals (PHs) in Hunan Province of central south China.
We randomly collected data from 57 Public Hospitals (PHs) at 3 different levels in Hunan province as well as 893 pulmonary physicians (PPs) who worked there in 2009. Questionnaires based on the recommendations of COPD guideline were designed, including availability of spirometers, inhaled agents for COPD and COPD-related health education for local residents, as well as PPs’ educational levels.
Spirometers equipped ratio in 3rd level PHs was much higher than 1st, 2nd PHs. The disparity varied vastly form 0% to 100%. The inhaled agents equipped ratio was 5.56%, 70.85% and 100% respectively for the 1st, 2nd and 3rd levels PHs. No 1st level PHs launched COPD-related healthcare education for local residents, only 10 of 24 for the 2nd level PHs and 10 of 15 for the 3rd level PHs. PPs of high educational levels concentrate in 3rd levels PHs, however, PPs working in 1st levels PHs and 2nd levels PHs were mainly low and median educational levels PPs’ knowledge of COPD of 3rd levels PHs was much better than of 1st levels PHs and 2nd levels PHs.
The extreme imbalance and disparity existed in COPD-related health resources allocation at three levels PHs in central south China. Inequity and insufficient in COPD-related health resources in 1st and 2nd levels PHs should be improved.
Allocation; COPD; Public Hospitals; Pulmonary physicians; Resourcec; China
The present study was designed in quasi-experiment to assess adoption of the essential clauses of particular clinical laboratory quality management requirements based on international organization for standardization (ISO 15189) in hospital laboratories and to evaluate the cost effectiveness of compliance to ISO 15189.
The quality management intervention based on ISO 15189 was conceded through three phases; pre – intervention phase, Intervention phase and Post-intervention phase.
In pre-intervention phase the compliance to ISO 15189 was 49% for study group vs. 47% for control group with P value 0.48, while the post intervention results displayed 54% vs. 79% for study group and control group respectively in compliance to ISO 15189 and statistically significant difference (P value 0.00) with effect size (Cohen’s d) of (0.00) in pre-intervention phase and (0.99) in post – intervention phase. The annual average cost per-test for the study group and control group was 1.80 ± 0.25 vs. 1.97 ± 0.39, respectively with P value 0.39 whereas the post-intervention results showed that the annual average total costs per-test for study group and control group was 1.57 ± 0.23 vs 2.08 ± 0.38, P value 0.019 respectively, with cost-effectiveness ratio of (0.88) in pre -intervention phase and (0.52) in post-intervention phase.
The planned adoption of quality management requirements (QMS) in clinical laboratories had great effect to increase the compliance percent with quality management system requirement, raise the average total cost effectiveness, and improve the analytical process capability of the testing procedure.
Quality management; Cost effectiveness; ISO1518
The most common geriatric psychiatric disorder is depression, known to be a multi factorial disorder. However, the influence of common preventable factors is yet to be discovered. This study was designed to evaluate the prevalence of depression and some possible risk factors in elderly residents of nursing homes in Iran.
Data on demographic characteristics, nutritional and health status of 244 residents aged 60 years or older were collected from seventeen nursing homes in Tehran, Iran, during 2010 to 2012. Depression was assessed and classified according to the 15-item GDS. Univariate and then multivariate complex sample survey ordinal regression analysis was performed to investigate the association between depression and the risk factors.
The average age of the 244 cases studied was 75.8 (±8.7) years, 53.3% were female (of whom 74.2% were housewives), 43.4% illiterate, and 32.0% were divorced or were living separately. The percentages of non-depressed, mild, moderate and severe depression were 9.8%, 50.0%, 29.5% and 10.7%, respectively. Multivariate analysis showed that dissatisfaction with personnel of nursing homes and food quality had odds ratios of 2.91 (1.33–6.36) and 2.64 (1.44–4.87), corresponding to greater odds of having a higher grade depression. Moreover, those who rested or walked had significantly higher risk of a more severe depression in comparison with those who did not (OR of 2.25 (1.50–3.38) and 1.98 (1.24–3.18), respectively), however, studying had a protective odds ratio of 0.17 (0.13–0.22).
Depression was very common in our sample and their lifestyle influenced its prevalence.
Depression; Elderly; Nursing homes; Iran
This longitudinal study aims to examine the relationships between the perception of parental style, hope, self-esteem and Eysenck’s psychoticism dimension throughout the span of four years.
The sample was composed of 884 students from the Wollongong Youth Study, which commenced when students entered high school. During the course of the 4 years of the study, each participant completed the test booklets each time data was collected. Data was analyzed using one way ANOVA, Post-hoc test, Repeated Measurement, Pearson and Partial Correlation and General Linear Model in order to provide the aims of the study.
The mean score of hope and self-esteem among adolescents from authoritative parents were higher from permissive and authoritarian families while the hope with a permissive perception were lower than those with authoritarian, and self-esteem was lower in the authoritarian group compared to the permissive group. Children with a permissive perception reported higher psychoticism compared to the two other. Significant correlations were found between authoritative perception and hope, self-esteem and psychoticism. Finally, hope, self-esteem and psychoticism showed a significant inter correlation in all of the parental styles.
Adolescents with the perception of each kind of parental style showed significant between group differences in psychological well-being throughout the four years of the study.
Parental Style; Adolescent; Well-being
One of the methods used in the analysis of data related to diseases, and their underlying reasons is drawing geographical map. Mapping diseases is a valuable tool to determine the regions of high rate of infliction requiring therapeutic interventions. The objective of this study was to investigate obesity pattern in Iran by drawing geographical maps based on Bayesian spatial model to recognize the pattern of the understudy symptom more carefully.
The data of this study consisted of the number of obese people in provinces of Iran in terms of sex based on the reports of non-contagious disease’s risks in 30 provinces by the Iran MSRT disease center in 2007. The analysis of data was carried out by software R and Open BUGS. In addition, the data required for the adjacency matrix were produced by Geo bugs software.
The greatest percentage of obese people in all age ranges (15–64) is 17.8 for men in Mazandaran and the lowest is 4.9 in Sistan and Baluchestan. For women the highest and lowest are 29.9 and 11.9 in Mazandaran and Hormozgan, respectively. Mazandaran was considered the province of the greatest odds ratio of obesity for men and women.
Recognizing the geographical distribution and the regions of high risk of obesity is the prerequisite of decision making in management and planning for health system of the country. The results can be applied in allocating correct resources between different regions of Iran.
Mapping; Obesity; Bayesian Spatial Model; Iran
The Ministry of Health, Treatment and Medical Education of Iran has recently announced an estimated figure of 200,000 injecting drug users (IDUs). The aim of this study was to pilot a national program using demographics, types of drug abuse and prevalence of blood-borne infections among IDUs.
In order to elicit data on demographics, types of drug abuse and prevalence of blood-borne infections among IDUs, a questionnaire was designed in the Bureau of Mental-Social Health and Addiction in collaboration with Iran’s Drug Control Headquarters of the Police Department. Therapeutical alliance of addiction in Shafagh Center was based on Methadone Maintenance Therapy (MMT).
Among 402 reported IDUs most of them were male, single and in age range of 20 to 39 years old with 72.7% history of imprisonment. Most of them had elementary and high school education and a history of addiction treatment. The majority were current users of opioid, heroin and crack. The prevalence of blood-borne infections was 65.9% and 18.8% for HCV and HIV/AIDS infections, respectively.
Prevention programs about harm reduction, treatment and counseling should include young IDUs as a core focus of their intervention structure.
IDUs; Harm reduction; Methadone maintenance treatment; Iran
Ethical consideration is a basic requirement for design of randomized clinical trials. The purpose of this study was to assess whether reports of Iranian dental clinical trials complied with the requirements of the ethical principles of human research.
In this retrospective observational study electronic search was performed to identify all dental clinical trials published between 2001 and 2011. Each trial report was assessed for inclusion of a statement that 17 items about research ethics.
Totally 242 papers were identified, of which 15.3%, stated that ethical approval had been obtained and 50.4% of the trial reports indicated that informed consent had been obtained. The mean ethical score for the mentioned studies was 7/68 out of 17.
Most Iranian dental clinical trial reports failed to consider important ethical principles. The reporting of the ethical issues associated with these trials could be improved further not only by the instructions to authors, but also by Journal editors refusing to publish trials that do not comply.
Ethics; Clinical Trials; Journal; Dental; Iran
This study was conducted to investigate the effects of Brewer’s yeast supplementation on serum lipoproteins and blood pressure in patients with Type 2 diabetes mellitus.
In a randomized double blind clinical trial, 90 adults with type 2 diabetes mellitus were recruited, and divided randomly into 2 groups, trial group received brewer’s yeast (1800 mg/day) and control group received placebo for 12 weeks. Weight, BMI, food consumption (based on 24 hour food recall), fasting serum lipoproteins (Cholesterol, Triglyceride, LDL-c, HDL-c), systolic and diastolic blood pressures were measured before and after the intervention. Data analyses were performed by Statistical Package for Social Sciences ver. 18.0, and the statistical tests included Independent t-test, Paired t-test, Kolmogorov-Smirnov and analysis of covariance. This trial was registered in Iranian Registry of Clinical Trials (IRCT), No.IRCT138807062513N1.
Eighty-four subjects (21 men and 63 women) aged 46.3±6.1 years completed the study. After 12 weeks supplementation, systolic and diastolic blood pressures were decreased in the group receiving brewer’s yeast (4.1±1.5, P=0.007 and 5.7±0.6, P=0.001 respectively). No-significant changes in LDL-c, HDL-c, Triglyceride and Cholesterol were shown.
Supplementation with Brewer’s yeast besides the usual treatment of type 2 diabetes mellitus can reduce systolic and diastolic blood pressures in diabetic patients.
Diabetes; Brewer’s yeast; Blood pressure
European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM.
This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings.
The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs’ scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs.
The INPHE’s assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs’ scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs’ (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable.
Quality Assessment; EFQM; INPHE; Emergency Department; Iran
Congenital toxoplasmosis is associated with variable complications including encephalitis, microcephaly, hydrocephaly, hepatitis, lymphadenopathy and even intrauterine death. Presence of Toxoplasma gondii in human placenta may induce congenital infection. The aim of this study was to determine the genotypes of Toxoplasma gondii infection in human spontaneous aborted fetuses in Shiraz, south of Iran.
Five hundred and forty two paraffin-embedded blocks of aborted placenta were collected, from two university-affiliated hospitals in Shiraz. Occurrence of spontaneous abortion was confirmed by examine of the slides. After re-cutting of the blocks and dewaxing, semi-nested PCR assay was used to detect the fragments of T. gondii B1 gene in the samples. Also direct molecular genotyping was performed on positive samples with Restriction Fragment Length Polymorphism-PCR analysis on the SAG2 gene.
Among the 542 tissue samples, the B1 gene was amplified from 78 (14.4%) of cases with the semi nested PCR and typed by RFLP. The genotype of Toxoplasma strains of 65 (out of 78) PCR-positive samples were evaluated and 54 out of 65 (83.1%) were found to be type II and 11 out of 65 (16.9%) were type I.
Considering the high level of Toxoplasma infection in aborted fetuses in this study, Toxoplasma might largely contribute to spontaneous abortion in this area of Iran.
Toxoplasma gondii; Abortion; Genotype; Iran
Maternal nutritional is the most important environmental factor influencing pregnancy outcome. While studies showed association between maternal iron-micronutrient deficiencies with pregnancy outcome, data examining impact of micronutrient supplementation on growth rate beyond birth are sparse. Present study examined the relationship between iron and multivitamins supplementation on growth rate of babies up to age of 18 month.
This study was a statistical analysis on data recorded through a routine procedure in health houses from 1994 to 2007. Subjects were selected by a two-stage randomization method and required data extracted from the records. Analyses were performed using STATA 10 software.
Data was collected for 3835 pairs of mother-baby. Mothers received 61.7±5.4 and 115.6±53.8 multivitamins and iron tablets, respectively. Analyses showed significant relationship between children’s weight and height at birth with iron supplementation and children’s height at 6, 12 and 18 month with multivitamins supplementation.
Mechanisms of these effects are unclear but it is safe to suggest supplementation during pregnancy is necessary.
Iron; Multivitamin supplementation; Intrauterine growth; Neonate growth; Pregnancy
Iran’s health system is expanding the disaster and emergency higher education programs over the country to enhance the capacity of human resources for effective and efficient disaster mitigation, preparedness, response and recovery. In this article we present an overview about the initiatives and progress of disaster and emergency health higher education in Iran. Following the Bam earthquake, in collaboration with the Ministry of Health & Medical Education and National Institute of Health Research, School of Public Health at the Tehran University of Medical Sciences, Iran took the initiative to develop a Master of Public Health (MPH) with disaster concentration in 2006, a PhD in disaster and emergency health in 2011, and a well constructed certificate course in 2008 entitled Disaster Health Management and Risk Reduction (DHMR). Iran, Kerman and Shahid Beheshti Universities of Medical Sciences and University of Social Welfare and Rehabilitation are other academia that joined this initiative. Regarding the importance of programs evaluation, we have planned for a comprehensive evaluation of MPH and DHMR programs in 2013–4 and the Accreditation and Evaluation Board of Disaster & Emergency Health, based in MOH&ME, is responsible for evaluation of the PhD program in 3–5 years from initiation.
Disaster; Emergency; Health; Higher education; Iran
Melamine is a new risk of urinary stones. Gansu province is a heavily affected area and has large population and underdeveloped economy. We hypothesized that number of family members and family income may play significant roles in the formation of urinary stones. A case-control study was performed among 190 infants. Results showed that the case group had less numbers of family members than the control (4.4 vs. 5.6, respectively). The multivariate logistic regression analysis indicated that number of family members was an independent influencing factor associated with urinary stones (OR, 0.606; 95% CI, 0.411–0.893; P = 0.011). Family income, however, did not exhibit a significant difference. Observed results suggested that number of family members was a new and significant influencing factor to affect the risk of melamine-associated urinary stones.
Family; Melamine; Urine
The Mediterranean tradition offers a cousine rich in colors, aromas and memories, which support the taste and the spirit of those who live in harmony with nature. Everyone is talking about the Mediterranean diet, but few are those who do it properly, thus generating a lot of confusion in the reader. And so for some it coincides with the pizza, others identified it with the noodles with meat sauce, in a mixture of pseudo historical traditions and folklore that do not help to solve the question that is at the basis of any diet: combine and balance the food so as to satisfy the qualitative and quantitative needs of an individual and in a sense, preserves his health through the use of substances that help the body to perform normal vital functions. The purpose of our work is to demonstrate that the combination of taste and health is a goal that can be absolutely carried out by everybody, despite those who believe that only a generous caloric intake can guarantee the goodness of a dish and the satisfaction of the consumers. That should not be an absolute novelty, since the sound traditions of the Mediterranean cuisine we have used for some time in a wide variety of tasty gastronomic choices, from inviting colors and strong scents and absolutely in line with health.
Mediterranean diet; Food pyramid; Obesity; Cardiovascular disease
Several studies have been conducted in Iran in order to investigate the prevalence of depression among infertile couples. However, there is a remarkable diversity among the results. This meta-analysis was conducted to estimate an overall prevalence rate of depression among infertile couples in Iran.
International and national electronic databases were searched up to June 2011 including MEDLINE, Science Citation Index Expanded, Scopus, SID, MagIran, and IranMedex as well as conference databases. Furthermore, reference lists of articles were screened and the studies’ authors were contacted for additional references. Cross-sectional studies addressing the prevalence of depression among infertile couples were included in this meta-analysis. We assessed 12 separate studies involving overall 2818 participants of which 1251 had depression.
Overall prevalence rate of depression among infertile couples was 0.47 (95% CI: 0.40, 0.55). The prevalence rate of depression was 0.44 (95% CI: 0.32, 0.56) during 2000 to 2005 and 0.50 (95% CI: 0.43, 0.57 during 2006 to 2011. The prevalence rate of depression was 0.46 (95% CI: 0.39, 0.53) among women and 0.47 (95% CI: 0.40, 0.54) among men.
Not only the prevalence of depression in infertile couples was high but also had increasing growth in recent years. Furthermore, despite many studies conducted addressing the prevalence of depression in infertile couples, there is however a remarkable diversity between the results. Thus, one can hardly give a precise estimation of the prevalence rate of depression among infertile couples in Iran now.
Depression; Infertility; Sterility; Meta-analysis; Cross-sectional; Prevalence; Iran
This study was carried out to compare the effect between nutrition education intervention and non-nutrition education intervention on awareness regarding iron deficiency among schooling adolescents in Tanah Merah, one of rural district in Kelantan, Malaysia.
This study which was started in year 2010 involved 280 respondents (223 girls, 57 boys, age: 16 yr) from schools in Tanah Merah. The selection criteria were based on hemoglobin level (Hb = 7 – 11.9 g/dL for girls; Hb = 7 – 12.9 g/dL for boys). They were divided into 2 groups. The first group received nutrition education package (Nutrition education, NE), whereas another group was entitled to receive non-nutrition education intervention (Non-Nutrition Education, NNE) (supplement only). Both interventions were implemented for 3 months. The changes in awareness among respondents of both groups were evaluated using multi-choices questionnaire.
Nutrition education receiver group (NE) demonstrated improvement in awareness at post-intervention. No substantial improvement was demonstrated by the counterpart group (NNE).
Multimedia nutrition education program conducted at school setting was in fact practical and effective in improving awareness on iron deficiency among anemic adolescents.
Nutrition education; Adolescents; Iron deficiency
To evaluate off-label and off-NCCN guidelines uses of antineoplastic drugs in a major Chinese hospital.
Totally 1122 patients were selected from July to December 2011. Then, the off-label and off-NCCN guidelines uses of antineoplastic drugs were analyzed.
In 798 of 1122 patients (71.12%), drugs were used for off-label. In 317 of 1122 patients (28.25%), the drugs were prescribed for off-label and off-NCCN guidelines. 2591 medical orders for 1122 patients, 1051/2591 (40.56%) medical orders were off-label; 445/2591(17.17%) medical orders were off-label and off-NCCN guidelines. In 445 off-label and off-NCCN medical orders, 399 (89.66%) were unapproved indications, 38 (8.54%) were unapproved drug concentration and 12 (2.70%) were unapproved route of administration. Percentage of off-label and off-NCCN guidelines drug uses in male was higher than that in female (21.92% vs. 11.39%, P<0.01). Compared with other lines of treatment, percentage of off-label and off-NCCN guidelines drug uses in postoperative adjuvant was the smallest (P<0.01) and percentage in three or multi-line treatments was the highest (P<0.01). The pancreatic cancer possessed the highest percentage (38.74%) of off-label and off-NCCN guidelines drug uses among all types of cancer (P<0.01).
Off-label uses of antineoplastic drugs are generally common in China hospitals based on NCCN guidelines. The fact suggests that anti-tumor treatment was relatively standard in China. Off-label and off-NCCN guidelines drug uses were mainly for individual treatment. Doctors should fully consider the adverse drug reaction, contraindication, cautions and increase the drug security monitoring. Uncorrected drug concentration should be avoided for drug risk.
Antineoplastic drug use; Off-label and off-NCCN guidelines; China
The aim of the study was to explore the mechanisms underlying the association of birth weight with later body mass index (BMI) from the biochemical markers related to metabolism and the Apa I polymorphism in IGF-II gene.
A total of 300 children were selected randomly from the Macrosomia Birth Cohort in Wuxi, China. The height and weight were measured and blood samples were collected. Plasma concentrations of 8 biochemical markers were detected. Apa I polymorphism was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).
Biochemical markers were detected for 296 subjects and 271 subjects were genotyped for the Apa I polymorphism. No association was found between birth weight and 8 biochemical markers. In boys, the BMIs of AA, AG and GG genotypes were 16.10 ± 2.24 kg/m2, 17.40 ± 3.20 kg/m2, 17.65 ± 2.66 kg/m2. And there was statistical difference among the three genotypes. But in girls, there was no statistical difference. The birth weights of AA, AG and GG genotypes were 3751.13 ± 492.43 g, 3734.00 ± 456.88 g, 3782.00 ± 461.78 g. And there was no statistical difference among the three genotypes.
Biochemical markers are not associated with birth weight. Apa I polymorphism may be related to childhood BMI, but it may be not associated with birth weight. Therefore, biochemical markers and Apa I polymorphism might not play a role in the association of birth weight and BMI.
Biochemical marker; Apa I polymorphism; Birth weight; BMI; IGF-II gene
Whilst there seem to be available data on blood pressure profiles of South African children, especially in urban areas, few data exist on rural children. The aims of this study were to determine the blood pressure profiles of rural South African children residing in Thohoyandou; and to examine the relationship between body mass index and blood pressure among the children.
The study involved 296 (134 boys and 135 girls) children aged 7–13 years. Body weight and height were measured using standard procedures. Overweight was defined by body mass index (BMI) for gender and age. Blood pressure was monitored in each child thrice using validated electronic devices (Omron 7051T). Hypertension was determined as the average of three separate blood pressure readings where the systolic or diastolic blood pressure was ≥ 90th percentile for age and sex.
Overweight among the girls (4.7%) was higher compared with the boys (3.9%). Both systolic and diastolic pressures (SBP and DBP) increase with age in both sexes. The proportion of children with > 90th percentile occur at only ages 12 and 13 years. The incidence of hypertension (SBP > 90th percentile) was 0.4% and 0.2% in boys and girls, respectively. The SBP and DBP pressures significantly (P<0.05) correlate with age; body mass, height and BMI.
Elevated blood pressure is prevalent among rural South African children residing in this region. Also, blood pressure increased with age in both boys and girls, and this positively correlated with age, body weight, height and BMI.
Overweight; Body mass index; Blood pressure; Rural children; South Africa
The incidence and hematological effects of helminth infection during pregnancy were investigated among pregnant women in Isiala, Mbano, Southeast Nigeria.
Totally 282 pregnant women were enlisted for the study between October 2011 and September 2012. Stool samples were examined for intestinal helminths using formalin-ether sedimentation technique. Hemoglobin (Hb) and Packed Cell Volume (PCV) levels were evaluated in venous blood samples using Sahli’s and microhaematocrit methods respectively.
Forty six (16.3%) subjects were infected with at least one helminth parasite; 24 (8.5%) hookworm, 14(5.0%) and 2(0.7%) A. lumbricoides and Trichuris trichiura infections respectively. Intestinal helminthiases in pregnant women was significantly associated with age (P<0.05). The prevalence of intestinal helminthiases by parity was also significantly different (P<0.05) with primigravidae having the highest infection rate (27.5%). Hematological assessment showed that the prevalence of anemia among the women was 58.9% (mean±SD = 9.3±1.0). The differences in hemoglobin levels by age groups was statistically significant (P <0.05). The contributory effect of gastrointestinal helminths in anemia showed that infected pregnant women had lower mean hemoglobin (8.60±0.22g/dl) than the uninfected (9.72±0.07g/dl). Significant difference (t-value = 5.660, P<0.05) was observed between the Hb of the infected and uninfected pregnant women. In addition, infected pregnant women had mean PCV of 26.09±0.65% while the uninfected had 34.54±2.96%. The mean PCV of infected pregnant women was significantly different (t-value= 0.013, P<0.05) from that of the uninfected.
Anti-helminthic therapy after the first trimester should be part of the antenatal programme. Intestinal helminth infection showed significant negative correlation with Hb and PCV and contributed moderately to anemia.
Anemia; Hematology; Hookworm; Hemoglobin; Packed cell volume