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1.  Risk Factors of Cardiovascular Disease and Their Related Socio-Economical, Environmental and Health Behavioral Factors: Focused on Low-Middle Income Countries- A Narrative Review Article 
Iranian Journal of Public Health  2015;44(4):435-444.
Background:
In order to decrease the burden of cardiovascular disease (CVD), social determinants for CVD risk factors have been extensively studied in developed countries. However, few studies about them have been performed in low-middle-income countries. This study describes factors related to CVD risk factors in low-middle-income countries at a national level.
Methods:
Data were assembled from international databases for 47 low-middle-income countries and were collected from various sources including WHO, World Bank, and previous studies. Coefficient estimates between male and female CVD risk factor prevalence and each independent variable were calculated via linear regression.
Results:
Statistically significant inverse associations were observed between adult literacy rate and systolic blood pressure, blood glucose. Pump price for gasoline was negatively associated with blood glucose also. Associations for female unemployment, adult literacy rate, paved roads and urban population, alcohol and western diet were positively associated with CVD risk factors. Unemployment, urban population and alcohol were positively associated with CVD risk factors in males.
Conclusion:
The effectiveness of intervention program for the prevention of cardiovascular disease in populations in developing countries should be explored, and more attention should be given to women.
PMCID: PMC4441956  PMID: 26056662
Cardiovascular disease; Health behavior; Obesity; Ecological study
2.  Equality of Medical Health Resource Allocation in China Based on the Gini Coefficient Method 
Iranian Journal of Public Health  2015;44(4):445-457.
Background:
The Chinese government is trying to achieve the goal of “universal access to basic health care services”. However, the inequality of the distribution of health care resources across the country is the biggest obstacle. This paper aims to explore these inequalities and the extent to which the method of analysis influences the perception.
Methods:
The indicators of health care resource distribution studied consisted of the number of health care institutions, the number of beds in health care institutions and the number of medical personnel. Data were obtained from the China Statistical Yearbook 2014. The extent of equality was assessed using the Lorenz Curve and Gini Coefficient Method.
Results:
Health care resource distribution in China demonstrates inequalities. The demographic Gini Coefficients based on the Lorenz Curves for the distribution of health care institutions, beds in health care institutions and medical personnel are 0.190, 0.070 and 0.070 respectively, while the corresponding Coefficients based on geographical areas are 0.616, 0.639 and 0.650.
Conclusion:
The equality of China’s demographically assessed distribution of health care resources is greater than that of its geographically measured distribution. Coefficients expressed by population imply there is ready access to healthcare in all regions, whilst the Coefficients by geographical area apparently indicate inequality. This is the result of the sparsity of population.
PMCID: PMC4441957  PMID: 26056663
Health care resources; Inequality; Lorenz curve; Gini coefficient
3.  Translated Versions of Voice Handicap Index (VHI)-30 across Languages: A Systematic Review 
Iranian Journal of Public Health  2015;44(4):458-469.
Background:
In this systematic review, the aim is to investigate different VHI-30 versions between languages regarding their validity, reliability and their translation process.
Methods:
Articles were extracted systematically from some of the prime databases including Cochrane, googlescholar, MEDLINE (via PubMed gate), Sciencedirect, Web of science, and their reference lists by Voice Handicap Index keyword with only title limitation and time of publication (from 1997 to 2014). However the other limitations (e.g. excluding non-English, other versions of VHI ones, and so on) applied manually after studying the papers. In order to appraise the methodology of the papers, three authors did it by 12-item diagnostic test checklist in “Critical Appraisal Skills Programme” or (CASP) site. After applying all of the screenings, the papers that had the study eligibility criteria such as; translation, validity, and reliability processes, included in this review.
Results:
The remained non-repeated articles were 12 from different languages. All of them reported validity, reliability and translation method, which presented in details in this review.
Conclusion:
Mainly the preferred method for translation in the gathered papers was “Brislin’s classic back-translation model (1970), although the procedure was not performed completely but it was more prominent than other translation procedures. High test-retest reliability, internal consistency and moderate construct validity between different languages in regards to all 3 VHI-30 domains confirm the applicability of translated VHI-30 version across languages.
PMCID: PMC4441958  PMID: 26056664
Voice handicap index; VHI-30; Translation; Validity; Reliability; Voice disorder
4.  Seatbelt Use and Traumatic Brain Injury in Taiwan: A 16-Year Study 
Iranian Journal of Public Health  2015;44(4):470-478.
Background:
A motor vehicle seat belt use law for the driver and front-seat passenger was implemented in Taiwan on June 1, 2001. The purpose of this study was to determine the effect of motor vehicle seat belt use on the severity of traumatic brain injuries because of motor vehicle accidents.
Methods:
Data were collected from 27 major teaching hospitals four years before June 1, 2001 and until May 31, 2013. A total of 822 brain-injured patients with a mean age of 37.4 (± 13.4) years were included; 251 were injured prior to implementation of the law and 571 after. The Glasgow coma scale was adapted to rate the severity of traumatic brain injury on admission. The Glasgow outcome scale was used to categorize the outcome on discharge.
Results:
After the seat belt law was implemented, traumatic brain injuries were less severe (P<0.001) and the rates of loss of consciousness, neurologic deficit, intracranial hematoma, craniotomy, and poor physical condition at discharge were all significantly lower (all P< 0.05). Male gender, longer hospital stays, not wearing a seat belt, and injury before the law was enacted were all associated with poorer physical condition at the time of discharge (all P <0.01).
Conclusion:
Among occupants who survived a motor vehicle accident but had traumatic brain injuries, those who had worn seat belts had a better prognosis. Seat belts remain one of the best methods to reduce both the severity of injuries and the number of fatalities.
PMCID: PMC4441959  PMID: 26056665
Glasgow coma scale; Motor vehicle accident; Seat belt; Traumatic brain injury
5.  Factors Influencing the Quality of Life (Qol) Among Thai Older People in a Rural Area of Thailand 
Iranian Journal of Public Health  2015;44(4):479-485.
Background:
The population prevalence of older people has been growing worldwide. Quality of Life (QoL) among older people is a significant public health concern. Hence, this study aimed to assess level of QoL and factors influencing QoL among rural Thai older people.
Methods:
The study was undertaken in Phayao Province where is one of the top ten provinces with the highest index of Thai aging. A district in this province was purposively selected to be the study area and the quota-sampling technique was used for sample collection, totally 400 older people participated according to Taro Yamane. The WHO QoL-Old was employed to interview elderly QoL. Multivariate linear regression was performed to determine the factors influencing QoL among the older people.
Results:
Over two-thirds of older people (68.5%) had QoL at fair level. The vast majority (96%) had high scores for Activity Daily Living (ADL). Approximately one-fifth (20.5%) reported current smoking and 31.7% reported ever drinking during previous year. Following univariate analysis, nine factors – gender, age, education, working, income, present illness, drinking, ADL, and participating in elderly club were identified as being significantly associated with QoL (P <0.05). Multivariate analysis revealed four factors predictive of QoL among elderly: ADL, income, alcohol drinking, and present illness (P < 0.01).
Conclusion:
Physical function, health status and financial were the predictor of QoL among elderly. Noticeably, drinking was one predictive factor of QoL but only among moderate drinkers. Hence, healthy life style should be considered as key areas in attempts to promote QoL among elderly people.
PMCID: PMC4441960  PMID: 26056666
Influencing factors; Quality of Life; Elderly
6.  Comparative Study of Lifestyle: Eating Habits, Sedentary Lifestyle and Anthropometric Development in Spanish 5- To 15-yr-Olds 
Iranian Journal of Public Health  2015;44(4):486-494.
Background:
The infant-juvenile period is one of high vulnerability during the lifestyles chosen become determining factors for future health status. This study aimed to evaluate lifestyle, specifically eating habits and physical activity, in 5–15-year-olds in Spain and their health status (anthropometry).
Methods:
This cross-sectional population study with two time points (2006 and 2013) was conducted by compiling data from the Spanish National Health Survey. We used the minor survey, specifically the data from the Health Determinants module, which included 5–15-year-olds. Compiled information was obtained from parents or guardians.
Results:
The overall overweight and obesity prevalence in Spain (2013) in 5- to 15-year-olds is 24.3%. A drop of 8.2% in meat consumption was found, while overall intake was high. Daily intake of plant-based food (fruit, vegetables, pulses) was low, especially vegetables (32.9%). Increased sedentary lifestyle was observed, probably because the use of communication technologies has increased in recent years (P<0.001). Moreover, watching TV rose to 19.3% for 1 hour/day watching TV on weekdays and to 23.5% at weekends.
Conclusion:
When comparing the two time points (2006 and 2013), we observed that lifestyle, eating habits and physical activity strongly associated with the Spanish infant-juvenile population’s anthropometry. Mediterranean diet patterns seem to be abandoned and physical activity is practiced less, which will have a negative impact on future quality of life.
PMCID: PMC4441961  PMID: 26056667
Lifestyle; Eating habits; Sedentary; Children; Obesity
7.  The Relationship between Nicotine Dependence and Age among Current Smokers 
Iranian Journal of Public Health  2015;44(4):495-500.
Background:
A recent study indicates that the incidence of smoking cessation varies with age. Although nicotine dependence (ND) has been regarded as one of the most significant barriers of successful smoking cessation, few researches have focused on the relationship between nicotine dependence and age.
Methods:
A cross-sectional study (conducted in 2013) with 596 Chinese rural male current smokers was performed to study the relationship between ND and age. The ND level was assessed using the Fagerström Test for Nicotine Dependence (FTND) scale. The univariate two-degree fractional polynomials (FPs) regression was used to explore the relation of ND to age.
Results:
The mean of FTND scores in the middle-aged group (45–64 yr old) was higher than that in the younger (<45 yr old) and older groups (≥65 yr old). The FPs regression showed an inverse U-shaped relationship between ND and age.
Conclusion:
The middle-aged current smokers had higher degree of ND than the younger and the older groups, which showed an inverse U-shaped relationship between ND and age. This finding needs to be confirmed by further researches.
PMCID: PMC4441962  PMID: 26056668
Age; Nicotine dependence; Smoking; Tobacco; China
8.  The Endemicity of Human Fascioliasis in Guilan Province, Northern Iran: the Baseline for Implementation of Control Strategies 
Iranian Journal of Public Health  2015;44(4):501-511.
Background:
The largest global outbreaks of liver fluke disease (Fascioliasis) in humans, caused by species of the genus Fasciola, have occurred in Guilan Province of Iran, affecting more than 15000 people. Although, different aspects of fascioliasis have been the subject of various researches during last two decades, nevertheless no community-based study has been performed in endemic regions of Guilan. The aim of present study was to obtain the basic information needed to develop future control strategies.
Methods:
Fecal and blood samples were collected from 1,984 volunteers in the Bandar-Anzali district, the region where previous epidemics occurred. Fecal samples were examined by Kato-Katz and formalin-ether methods for the presence of Fasciola eggs. Sera samples were analyzed by ELISA to detect anti-cathepsin L antibodies.
Results:
Twenty-seven (1.36%) individuals were seropositive, 9 (0.45%) individuals were egg positive (mean egg count 50.7 (±30.36) eggs per gram of faeces) and 30 individuals (1.51%) were positive using both methods. No statistical association was observed between infection and age, gender, location, occupation, educational status and dietary habits. The prevalence of intestinal parasites is also included.
Conclusion:
Human fascioliasis is hypoendemic in this region and recommends a passive case-finding approach, effective primary prevention measures, health education through mass media and effective veterinary public health measures for control of human disease.
PMCID: PMC4441963  PMID: 26056669
Fasciola hepatica; Human fascioliasis; Epidemiology; Endemicity; Control; Iran
9.  The Economic Burden of Liver Cirrhosis in Iran: a Cost of Illness Study 
Iranian Journal of Public Health  2015;44(4):512-521.
Background:
According to importance of cirrhosis of the liver and the lack of information about the economic burden of the disease, we performed this study to estimate the economic burden of liver Cirrhosis in Iran in 2011.
Methods:
The cost-of-illness method, based on the human capital theory, has been used. Both direct and indirect costs have been estimated using a prevalence approach and bottom-up method. The inpatient and outpatient records were investigated for obtaining the medical costs. Also, a questionnaire was used for collection the other data such as transportation costs, out of pocket payment and times of inpatients, etc. Costs consisted of expenditures which happened during March 2011 to February 2012 and the perspective of the study was Iranian society.
Results:
The total cost of the disease was 2014.5 billion Rials (USD164.32 million). Direct and indirect costs were 1384.16 and 630.4 billion Rials (86.7% and 11.3% of the total cost), respectively. Cost due to premature death was USD 38.66 million, included 23.52% of the total cost and 75% of indirect cost.
Conclusion:
Liver Cirrhosis impose enormous economic burden on Iranian society. Policymakers should therefore take this into consideration and according to available health resources provide services and facilities for the prevention and treatment of the disease.
PMCID: PMC4441964  PMID: 26056670
Liver cirrhosis; Economic burden; Cost of illness; Out of pocket payments; Iran
10.  Developing a Shortened Quality of Life Scale from Persian Version of the WHOQOL-100 Using the Rasch Analysis 
Iranian Journal of Public Health  2015;44(4):522-534.
Background:
Few studies use modern approaches to develop a quality of life (QOL) questionnaire with acceptable construct validity, especially in Iran. Our main objective was to construct a new validated and uni-dimensional questionnaire, based on WHOQOL-100, using the Rasch analysis.
Methods:
In a population-based, cross-sectional study in 2007, 500 Tehran residents aged≥18 were randomly sampled. The Persian version of WHOQOL-100 was used to measure the participants' QOL. After using targeting and person fit analysis, we performed category/threshold ordering, item fit, and differential item functioning analyses, in succession. We used outfit or infit statistics>1.5 and <0.5 for detecting under-fit and overfit items/persons, respectively. We also deleted items with disordered category and/or threshold. Person Separation Index and test reliability were also calculated in the datasets.
Results:
Male to female ratio was 0.98 and the mean age (SD) of participants was 35.1 (12.8) years. Initial analyses showed significant differences in quality of life between age groups (P=0.002), educational levels (P=0.001), and current health status groups (P<0.001). We eliminated 67 persons for under-fitting, 38 items for category and/or threshold disordering, 6 items for under-fitting, and 26 items for item bias. Test reliability for the final 30-item scale was 0.89.
Conclusion:
We prepared a shortened version of the WHOQOL-100 that is single construct, uni-dimensional and free of item bias or any disordering, according to the Rasch model.
PMCID: PMC4441965  PMID: 26056671
Rasch analysis; Quality of life; WHOQOL-100
11.  Content Validity of National Post Marriage Educational Program Using Mixed Methods 
Iranian Journal of Public Health  2015;44(4):535-542.
Background:
Although the validity of content of program is mostly conducted with qualitative methods, this study used both qualitative and quantitative methods for the validation of content of post marriage training program provided for newly married couples. Content validity is a preliminary step of obtaining authorization required to install the program in country's health care system.
Methods:
This mixed methodological content validation study carried out in four steps with forming three expert panels. Altogether 24 expert panelists were involved in 3 qualitative and quantitative panels; 6 in the first item development one; 12 in the reduction kind, 4 of them were common with the first panel, and 10 executive experts in the last one organized to evaluate psychometric properties of CVR and CVI and Face validity of 57 educational objectives.
Results:
The raw data of post marriage program had been written by professional experts of Ministry of Health, using qualitative expert panel, the content was more developed by generating 3 topics and refining one topic and its respective content. In the second panel, totally six other objectives were deleted, three for being out of agreement cut of point and three on experts' consensus. The validity of all items was above 0.8 and their content validity indices (0.8–1) were completely appropriate in quantitative assessment.
Conclusion:
This study provided a good evidence for validation and accreditation of national post marriage program planned for newly married couples in health centers of the country in the near future.
PMCID: PMC4441966  PMID: 26056672
Content validity; Marriage educational program; Mixed methods
12.  Application of the Multiplicative-Additive Model in the Bone Marrow Transplantation Survival Data Including Competing Risks 
Iranian Journal of Public Health  2015;44(4):543-550.
Background:
Cox proportional hazard model is a popular choice in modeling the survival data, but sometimes proportionality assumption is not satisfied. One of the tools for handling the non-proportional effects is the multiplicative-additive model named “Cox-Aalen model”. Recently these flexible regression models developed for competing risks setting. The aim of this paper is showing the application of the multiplicative-additive model in competing risks setting on real bone marrow transplantation (BMT) data when the proportionality assumption is violated.
Methods:
The data was from a retrospective study on class III thalassemia patients who undergo hematopoietic stem cell transplantation (HSCT) in BMT ward of Shariatei Hospital, Tehran, Iran. The neutrophil engraftment time as the early outcome of HSCT on37 patients who received mesenchymal stem cell infusion (MSC group) compared with 50 patients who did not. We fit the standard proportional models and flexible Cox-Aalen model in the sub distribution hazards.
Results:
By day 30 after transplantation, the cumulative incidence of neutrophil recovery was 97% (95%CI: 89%–100%) and 76%(95%CI: 64%–88%) in MSC and control group, respectively. Based on the Cox-Aalen model for cumulative incidence function, the MSC infusion had a significant delay effect on neutrophil engraftment (P=.044). In patients who did not neutrophil recovery immediately after HSCT, those who received MSC had faster recovery.
Conclusion:
Cox-Aalen model provides more accurate statistical description for time-varying covariate effects. There is a positive effect of MSCs on the neutrophil recovery, however further study on the advantages and disadvantages of MSCs are needed.
PMCID: PMC4441967  PMID: 26056673
Bone marrow transplantation; Competing risks; Multiplicative-additive model; Semi parametric Cox-Aalen model
13.  Personality Traits and Their Relationship to Demographic Features in Addicts Referring to a Drug Rehabilitation Center in the City of Isfahan, Iran 
Iranian Journal of Public Health  2015;44(4):551-560.
Background:
Addiction is one of the most serious social damages and due to its progressive nature in all aspects, adversely affects people’s physical and psychological health. Hence, this paper investigates the characteristics of drug addicts in a drug rehabilitation center in the city of Isfahan.
Methods:
In this cross-sectional study conducted in 2012, the population consisted of all addicts that referred to Shefa Drug Rehabilitation Center. A sample of 201 individuals was selected randomly. Two questionnaires were drawn up to collect data; the first questionnaire examined demographic characteristics and the second was the 71-item Minnesota Multiphase Personality Inventory short form. Chi-square test, Fisher’s exact test and Kruskal-Wallis test were used in SPSS20 to analyze the data.
Results:
Overall, 98% of participants were men, 65.7% were married, and 13.3% were unemployed. Depression and hypomania were respectively the most and the least prevalent disorders among individuals with high-risk psychological profiles of clinical scales respectively. Psychopathic deviation and schizophrenia were seen among the unemployed more than the employed ones.
Conclusion:
Considering the fact that depression was the most common personality disorder among the addicts participating, it is recommended that this disorder be given priority in investigations in the treatment programs of these patients. In addition, the scales of disorder, schizophrenia, mental infirmity, mental deviation, and paranoia had a significant relationship to aggression, delirium and hallucination, which must be taken into consideration in the treatment of such patients.
PMCID: PMC4441968  PMID: 26056674
Addiction; Personality disorder; Drug; MMPI; Psychological characteristics
14.  The Role of Positive Personality Traits in Emotion Regulation of Patients with Irritable Bowel Syndrome (IBS) 
Iranian Journal of Public Health  2015;44(4):561-569.
Background:
Personality traits and emotion regulation processes play an important role in human health. The purpose of this study was to investigate the role of positive personality traits (psychological hardiness and interpersonal forgiveness) in emotion regulation of patients with Irritable Bowel Syndrome.
Methods:
The research was a cross-sectional study. Statistical population included all of IBS patients referred to the Subspecialty Center of Psychiatry in Isfahan in 2013. Overall, 123 subjects (100 women, 83.3%, and 30 men, 16.7%) were selected by census method, according to criteria of research and during a particular period. To collect data, the Difficulties in Emotion Regulation Scale (DERS), Lang and Goulet Hardiness Scale (LGHS) and Interpersonal forgiveness Inventory (IFI) were used. Data was analyzed using Pearson’s correlation coefficient and Multivariate and Binary Logistic regression analyses.
Results:
Mean age of patients was 33.82±10.45 years and 83.3% (100) of them were female. Regression analyses showed that both personality traits of hardiness and forgiveness were as protective factors for emotional dysregulation with OR, 95% CI: 0.93 and 0.96 sequentially, with adjusting demographic variables (age, gender, and education level and disease duration).
Conclusion:
Patients who are more hardy and forgiving toward others, are likely more successful at adaptive emotion regulation. It emphasizes the positive and beneficial role of the personality traits in regulating of emotional problems of IBS patients. Hence, these variables should be considered as effective factors in the treatment process of the patients.
PMCID: PMC4441969  PMID: 26056675
Emotional regulation; Psychological hardiness; Interpersonal forgiveness; Irritable bowel syndrome
15.  Effects of Targeted Subsidies Policy on Health Behavior in Iranian Households: A Qualitative Study 
Iranian Journal of Public Health  2015;44(4):570-579.
Background:
This study aimed to explore the effects of national targeted subsidies policy on health behavior of Iranian households.
Methods:
In this qualitative study, data were collected between January 2012 and December 2013 through face-to-face interviews (23 experts in national and provincial levels of health system and 18 household heads) and through a comprehensive and purposive document analysis. The data was analyzed using a thematic analysis method (inductive-deductive) and assisted by Atlas-ti software.
Results:
Rising health care costs, removing some food subsidies and the increase in price of most goods and services due to the implementation of economic policy of targeted subsidies have led to significant changes in the demand for health services, changes in the consumption trends of goods and services affecting health as well as changes in the health habits of households.
Conclusion:
Targeted subsidies and the cash subsidy policy have some negative effects on population health behavior especially among poor people. Hence, maintaining or increasing the cash subsidy is not an efficient allocation of resources toward health care system. So, it is necessary to identify appropriate strategies and policies and apply interventions in order to moderate negative effects and enhance positive effects resulted from implementing this economic reform on population health behavior.
PMCID: PMC4441970  PMID: 26056676
Policy; Economic reform; Health system; Health behavior; Subsidies; Targeted subsidies; Iran
18.  Breast Cancer among Pakistani Women 
Iranian Journal of Public Health  2015;44(4):586-587.
PMCID: PMC4441973  PMID: 26056679
25.  A Comprehensive Review of Cutaneous Leishmaniasis in Kerman Province, Southeastern Iran-Narrative Review Article 
Iranian Journal of Public Health  2015;44(3):299-307.
Background:
Cutaneous leishmaniasis (CL) remains a serious public health concern in Kerman Province, eastern Iran. This study was aimed to conduct a comprehensive review and highlights various aspects of CL in the province of Kerman.
Methods:
This article mainly focuses on the studies published in the past 26 years on CL in the province. Current data for the present status were obtained through the provincial health system.
Results:
Bam was the most infected district (63.6%), followed by Kerman (24.7%) and other districts to a less extent. Leishmania tropica is the major causative agent (95.5%) of CL in Kerman province, however, L. major accounts for 4.5% of the total cases. Bam, Kerman and southern districts of Kerman province were purely anthroponotic CL (ACL), while Rafsanjan, Baft, and Sirjan showed both ACL and zoonotic CL (ZCL). In contrast, Orzoieh district was merely endemic to ZCL type. Phlebotomus sergenti was the main vector in ACL foci while Ph. papatasi was the major vector in the ZCL district of Orzoieh. Localized CL was the most prevalent form (80%) of the disease, while leishmaniasis recidivans was the most uncommon clinical manifestation (18.7%).
Conclusion:
Due to recent rises in CL disease both in regard of increases in incidence rate and expansion of the disease to new foci, and presence of various risk factors in the province, control measures and health strategies should have high priorities to help treat the existing cases and prevent the expansion of the disease to new areas.
PMCID: PMC4402407  PMID: 25905072
Cutaneous leishmaniasis; Leishmania tropica; Leishmania major; Iran

Results 1-25 (899)