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1.  Trends in publication on evidence-based antioxidative herbal medicines in management of diabetic nephropathy 
Recently, popularity and use of herbal medicine in treatment of diabetes have been increased. Since, oxidative stress is known as the main underlying pathophysiology of diabetes and its complications, the purpose of this bibliometric study is to assess the global scientific production analysis and developing its trend in field of antioxidative hypoglycemic herbal medicines and diabetic nephropathy focusing on the scientific publication numbers, citations, geographical distribution in the world and determining the main journal (source) in the field.
Our search terms were “diabetes”, “renal”, “nephropathy”, “herb”, “Chinese medicine”, “traditional medicine”, and “antioxidant” from Scopus database until January 2015 and analysis of the distribution of words in the publication year, main journal (source) in the field, geographical distribution, documents’ type and language, subject area, and h-index of citations were crried out. The Scopus analysis tools and VOSviewer software version 1.6.3 have been used for analysis.
Within 1166 papers were published until year 2015, 78 studies were related to this topic in human. Increasing trend in number of related researches was shown. Fifty eight percent of the published papers were original articles, and the highest number was produced in 2013 with 21 documents. Top subject areas were medicine with global publication share of 71.8 %, and pharmacology was ranked the second (39.7 %). Iran was the first country with global publication. The total citation of the documents were 2518 times and h-index was 24. The highest cited paper was a review article with 336 citation number, and top source was “Journal of Medicinal Plants”. Both of top authors and affiliation were from Iran; “Tehran University of Medical Sciences”. Also, top author in the co-authorship mapping and clustering assessment was from Iran.
Although, we found an ascending trend of scientific publications in field of antioxidative herbal medicine and diabetic nephropathy with a good position for Iran, the number of publications is insufficient and more researches in this topic is necessary.
PMCID: PMC4752788  PMID: 26877997
Herbal medicine; Antioxidative; Diabetic nephropathy; Scientometric analysis
2.  New Horizons in Diabetology 
Journal of Diabetes Research  2016;2016:9075924.
PMCID: PMC4739454  PMID: 26885532
3.  The Relationship Between Dietary Intakes of Amino Acids and Bone Mineral Density Among Individuals with Spinal Cord Injury 
Oman Medical Journal  2016;31(1):22-28.
The effect of dietary protein intake on bone mineral density (BMD) has not been explained in patients with spinal cord injury (SCI). In this study, we looked at the relationship between BMD and higher protein intake in patients with SCI while controlling for possible confounders.
Patients with SCI, who were referred to the Brain and Spinal Cord Injury Research Center between November 2010 and April 2012, were included in the study. In total, the dietary intakes of 103 patients were assessed by 24–hour dietary recall interviews. We used dual-energy X-ray absorptiometry to measure BMD in the femoral neck, trochanter, intertrochanteric zone, hip, and lumbar vertebras.
Eighty-six men and 17 women participated in this study. Protein intake was negatively associated with the BMD of lumbar vertebrae (p = 0.001, r = –0.37 for T-score and p = 0.030, r = –0.24 for Z-score). The BMD of lumbar vertebrae were negatively associated with intake of tryptophan, isoleucine, lysine, cysteine, and tyrosine (p = 0.007, 0.005, 0.009, 0.008, and 0.008 for T-score, respectively). Higher intakes of threonine, leucine, methionine, phenylalanine, valine, and histidine were related to a lower BMD of lumbar vertebrae (p = 0.006, 0.010, 0.009, 0.010, 0.009, and 0.008 respectively for T-scores).
We found that high protein intake led to a lower BMD of lumbar vertebrae in patients with SCI after controlling for confounders including demographic and injury-related characteristics and calcium intake. No relationship between higher amino acids intake and BMD of the femur and hip was detected. Intake of alanine, arginine, and aspartic acid were not related to BMD.
PMCID: PMC4720942  PMID: 26816565
Spinal Cord Injuries; Diet; Bone Density; Protein; Amino Acids
4.  Association of adiponectin and metabolic syndrome in adolescents: the caspian- III study 
This study aimed to investigate the associations between metabolic syndrome (Mets) and adiponectin concentrations in Iranian adolescents.
This study was conducted as a sub-study of a national school- based surveillance program in 10–18 year- old students from 27 provinces in Iran. Plasma adiponectin was measured in 180 randomly selected participants. Metabolic syndrome (Mets) was defined based on the Adult Treatment Panel III (ATP- III) criteria modified for the pediatric age group. Multiple logistic regression analyses were used to evaluate the association between adiponectin and cardiometabolic risk factors.
The median of adiponectin concentrations was significantly lower among participants with Mets [2.95 μg/ml (interquartile range 2.72–3.30)] compared with subjects without Mets [4.55 μg/ml (interquartile range 3.02–5.75)]. Adiponectin showed significant negative association with higher number of Mets components (P- trend < 0.05). Significant correlations were observed between adiponectin concentrations and metabolic parameters, except blood pressure.
Significant inverse association existed between adiponectin levels and presence of Mets (OR, 0.21; 95%CI: 0.10–0.45; p < 0.001). In multivariate models, this association remained significant after adjustment for other risk factors (OR, 0.18; 95%CI: 0.07–0.47; p < 0.001.
Adiponectinhas inverse association with cardiometabolic parameters in Iranian adolescents, and it is a determinant of Mets independent of other risk factors. These findings can be used in comparison with other ethnic groups. Further longitudinal studies are necessary to assess the clinical impact of such inverse association.
PMCID: PMC4683711  PMID: 26688792
Adiponectin; Metabolic syndrome; Cardiometabolic; Pediatric
5.  Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system) 
BMJ Open  2015;5(12):e009597.
The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events.
Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study (participation rate=90.2%).
Findings to date
Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men.
Future plans
Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration.
PMCID: PMC4691780  PMID: 26674503
6.  Effect of metabolic control on oxidative stress, subclinical atherosclerosis and peripheral artery disease in diabetic patients 
By rising diabetes mellitus prevalence, the prevalence of its most complication; cardiovascular disease (CVD) is also increasing. Moreover, oxidative stress has important role in pathogenesis of diabetes and its complications. We investigated relationship between total antioxidant status (TAS) and surrogate measures of subclinical atherosclerosis (SA) with glycemic status in diabetics.
Methods & materials
In a cross-sectional study, we recorded height, weight, waist circumference (WC) and blood pressure of 267 subjects. Blood samples were collected to measure fasting blood sugar (FBS), glycated hemoglobin (HbA1c), lipid profiles and TAS. The surrogate measures of SA were Carotid Intima Media Thickness (CIMT), and Ankle Brachial Index (ABI).
We found significantly lower TAS leves and ABI values and higher CIMT in diabetic patients especially in poor glycemic group. There was a nonsignificant, weak correlation between TAS, ABI and CIMT with glycemic status (r = −0.10, −0.16, and +0.09, respectively). Multivariate regression analysis showed a significant influence of increasing age and diabetes duration on worsening CIMT in poor glycemic group.
Our study showed poor glycemic control leads to worse CIMT by increasing age and duration of diabetes. However we did not find a significan correlation between glycemic status and TAS levels. We suggest CIMT measurement along with other SA markers in poor glycemic diabetics, especially in older patients with longer duration of diabetes, to identify high risk CVD patients.
PMCID: PMC4641427  PMID: 26561542
Diabetes; Oxidative stress; Subclinical atherosclerosis; Peripheral artery disease
7.  Mortality Attributable to Excess Body Mass Index in Iran: Implementation of the Comparative Risk Assessment Methodology 
The prevalence of obesity continues to rise worldwide with alarming rates in most of the world countries. Our aim was to compare the mortality of fatal disease attributable to excess body mass index (BMI) in Iran in 2005 and 2011.
Using standards implementation comparative risk assessment methodology, we estimated mortality attributable to excess BMI in Iranian adults of 25–65 years old, at the national and sub-national levels for 9 attributable outcomes including; ischemic heart diseases (IHDs), stroke, hypertensive heart diseases, diabetes mellitus (DM), colon cancer, cancer of the body of the uterus, breast cancer, kidney cancer, and pancreatic cancer.
In 2011, in adults of 25–65 years old, at the national level, excess BMI was responsible for 39.5% of total deaths that were attributed to 9 BMI paired outcomes. From them, 55.0% were males. The highest mortality was attributed to IHD (55.7%) which was followed by stroke (19.3%), and DM (12.0%). Based on the population attributed fractions estimations of 2011, except for colon cancer, the remaining 6 common outcomes were higher for women than men.
Despite the priority of the problem, there is currently no comprehensive program to prevention or control obesity in Iran. The present results show a growing need to comprehensive implications for national and sub-national health policies and interventional programs in Iran.
PMCID: PMC4671178  PMID: 26644906
Body mass index; burden; mortality; obesity; population attributed fraction
8.  Evaluation of bone mineral loss in patients with chronic traumatic spinal cord injury in Iran 
We described the associations between demographic and injury-related factors on bone mineral density (BMD) of the spine and the hip among adult patients with chronic spinal cord injury (SCI).
BMD in spinal and femoral bone sites were assessed. Multivariate analysis was performed to evaluate the relationship between anthropometric and injury-related factors with BMD. Serum level and amount of dietary intake of calcium, phosphor, and 25-hydroxy vitamin D were measured.
A referral tertiary rehabilitation center in Iran.
Patients with SCI who had no previous history of endocrine disorders and were not on specific medications entered the investigation. Those with non-traumatic SCI, pregnant, or with substance dependency were excluded as well.
No interventions were applied.
Main study outcome measures
Dual X-ray absorptiometry was performed to estimate BMD. Body mass index was positively associated with higher femoral (P < 0.01, r = 0.56) and hip (P < 0.0001, r = 0.82) BMD only in female participants. The high prevalence of vitamin D deficiency (60%) was noticeable.
Older male patients revealed lower BMD only in spinal vertebrae (P < 0.02, r = −0.21). A significant higher BMD loss in lumbar vertebras in male patients with complete spinal cord lesion (P < 0.009) was detected. Spinal reduction of BMD was more severe when the level of injury was above T6 (P < 0.02).
Along with the clarification of age, gender, post injury duration, and the other factors' effect on the BMD in the SCI patients, here we have also shown the noticeable prevalence of the 25-hydoxy vitamin D deficiency in these patients which needs attention.
PMCID: PMC4231962  PMID: 24621041
Spinal cord injury; Vitamin D; Bone mineral density; Osteoporosis
9.  Inequality of obesity and socioeconomic factors in Iran: a systematic review and meta- analyses 
Background: Socioeconomic status and demographic factors, such as education, occupation, place of residence, gender, age, and marital status have been reported to be associated with obesity. We conducted a systematic review to summarize evidences on associations between socioeconomic factors and obesity/overweight in Iranian population.
Methods: We systematically searched international databases; ISI, PubMed/Medline, Scopus, and national databases Iran-medex, Irandoc, and Scientific Information Database (SID). We refined data for associations between socioeconomic factors and obesity/overweight by sex, age, province, and year. There were no limitations for time and languages.
Results: Based on our search strategy we found 151 records; of them 139 were from international databases and the remaining 12 were obtained from national databases. After removing duplicates, via the refining steps, only 119 articles were found related to our study domains. Extracted results were attributed to 146596 person/data from included studies. Increased ages, low educational levels, being married, residence in urban area, as well as female sex were clearly associated with obesity.
Conclusion: Results could be useful for better health policy and more planned studies in this field. These also could be used for future complementary analyses.
PMCID: PMC4715390  PMID: 26793632
Obesity; Socioeconomic factors; Iran
10.  Prevalence of osteoporosis and vitamin D receptor gene polymorphisms (FokI) in an Iranian general population based study (Kurdistan) (IMOS) 
Background: Osteoporosis, or porous bone, is a disease characterized by low bone mass density (BMD) and structural deterioration of bone tissue, leading to bone fragility and increased risk of hip, spine, and wrist fractures. There are numerous risk factors for osteoporosis. While many of these factors are non-genetic in nature, there is a definite genetic component responsible for this condition. The main aim of this study was to evaluate the association between VDR (Vitamin D receptor gene) polymorphisms (Fok1) A>G (rs2228570) and bone mineral density in an Iranian defined population.
Methods: The study participants comprised of 1032 Iranians recruited from the city of Sanandaj during IMOS (Iranian Multi Center Osteoporosis Study). Bone mineral density measurement was performed in all the participants with and without osteoporosis. All samples were genotyped for VDR genes (Fok1) polymorphism with polymerase chain reaction, using a predesigned TaqMan allele discrimination assay.
Results: There was a significant association between Fok1 polymorphism and osteoporosis in postmenopausal women, 0.138 (0.025-0.768).
Conclusion: It seems that cohort studies, which are more powerful than case-control studies, can be useful in evaluating the roles of genetic variants as risk or protective factors for osteoporosis.
PMCID: PMC4715426  PMID: 26793629
Osteoporosis; Vitamin D Receptor Gene; Fok1; Bone Mineral Density
11.  Targeting metabolic disorders by natural products 
The most prevalent metabolic disorders are diabetes mellitus, obesity, dyslipidemia, osteoporosis and metabolic syndrome, which are developed when normal metabolic processes are disturbed. The most common pathophysiologies of the above disorders are oxidative stress, Nrf2 pathways, epigenetic, and change in miRNA expression. There is a challenge in the prevention and treatment of metabolic disorders due to severe adverse effects of some synthetic drugs, their high cost, lack of safety and poverty in some conditions, and insufficient accessibility for the general population in the world. With increasing interest in shifting from synthetic drugs to phytotherapy as an alternative treatment, there is still a gap in scientific evidences of plant-derived therapeutic benefits. One reason may be slow rate of translation of animal studies’ findings into human clinical trials. Since metabolic disorders are multifactorial, it seems that poly-herbal medications, or drug-herbal combination are needed for their treatment. However, further researches to determine the most effective plant-derived metabolites, and their cellular mechanism in order to set priorities for well-designed animal and clinical trials, and also more studies with strong scientific evidences such as systematic review and meta-analysis of controlled studies are needed.
PMCID: PMC4495701  PMID: 26157708
Metabolic disorders; Oxidative stress; Epigenetic; Natural products
12.  Obesity Researches Over the Past 24 years: A Scientometrics Study in Middle East Countries 
Researchers, practitioners, and policy-makers call for updated valid evidences to monitor, prevent, and control of alarming trends of obesity. We quantify the trends of obesity/overweight researches outputs of Middle East countries.
We systematically searched Scopus database as the only sources for multidisciplinary citation reports, with the most coverage in health and biomedicine disciplines for all related obesity/overweight publications, from 1990 to 2013. These scientometrics analysis assessed the trends of scientific products, citations, and collaborative papers in Middle East countries. We also provided Information on top institutions, journals, and collaborative research centers in the field of obesity/overweight.
Over 24-year period, the number of obesity/overweight publications and related citations in Middle East countries had increasing trend. Globally, during 1990–2013, 415,126 papers have been published, from them, 3.56% were affiliated to Middle East countries. Iran with 26.27%, compare with other countries in the regions, after Turkey (47.94%) and Israel (35.25%), had the third position. Israel, Turkey, and Iran were leading countries in citation analysis. The most collaborative country with Middle East countries was USA and within the region, the most collaborative country was Saudi Arabia.
Despite the ascending trends in research outputs, more efforts required for promotion of collaborative partnerships. Results could be useful for better health policy and more planned studies in this field. These findings also could be used for future complementary analysis.
PMCID: PMC4434496  PMID: 26015861
Iran; Middle East; obesity; scientometrics
13.  Evaluation of fetal cell transplantation safety in treatment of diabetes: a three-year follow-up 
Rapidly increasing prevalence of diabetes throughout the world highlights the importance of looking for new treatment options for the disease such as stem cell therapy. With regard to the increasing attention towards stem-cell therapy as a curative treatment for diabetes in recent years, it is of crucial importance to ensure the safety of this novel therapeutic technique. In this study we aim to evaluate the safety of fetal liver-derived cell suspension allotransplantation in the diabetic patients who had attended a clinical trial in 2007.
44 out of a total number of 56 patients who had undergone either fetal liver-derived cell suspension allotransplantation or placebo injection in 2007 (IRCT number: 138811071414 N10) were contacted and recruited for the evaluation of possible complications. Patients were referred to a designated ophthalmologist and cardiologist to be screened for retinopathy and cardiovascular diseases. 24-hour urine was collected and tested for the evaluation of nephropathy; and, neuropathy was assessed by means of neuropathic symptoms and monofilament test.
There were no life-threatening complications nor significant differences in terms of evaluated diabetes complications ( retinopathy, neuropathy, nephropathy and cardiovascular diseases ) between the case and control groups. However, one case of meningioma was reported.
Findings of our study demonstrated that stem cell transplantation can be considered a relatively safe procedure apart from one case of meningioma; it did neither cause any life-threatening complications nor increased the rate of the diabetes micro- and macrovascular complications.
PMCID: PMC4511990  PMID: 26207222
Diabetes mellitus; Fetal stem cell; Cell therapy
14.  Regional Disparities in Sedentary Behaviors and Meal Frequency in Iranian Adolescents: The CASPIAN-III Study 
Iranian Journal of Pediatrics  2015;25(2):e182.
The prevalence of obesity is increasing among Iranian youngsters like other developing countries.
This study was conducted to assess regional disparities in sedentary behaviors and meal frequency in Iranian adolescents.
Patients and Methods:
In this national survey, 5682 students aged 10 - 18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. The country was classified into four sub-national regions, based on criteria of the combination of geography and socioeconomic status (SES). Mean of meal frequency and physical activity levels as well as prevalence of omitting meals and sedentary behavior were compared across regions with different SES after stratifying with sex and age group.
Meal frequency in lower socio-economic regions was significantly higher than two other regions in 10 - 13 and 10 - 18 years old groups (P trend < 0.001). However, the mean of working hours with computer was linearly increased with increasing the SES in studied regions (P trend < 0.001), whereas the corresponding figure was not significant for the mean of watching TV (P trend > 0.05). Frequency of adolescents omitting their meals was higher in higher SES regions especially in West Iran (P < 0.001) in 10 - 13 years old age group. Having personal computer and working with it more than two hours per day mainly was observed in central Iran which ranked as the highest SES group.
Efforts to ensure Iranian youth meet healthy food habits and screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time is required.
PMCID: PMC4505997  PMID: 26195993
Adolescent; Obesity; Behavior
15.  Diabetes research in Middle East countries; a scientometrics study from 1990 to 2012 
Diabetes burden is a serious warning for urgent action plan across the world. Knowledge production in this context could provide evidences for more efficient interventions. Aimed to that, we quantify the trend of diabetes research outputs of Middle East countries focusing on the scientific publication numbers, citations, and international collaboration.
Materials and Methods:
This scientometrics study was performed based on the systematic analysis through three international databases; ISI, PubMed, and Scopus from 1990 to 2012. International collaboration of Middle East countries and citations was analyzed based on Scopus. Diabetes’ publications in Iran specifically were assessed, and frequent used terms were mapped by VOSviewer software.
Over 23-year period, the number of diabetes publications and related citations in Middle East countries had increasing trend. The number of articles on diabetes in ISI, PubMed, and Scopus were respectively; 13,994, 11,336, and 20,707. Turkey, Israel, Iran, Saudi Arabia, and Egypt have devoted the five top competition positions. In addition, Israel, Turkey, and Iran were leading countries in citation analysis. The most collaborative country with Middle East countries was USA and within the region, the most collaborative country was Saudi Arabia. Iran in all databases stands on third position and produced 12.7% of diabetes publications within region. Regarding diabetes researches, the frequent used terms in Iranian articles were “effect,” “woman,” and “metabolic syndrome.”
Ascending trend of diabetes research outputs in Middle East countries is appreciated but encouraging to strategic planning for maintaining this trend, and more collaboration between researchers is needed to regional health promotion.
PMCID: PMC4468230  PMID: 26109972
Diabetes; Middle East; scientometrics
16.  The effect of Norouz holiday on anthropometric measures and body composition 
This study examined the effect of holiday season on the anthropometric measures in Shariati hospital staff.
This study was conducted in 2014 on 66 subjects, aged 21–68 years. Weight, height, waist circumference (WC), hip circumference (HC), waist -to-hip ratio (WHR), waist-to- height ratio (WHtR) and physical activity were measured. Bioelectrical impedance analysis (BIA) method and the Tanita body composition analyzer were used to analyze body composition.
In this study, 80.3% of subjects were female and 19.7% were male. The mean age of subjects was 39.5 (SD: 9.7) years (range: 21–68). The percentage of overweight and obesity in the study population were 40.9% and 12.1%, respectively. After the holiday, participants gained 0.58 kg of weight and 0.19 units of BMI) P < 0.001). The average of WC, WHR and WHtR also increased after the holiday; however they were not statistically significant. Basal metabolic rate and fat free mass raised significantly, but the amount of fat mass decreased after the holiday.
The holiday season is a critical period for weight gain and body fat. It’s highly recommended to weight daily during the holiday season and to increase their physical activity while limiting high-calorie foods.
PMCID: PMC4357064  PMID: 25767788
Holiday; Body weight; Body composition; Obesity; Metabolic syndrome; Norouz Holiday
17.  Socioeconomic inequalities and diabetes: A systematic review from Iran 
Socioeconomic factor is a determinant of health may contribute to diabetes. We conducted a systematic review to summarizing evidences on associations between socioeconomic factors and diabetes in Iranian population. We systematically searched international databeses; ISI, PubMed/Medline, Scopus, and national databases Iranmedex, Irandoc, and Scientific Information Database (SID) to retrieve relevant articles to socioeconomic factors and diabetes without limitation on time. All identified articles were screened, quality assessed and data extracted by two authors independently.
From 74 retrieved articles, 15 cases were relevant. We found increased diabetes prevalence among female sex, over 50 years’ old age, illiterate population, retired status, unemployed, urban residents, and low economic status. There was a negative association between social capital and diabetes control. Diabetes complications were more frequent in upper age group, higher education levels and low income populations.
Socioeconomic factors were associated with diabetes that leads to inequality. Improving modifiable factors through priority based interventions helps to diabetes prevention and control.
PMCID: PMC4372329  PMID: 25806357
Diabetes; Socioeconomic factors; Iran
18.  Acknowledgement of manuscript reviewers 2014 
Contributing reviewers
The editors of Journal of Diabetes & Metabolic Disorders would like to thank all our reviewers who have contributed to the journal in Volume 13 (2014).
PMCID: PMC4412102  PMID: 25922826
19.  Stem cell-based approach for the treatment of Parkinson's disease 
Parkinson’s disease (PD) is the second most common neurodegenerative brain disorder which is around 1.5 times more common in men than in women. Currently, drug medications, surgery, and lifestyle changes are common approaches to PD, while all of them focused on reducing the symptoms. Therefore, regenerative medicine based on stem cell (SC) therapies has raised a promising hope. Various types of SCs have been used in basic and experimental studies relevant to PD, including embryonic pluripotential stem cells, mesenchymal (MSCs) and induced pluripotent SCs (iPSCs). MSCs have several advantages over other counterparts. They are easily accessible which can be obtained from various tissues such as bone marrow, adipose tissue, peripheral blood, etc. with avoiding ethical problems. Therefore, MSCs is attractive clinically because there are no related ethical and immunological concerns . Further studies are needed to answer some crucial questions about the different issues in SC therapy. Accordingly, SC-based therapy for PD also needed more complementary evaluation in both basic and clinical study areas.
PMCID: PMC4431356  PMID: 26000262
Cellular therapy; Neurodegenerative diseases; Parkinson’s disease; Stem cell
20.  Informal Payments for Health Care in Iran: Results of a Qualitative Study 
Informal payments to health care providers have been reported in many African, Asian and European countries. This study aimed to investigate different aspects of these payments that are also known as under-the-table payments in Iran.
This is an in-depth interview-based qualitative study conducted on 12 purposively chosen clinical specialists. The interviewees answered 9 questions including the ones about, definitions of informal payments, the specialties and hospitals mostly involved with the problem, how they are paid, factors involved, motivation of patients for the payments, impact of the payments on the health care system and physician-patient relationship and the ways to face up with the problem. The findings of the study were analyzed using qualitative content analysis method.
Six topics were extracted from the interviews including definitions, commonness, varieties, motivations, outcomes and preventive measures. It was revealed that under-the-table payments are the money taken (either in private or public portions) from patients in addition to what formally is determined. This problem is mostly seen in surgical services and the most important reason for it is unrealistic tariffs.
Regarding the soaring commonness of informal payments rooted in underpayments of health expenditures in some specialties, which deeply affect the poor, the government has to boost the capitation and to invest on health sectors through supporting the health insurance companies and actualizing the health care costs in accord with the real price of the health care delivered.
PMCID: PMC4450017  PMID: 26060779
Informal payments; Health care; Iran; Qualitative research
21.  Efficacy and safety of Samtropin™ recombinant human growth hormone; a double-blind randomized clinical trial 
Recombinant human growth hormone (rhGH) can increase the growth rate in growth hormone deficient children (GHD). In this randomized clinical trial, we compared the efficacy and side effects of an Iranian brand; Samtropin with Norditropin.
The GHD children were randomly treated either with standard dose of Samtropin or Norditropin rhGH for one year. Upstanding height, height standard deviation score (HSDS), growth velocity (GV), serum levels of insulin like growth factor-1 (IGF-1), and bone age (BA) were determined before and during one year treatment concomitant side effects of treatment.
We evaluated 22 subjects; 12 on Samtropin and, 10 on Norditropin. In each group, mean age was 12 yr and 50% of them were male. The mean differences in height, HSDS, IGF-1 and BA by Norditropin before and after 12 months were 8.8 cm, 0.5, 49 ng/ml and 2.8 yr, respectively. These measures by Samtropin were 9.1 cm, 0.6, 133 ng/ml, and 1.7 yr, respectively without any significant difference. The mean of GV by Samtropin was 9.1 vs. 8.8 cm by Norditropin without significant difference. Since the efficacy of Samtropin was found to be similar to Norditropin after 12 months; we switched to use only Samtropin for the next 12 months. The mean differences in height, HSDS, GV and BA in 20 children between months 12 and 24 were 7.0 cm, 1.6, 2.1 cm/yr and 1.0 yr, respectively (P < 0.001). We also found a non-significant decrease in IGF-1 levels. No side effects were observed.
We need to conduct a post marketing surveillance with a large sample size in order to confirm our findings.
Trial registration
Registration code number in the Iranian Registry of Clinical Trials (IRCT): IRCT1138901181414N11.
PMCID: PMC4304100  PMID: 25648850
Growth hormone deficiency; Recombinant human growth hormone; Insulin like growth factor-1; Children
22.  Prevalence of obesity and overweight in adults and children in Iran; a systematic review 
Obesity is one of the most important underlying risk factors for chronic disease. Dramatically increasing and following complication of obesity should be alerted to health politicians and practitioners to prevent associated health risks. This review aimed to give a better insight into the prevalence of obesity and overweight in different areas of Iran.
All published internal (SID, Irandoc, Iranmedex), and international (Web of Knowledge, Pubmed, Scopus) source studies, reported the prevalence of overweight/obesity among normal population samples, during Jan 2005 through Jan 2014, were assessed in this review. Paper selection processes were done by two researchers separately. Studies which met the eligible criteria were included in this review.
One hundred ninety three eligible studies enter into our review. Of 193 final selected studies, 86 (15 national, 71 sub national) of them were reported the prevalence of obesity/overweight in adult, and 107 studies (11 national, 96 sub national) in under-18 by individual. The range of overweight and obesity prevalence in national studies in adult, was 27.0-38.5 (95% CI: 26.8-27.1, 37.2-39.8), and 12.6-25.9 (95% CI: 12.2-13.0, 24.9-26.8), separately. In under-18 the range of overweight and obesity prevalence in national studies were 5.0-13.5 (95% CI: 4.5-5.5, 13.4-13.6), and 3.2-11.9 (95% CI: 3.0-3.4, 11.3-12.4).
Obesity as an important public health problem has been discussed in recent few decades worldwide. Although the national reported prevalence of obesity in Iran was not considerably diverse, but remarkable differences were seen in the sub national prevalence which must be noticed more in political health programs especially among women and children.
Electronic supplementary material
The online version of this article (doi:10.1186/s40200-014-0121-2) contains supplementary material, which is available to authorized users.
PMCID: PMC4301060  PMID: 25610814
Obesity; Overweight; Prevalence; Iran; Metabolic syndrome
23.  Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in a young Iranian population 
Background: Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard for non-invasive measurement of bone mass. T-scores and Z-scores are used to present the results of bone mass. The present study was designed to evaluate the discordance between T-scores and Z-scores calculated at a same level and its relation with age, gender and body mass index (BMI) in a representative sample of normal population.
Methods: This cross-sectional study was conducted as a part of a comprehensive survey, Iranian Multicenter Osteoporosis Study (IMOS), designed to assess bone health among healthy adults. Each individual underwent both L1–L4 antero-posterior lumbar spine and hip DXA scan. The difference between the T- and Z-scores measured at each of the four skeletal sites was then calculated.
Results: A -1.21 to 1.21 point difference was noted in the Z- and T- scores measured at each site. While the difference between the T-and Z-scores was less than 0.5 SD in most of the cases, the difference was higher than 1 SD in about 5% of the subjects.
Conclusion: Standardization of Z-score definition and calculation techniques as well as developing an ethnicity-matched reference population is needed to improve the reliability of DXA-generated Z-scores.
PMCID: PMC4322344  PMID: 25695009
Osteoporosis; Bone Mineral Density; T-scores; Z-scores; Iran
24.  An overview on the successes, challenges and future perspective of a national school-based surveillance program: the CASPIAN study 
The Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease (CASPIAN) study is implemented in the Islamic Republic of Iran from 2003. The aim of this national school- based surveillance program was to provide accurate data of regular surveys of this program to be reviewing methodology, protocols, data collection and questionnaires of these surveys. Information was obtained from articles and books were published from CASPIAN studies. The CASPIAN studies were repeated every two years, with blood sampling for biochemical factors every four years. Methods and questionnaires of all surveys were similar at their core level and some optional factors added in different surveys. The results of CASPIAN studies represent the public health of Iranian children and adolescents that are useful for policy makers and based on them, intervention programs can set in national and sub-national level.
PMCID: PMC4302132  PMID: 25614853
Prevention; School- based survey; Non-communicable diseases; Children; Adolescents
25.  Knowledge, attitude and practice of urban and rural households towards principles of nutrition in Iran: results of NUTRIKAP survey 
The aim of this study was to assess knowledge, attitude and practice of urban and rural households toward principles of nutrition in Iran.
The study population was Iranian households who live in rural and urban areas in all provinces of the country. The sampling method at households’ level in each province was single stage cluster sampling with equal size clusters. The incumbent data was collected by a structured questionnaire and through the interview with the eligible subject in each household.
A total of 14,136 Iranian households were selected as total sample size, 9,149 urban households, and 4,987 rural households. Around 57.2% of urban and 49.5% of rural households was aware of food groups. Respectively in urban and rural households, about 35.1% and 39.7% had correct knowledge toward roles of food groups. Approximately 41.5% and 39.9% of households had accurate knowledge about reason of food eating in urban and rural areas, respectively. The results showed that 79.6% of them had favorable attitudes.
The most of the households consumed red meat and poultry weekly whereas fish was eaten rarely. Fruits, vegetables and dairy were consumed daily in the most of households. Sugar intake was daily in the most of households and cream and butter intake was weekly.
The most of households had moderate knowledge and good attitudes. Practice of families about food consumption was good. The results of this study can be used for proper intervention for improving of health society.
PMCID: PMC4279888  PMID: 25551099
Knowledge; Attitude; Practice; Nutrition; Urban; Rural

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