Iranian Journal of Public Health
Year:2017 | Volume:46 | Issue:9|Papers Count:24

Background: After the establishment of Primary Health Care (PHC) program in Iran, health indicators have im-proved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran‘ s PHC system (strengths, weak-nesses, opportunities and threats) in terms of health system‘ s control knobs. Methods: The search was conducted through two English `databases of Web of Knowledge and PubMed, two Eng-lish publications of Science Direct and Springer and two Persian databases of Magiran and SID. Keywords were se-lected from MeSH and included primary health care, PHC and Iran in both Persian and English. No time limit was considered. Results: Iran's PHC system has numerous successes in dealing with health system‘ s control knobs; which largely part of that related to the health network implementation, the role of Behvarz, improvement of health indicators in rural areas and the elimination of urban-rural inequality, but there are some weaknesses, opportunities and threats in the Iranian PHC system as well. Conclusion: By considering socio-economic changes the current structure of PHC system needs to be reformed to coordinate with phenomenon of chronic diseases, accidents and aging. The current information system in PHC does not provide the required information for decision makers and policy makers so it needs to be transformed to the elec-tronic system with unique electronic health file for individuals.

Background: Hair follicle stem cells exist in different sites. Most of the hair follicle stem cells are reside in niche called bulge. Bulge region is located between the opening of sebaceous gland and the attachment site of the arrector pili muscle. Methods: Data were collected using databases and resources of PubMed, Web of Science, Science Direct, Scopus, MEDLINE and their references from the earliest available published to identify English observational studies on hair follicle bulge region. Results: Bulge stem cells are pluripotent with high proliferative capacity. Specific markers allow the bulge cells to be isolated from mouse or human hair follicle. Stem cells isolated from bulge region are label retaining and slow cycling hence these cells are defined as label-retaining cells. Bulge cell populations, due to their plasticity nature are able to differentiate into distinct linage and could contribute in tissue regeneration. Conclusion: The current review discuss about bulge stem cells characteristics and biology including their cycle, loca-tion, plasticity, specific markers and regenerative nature. Also the differences between mouse and human hair follicles are investigated.

Background: From old times, the human kind has used clays, externally or internally, for maintaining body health or treating some diseases. Meanwhile there are few scientific articles reviewing the beneficial effects of clays on body function. Bentonite clay is one of the available clays in nature, used as traditional habits, and remedies in many cul-tures. Methods: These articles explored among 2500 scientific articles published in PubMed to sort the scientific works have been done on the effects of this clay on body function (it was about 100 articles). Results: Bentonite has a broad range of action on different parts of body. Conclusion: As traditional remedies seem to have a deep root in maintaining body health, it merits doing more re-search works on bentonite clay and its impacts on body function.

Background: The aim of this study was to provide evidence for developing intervention and effective management for the prevention of malaria based on epidemiological analysis and assessment of Korean soldiers‟ knowledge on ma-laria and malaria preventive behavior. Methods: The data were collected from 294 Korean soldiers nearby the demilitarized zone in Gyeonggi Province in 2016. Multiple regression analyses were applied for statistical analysis. Results: The level of education (β =. 24, P<. 001), educational experience on malaria (β =. 21, P<. 001) and ranks like corporal (β =. 13, P<. 05), and sergeant (β =. 13, P<. 05) were observed to be associated with the level of knowledge of malaria (F=9. 62, =. 12, P<. 001). Knowledge of malaria (β =. 25, P<. 001) and malaria education experience (β =. 22, P<. 001) were the factors that influenced malaria prevention behavior and practice (F=12. 45, =. 18, P<. 001). Conclusion: The level of knowledge and education experience was associated with malaria prevention practice. Therefore, malaria education is very important for the soldiers in nearby DMZ for prevention of malaria. The findings provide implications for the development of intervention programs focusing on increasing the levels of knowledge and practices related to malaria.

Background: Population aging has become increasingly serious in China. The demand for medical insurance of the elderly is increasing, and their health status and life satisfaction are becoming significant issues. This study investigates the effects of medical insurance on the health status and life satisfaction of the elderly. Methods: The national baseline survey data of the China Health and Retirement Longitudinal Survey in 2013 were adopted. The Ordered Probit Model was established. The effects of the medical insurance for urban employees, medi-cal insurance for urban residents, and new rural cooperative medical insurance on the health status and life satisfaction of the elderly were investigated. Results: Medical insurance could facilitate the improvement of the health status and life satisfaction of the elderly. Accordingly, the health status and life satisfaction of the elderly who have medical insurance for urban residents im-proved significantly. The regression coefficients were 0. 348 and 0. 307. The corresponding regression coefficients of the medical insurance for urban employees were 0. 189 and 0. 236. The regression coefficients of the new rural cooper-ative medical insurance were 0. 170 and 0. 188. Conclusion: Medical insurance can significantly improve the health status and life satisfaction of the elderly. This de-velopment is of immense significance for the formulation of equal medical security.

Background: Human papillomavirus (HPV) infection has been considered as main cause of cervical cancer. Recently, aberrant DNA methylation at tumor suppressor genes (TSGs), leading to inactivation, has also been an early epigenet-ic event and cofactor in cervical carcinogenesis. This study was performed to evaluate an association between the hypermethylation of p16INK4α gene’ s promoter and HPV exposure in non-invasive samples (liquid-based papanicolaous samples) in Vietnamese population. Methods: 109 liquid-based papanicolaous test samples were archived and admitted from the Medic Medical Center and Au Lac Clinic Laboratory, Vietnam, from 2011– 2014. Methylation-Specific-PCR (MSP) was performed to analyze methylation status from the liquid-based papanicolaous test samples identified whether HPV/or non-HPV, high-risk/low-risk HPV infection. Results: An upward trend was observed concerning the p16INK4α hypermethylation frequency in high-risk HPV infec-tion, counting for 55. 6%, and the low methylation frequency in low-risk and non-HPV infected samples, counting for 22. 9%, 8. 0%, respectively. The significant correlation between candidate p16INK4α hypermethylation and HPV exposure was observed (P<0. 0001). Moreover, the odds ratio (OR) and relative risk (RR) were found in statistical significant value. (OR=5. 76, 95%CI: 2. 36 – 14. 04, P<0. 01; RR=3. 11, 95%CI: 1. 75– 5. 53, P<0. 01). Conclusion: Presence of p16INK4α hypermethylation was the specific characteristic of high-risk HPV infected samples in Vietnamese population. The OR and RR values showed that the strong correlation between p16INK4α hypermethyla-tion and high-risk HPV infection, in which increased the risk of cervical cancer. The combination of p16INK4α hyper-methylation and HPV detection based biomarker could be used in non-invasive samples obtained from high-risk can-cer patients, offer significant practical advantages.

Background: Currently, the studies on the relationship between type 2 diabetes and platelets indicators were carried out on a selective small sample population generally. Large sample studies in this area are rare, especially in Chinese population. In this study, we aimed to investigate the relationship between type 2 diabetes and the mean platelet vol-ume (MPV), platelet count (PLT) and platelet distribution width (PDW). Methods: This is a cross-sectional analysis of the routine health examination data from 20128 participants with com-plete baseline data in Yinzhou District 2013. The detection of indicators in this study was completed by automatic hematology analyzer. Results: The PDW and PLT were not significantly different between diabetic group and non-diabetic group, (16. 00% vs. 16. 00%, P=0. 88, and 194*109/L vs. 196*109/L, P=0. 05 respectively). The MPV was significantly higher in diabetic group (9. 3fl vs. 9. 2fl, P<0. 05). MPV was an independent risk factor of diabetes mellitus (Unadjusted OR=1. 07 (95% CI: 1. 03, 1. 11), Adjusted for age, sex OR=1. 07 (95% CI: 1. 02, 1. 12)). The adjusted odds ratio of diabetes rose with increasing MPV levels and were most pronounced in subjects with MPV levels exceeding the 90th percentile (MPV≥ 10. 70 fl, Crude or=1. 23 adjusted or=1. 19). Conclusion: There was no relationship between the presence of diabetes with PDW and PLT. The MPV was inde-pendently associated with the presence of diabetes.

Background: We aimed to identify factors influencing the therapeutic outcome of orthokeratology on controlling juvenile myopia progression, and the risk factors for complications. Methods: Myopic patients (n=724) in Shenzhen Second Hospital from Jan 2011 to Jan 2016 fitted with orthokeratol-ogy lenses and followed-up for 6– 65 months were reviewed retrospectively. Univariate and multivariate logistic regres-sion analyses were used to screen for the factors that can improve treatment outcome and prevent the development of complications. Results: Patients where the orthokeratology treatment was effective displayed a shorter myopia time, smaller diopter and corneal curvature, larger corneal endothelium density, high proportion of overnight wear and longer wearing times compared with patients whose treatments were ineffective. Additionally, wearing Ortho-k for 6 or 12 months yielded improved corrective effect and achieved higher comfort level. Logistic regression analyses showed that myopia time, diopter, corneal curvature e value, corneal endothelium density, time with Ortho-k and corrective effect after wearing Ortho-k for 6 or 12 months were all independent factors influencing the treatment effects. Results showed corneal curvature, anterior chamber depth and central corneal thickness were independent risk factors. Conclusion: This study systematically identified the factors leading to effective treatments, and those carrying a risk for complications, to provide guidance for the prescription and follow-up of orthokeratology in the treatment of juve-nile myopia.

Background: China had implemented policies to limit antimicrobials prescription since 2004; we conducted this study to reflect the effect of these national policies by analyzing antimicrobial prescription trends of medical insurance in patients from 2003 to 2014 in Changsha city, China. Methods: The participants were inpatients of the medical insurance of urban workers (UEBMI). Data were extracted from medical insurance information system of Changsha Medical Insurance Institution, which directly connects with hospitals information systems. Results: Trend analysis showed great changes in antimicrobial prescription and inpatients’ cost on antimicrobials over the study period. Antimicrobial prescription rates gradually declined over the study period from 79. 0% in 2003 to 43. 5% in 2014 (adjusted OR0. 205; 95%CI 0. 198 to 0. 213). There was a quicker decline from 2011 to 2014 (with im-plementing national antimicrobial stewardship action plan) than the period from 2003 to 2010 (with implementing antimicrobials use education and self-management strategies). The proportion of inpatients used one antimicrobial increased significantly from 25. 6% in 2003 to 46. 7% in 2014, while the proportion of inpatients used three or more antimicrobials gradually decreased. Bacterial culture rate increased from 20. 4% in 2003 to 36. 6% in 2014 (adjusted OR 2. 248; 95% CI 2. 149 to 2. 352). The average costs on antimicrobials decreased significantly, from 277. 43 US Dollar in 2003 to 91. 05 US Dollar in 2014. Conclusion: National efforts to promote rational use of antimicrobials in clinical practice have had a positive effect over the past decade in China.

Background: We investigated the application of a predictive nursing education process on the degree of comfort and quality of life for cancer patients. Methods: A total of 168-cancer patient in Zhujiang Hospital of Southern Medical University, Guangzhou, Guang-dong, China between June 2014 and June 2016 were enrolled and admitted for surgery or radiotherapy/chemotherapy treatment. Patients were randomly divided into control and observation groups, each containing 84 cases. Patients in the control group received routine cancer care, whereas the observation group received care incorporating a predictive nursing education process. Patients were assessed after admission and prior to discharge via the Kolcaba's comfort status scale (through a General Comfort Questionnaire (GCQ)), quality of life scale (QOL), and Barthel Index (BI) for activities of daily living (ADL). Patient mental state was also evaluated using the Hamilton Anxiety Rating Scale (HA-MA) and Hamilton Depression Rating Scale (HAMD). Results: GCQ, QOL, and BI scores of the observation group were all significantly higher than those of the control group (P <0. 05). HAMA and HAMD scores were significantly lower in the observation group compared to the con-trol group (P < 0. 05). Conclusion: The predictive nursing education process could significantly improve degree of comfort and activities of daily living for cancer patients, and thus improve mental states and quality of life.

Background: This study aimed to determine the prevalence of hearing impairment (HI) by age and gender in a popu-lation aged 5 yr and older residing in Tehran, Iran. Methods: In this cross-sectional study, 140 clusters each including 10 households from Tehran, Iran were sampled between 2012 and 2013 using cluster random sampling. Trained audiologists examined the participants during face-to-face interviews. The hearing of the participants was evaluated before the removal of wax or other foreign bodies. In this study, HI was categorized as mild (grade 1, 26-40 db), moderate (grade 2, 41-60 db), severe (grade 3, 61-80 db), and deaf (grade 5, 81 db or more). All participants signed informed consent forms. The SATA software was used for data analysis. Results: Of 6521 individuals, 4370 (67%) were interviewed. The prevalence of HI (auditory threshold of 0. 5, 1, 2, 4 KHz and more than 25 db in the better ear) was 14. 27 (11. 53-17. 91) of whom 9. 52 (7. 07-11. 98) had grade 1, 4. 04 (3. 02-5. 06) had grade 2, 0. 67 (0. 33-1. 02) had grade 3 HI and 0. 48 (0. 16-0. 8) were deaf. About 5. 19% of the participants had disabling hearing impairment. All HI grades increased significantly with age but no significant difference was ob-served between men and women. Conclusion: The considerable prevalence of HI in Iran in comparison with other developing countries, with regards to the trend of aging in the population, seems concerning. The results of the study could be used as a treatment and research guideline for future works in the area of policymaking and plan to decrease these disorders.

Background: Complementary health insurance is increasingly used to remedy the limitations and shortcomings of the basic health insurance benefit packages. Hence, it is essential to gather reliable information about the amount of Will-ingness to Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable complementary health insurance. Methods: The study sample consisted of 300 household heads all over provinces of Iran in 2013. The method applied was double bounded dichotomous choice and open-ended question approach of contingent valuation. Results: The average WTP for complementary health insurance per person per month by double bounded dichoto-mous choice and open-ended question method respectively was 199000 and 115300 Rials (8 and 4. 6 USD, respective-ly). Household’ s heads with higher levels of income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size. Conclusion: The WTP value can be used as a premium in a society. As an important finding, the study indicated that the households were willing to pay higher premiums than currently collected for the complementary health insurance coverage in Iran. This offers the policy makers the opportunity to increase the premium and provide good benefits package for insured people of country then better risk pooling.

Background: This study aimed to determine drug resistance mutations in patients with virological failure and find correlation between HIV drug resistance test and viral load. Methods: Blood sample was collected from 51 patients who suspicious treatment failure in the center of Imam Kho-meini Hospital, Tehran, Iran in 2015. Viral voluntary counseling and testing load test was done and the patients with viral load above 1000 copies choose for detection of drug resistance mutations by genotyping method (29 patients). Results: The majority of patients (82. 75) harbored the HIV subtype CRF 35 A-D. The 86. 2% patients compromised at least one resistance mutation. The analysis of reverse transcriptase showed M184V (68. 9%), T215YISF (44. 8%), K103N (27. 6%) and the analysis results of protease revealed G73SC (13. 8%) and I47VA (6. 9%). Eventually, the signif-icant correlation between viral load and drug resistance was found. Conclusion: The result of our research stress the significance of recognizing drug resistant on time that prohibits the accumulation of drug resistance mutation and circulates the resistance strain of HIV-1 virus and the importance of national study according to the reliable findings for treatment guidelines.

Background: Female genital mutilation is an intentional inhumane procedure that threatens girls and women's health. It is especially widespread in developing countries due to cultural, traditional and religious preferences. The aim of the current study was to investigate how circumcision affects women's sexual function. Methods: This cross-sectional study was conducted in the urban and rural area of Piranshahr County, Iran, in 2015 among convenience samples of 200 women, 15-49 yr old, who were applying to health care centers for receiving rou-tine health care services. Data collection was conducted with the use of a self-administered written questionnaire to assess female sexual function, mental well-being, and quality of life. Results: Significant differences were found between circumcised and non-circumcised women in total score of female sexual function index (FSFI) in domains of desire, arousal, vaginal moisture, orgasm, satisfaction, and pain [(P<0. 001), MD(95%CI)=5. 64(3. 64 to 7. 64)] and based on Hotelling's T-square, significant differences were found in dimensions of quality of life and FSFI. Conclusion: The revealed sexual dysfunction among mutilated women gives ground to require that public health sys-tems take actions aimed at implementing special sexual education program to improve sexual functions of mutilated women and changing beliefs and social norms in the community level.

Background: Nitrite (NO2-) and nitrate (NO3-) contaminations of groundwater are considered as one of the major health challenges in recent decades. This study aimed to evaluate the nitrite and nitrate concentrations in the drinking groundwater of Shiraz, South-central Iran by statistical models. Methods: From 43 active wells of Shiraz drinking water supplies, 344 samples were collected in the high and low pre-cipitation seasons from 2010 to 2014. Nitrate and nitrite concentrations were tested by a DR6000 spectrophotometer, and the results were analyzed by different software, including SPSS ver. 20, ArcView GIS 9. 3. It was done by variable and multivariate regression models. In all tests, the level of significance was set at 5%. Results: Nitrate concentrations in the samples were in the range of 5 to 72 mg/l, and 38 (11%) of the samples had nitrate concentrations above the standard level 10 mg/L as nitrogen. The annual mean concentration of nitrite varied from 0 to 0. 025 mg/l. There was an inverse correlation between nitrate and nitrite concentrations and well depths. Conclusion: The most important reason for the high concentration of nitrate in Shiraz drinking groundwater supplies were lack of health privacy of wells, the impact of residential construction around drinking water wells, and placement of wells in the direction of groundwater flow.

Background: Considering the importance of hospital wastewaters as potential reservoirs for the dissemination of bacterial pathogens such as Escherichia coli and antibiotic resistance genes in the environment, the need for such infor-mation becomes imperative. Methods: E. coli strains were isolated from hospital wastewater sources in Tehran, Iran, over a 24-month sampling period (Jun 2014-Jun 2016) and identified using standard bacteriological methods. Quinolone resistance among the strains was determined using Kirby-Bauer method and the frequency of plasmid-mediated quinolone resistance genes (qnrA, qnrB, qnrS) was investigated by PCR. Results: In total, 80 E. coli strains were isolated during the study period, of which 51 (63. 8%) isolates were resistant to tested antibiotics. Of note, 13 isolates were resistant to all the antibiotics employed. The highest rates of antibiotic resistance were obtained for nalidixic acid (60%), followed by norfloxacin (30%), and ciprofloxacin (25%). Of the 51 quinolone-resistant strains, 24 (47. 1%) isolates harbored qnr genes. None of the isolates harboured the qnrA gene, while 11 (45. 8%) and 7 (29. 2%) isolates contained qnrB and qnrS, respectively. Conclusion: Our findings showed high rates of quinolone resistance (63. 8%) and qnr genes, underlining the im-portance of hospital wastewaters as reservoirs for dissemination of potentially pathogenic E. coli and horizontal gene transfer between other waterborne bacterial species. Other possible mechanisms of resistance should also be investi-gated for better characterization of quinolone-resistant E. coli isolates.

Dear Editor-in-ChiefMost of college students, despite their commonly perceived good health, report experiencing medical conditions, such as attention-deficit/hyperactivity disorder, learning disabilities, psychiatric disorders, and other chronic illnesses (1-2)...

Dear Editor-in-ChiefDrug craving and the other compulsive behaviours are the essences of addiction. People who abuse substances are likely to find them-selves increasingly isolated from their families. Several drug abuse studies have been conducted (1-3)...

Dear Editor-in-ChiefMany studies are underway on youth baseball players shoulder ROM (range of motion) and ball speed in order to prevent them from having inju-ries to their shoulder joints, to work out the ap-propriate number of pitches, and to develop ef-fective training programs...

Dear Editor-in-ChiefSilicosis is the oldest occupational lung disease caused by the inhalation of dust crystalline silica (1). There is no effective cure for this endemic disease and the principal help we could provide for patients is to extend their survival and im-prove their Health-Related Quality of Life (HRQoL) (2). Silicosis patients in Algeria are re-ported to be young and to have low economic level. Silicosis has become the greatest threat to workers’ occupational safety (Algerian stone carvers) considered as the most serious occupa-tional disease worldwide...

Dear Editor-in-ChiefPediculosis human's capitis, more commonly known as head lice infestation, include adult lice, larvae (nymphs) and eggs that solely affect the human scalp (1-3). Pediculosis capitis is a widespread medical problem in both developing and developed countries and is considered as one of the community health concerns that affect school students, children, adolescences and adults (4, 5). Furthermore, the prevalence of infestation worldwide ranges from 5%-80% with the highest prevalence among preschool and elementary school children (2, 6)...

Dear Editor-in-ChiefSuicide is a serious, yet preventable, health con-cern that effects and affects individuals, families, and communities all around the world. It is con-sidered to be one of the leading causes of mortal-ity in western countries with evidence showing that it is the second underlying cause of death among individuals aged 15 to 19 yr old in differ-ent communities (1, 2). The global rate of sui-cides is estimated at 16 per 100000 or one suicide every 40 sec, representing more than 800000 committed suicides per year (excluding attempted suicides or non-fatal suicidal behavior) (3)...

Dear Editor-in-ChiefZkia virus (ZIKV) is a flavivirus from the flaviviridae family, transmitted to humans pre-dominantly by infected mosquitoes (mostly by Aedes spp. ). This arbovirus was initially isolated from a rhesus monkey in the Zika forest in Uganda in 1947. ZIKV infection is commonly associated with unclear symptoms. However, in about 20% of cases, it can cause self-limited symptoms such as fever, joint pain, rash, and conjunctivitis for several days (1). ZIKV likely causes microcephaly in babies, suggesting the congenital and perinatal transmission. Another concern is about the relation between ZIKV and Guillain-Barré syndrome (1)...

Dear Editor-in-ChiefOne of the most effective and valuable principles to promote health in all countries has been adoption of Primary Health Care (PHC) as a fundamental strategy. In Sept. 1978, an interna-tional conference was held in Alma-Ata, whose great achievement was declaring PHC as a roadmap for “ Health for All” by the year 2000 (HFA 2000). Indeed, as a new approach beyond the traditional system of health care, PHC insist-ed on justice in the delivery and distribution of services in the health sector (1)...