Iranian Journal of Public Health
Year:2019 | Volume:48 | Issue:6|Papers Count:30

Background: The incidence of chronic diseases, such as cardiovascular disease, diabetes, overweight, obesity, cancer and other diseases has been increasing. It is a huge challenge to public health industry about how to provide risk intervention and preventive medical services and explore advanced technology platform for effective preven-tion and control of chronic diseases. Methods: We collaborated domestic and international experts on preventive medicine, and analyzed pathogenesis and risk factors for the major chronic diseases. Results: We established Target Elimination--denatured and unstable proteins, environmental toxins, metabolic wastes, immunosuppressive factors and chronic inflammatory factor (TE-PEMIC) system that offer us the stand-ard and methods to eliminate and intervene pathogenic factors of the chronic diseases. Conclusion: It provides new researches and exploring new ideas to prevent and intervene chronic diseases by applying the TE-PEMIC chronic diseases prevention medical technology system.

Background: This systematic review was conducted to highlights key challenges, and outlines important next steps to maximize the potential to contribute to the broader malaria elimination interventions. Methods: This systematic review on malaria elimination intervention and challenges was undertaken searching six databases, between 1995 and 2018. Inclusion and exclusion criteria were set. The references were collated and categorized according to type of study, intervention, population, and health outcome. Articles selection based on title and abstract, retrieval of full text and additions of articles from reference lists and recommenda-tions from experts. Disagreement in data extraction was solved by consultation of third reviewer. Results: Overall, 4039 records were examined related to malaria elimination that initially identified by our des-ignated electronic databases search. Overall, 35 studies contained 14 experimental studies (40%) and 21 analytic observational studies (60%) met the inclusion criteria for this review. Studies used a wide variety of malaria elimination interventions. Types of interventions either elimination-focused interventions or general interven-tions on educational, prevention and treatment of malaria are included. This review pointed out the variety of challenges for eliminate malaria among low and high endemic countries. Conclusion: Malaria elimination is facilitated by strong health systems, determined leadership, appropriate in-centivization, an effective surveillance system, and regional collaborations. We have identified areas for elimina-tion-specific interventions deserve more attention in the conduct and reporting.

Background: We assessed the information regarding the psychometric properties of the Short Form-12 Health Survey Version 2 (SF-12v2) among older adults in China Methods: A cross-sectional study was conducted on a stratified representative sample of older adults (≥ 60 years) residing in community and nursing home settings in 2017-18. Reliability was estimated using the internal consistency method. Validity was assessed using convergent and discriminant validity checks, factor analyses (including both exploratory and confirmatory factor analyses [EFA and CFA]), and “ known groups” construct validity. Results: The final sample comprised 1000 older adults (451 community-dwelling and 549 institutional). Cronbach’ s α was 0. 81 for the Physical Component Summary (PCS) and 0. 83 for the Mental Component Summary (MCS), showing satisfactory internal consistency for both. Most items were strongly correlated with their represented component (Spearman’ s correlation coefficient: 0. 62– 0. 87), although the correlation of SF items with PCS was a bit stronger than that with MCS. A two-factor structure (physical and mental health) in-dicated by EFA jointly accounted for 68. 50% of the variance and presented adequate goodness-of-fit indices (GFI=0. 98, AGFI=0. 92, RMSEA=0. 08, 90% Cl RMSEA=0. 06 to 0. 11, NFI=0. 98, and CFI=0. 98) in CFA. Known-groups comparison showed that SF-12v2 summary scores did well in differentiating subgroups of old-er adults by age, marital status, and self-reported health problems (P≤ 0. 05). Conclusion: SF-12v2 is a reliable and valid health-related quality of life instrument for Chinese older adults that works equally well with older adults under institutional care and community-based home care models.

Background: The risk factors of metabolic syndrome (MetS) in menopausal women are potential causes of osteoporosis. However, there is no consensus on this. We aimed to determine the relationship between risk factors of MetS and bone mineral density (BMD) in menopausal Korean women. Methods: We enrolled 205 menopausal Korean women who visited a health promotion center in Seoul in 2015 and divided them into the following two groups according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria with modified waist-circumference criteria: the non-MetS group (Group 1, n=90) and the MetS group (Group 2, n=115). Anthropometric parameters and clinical parameters, including blood pressure, blood lipid profile (cholesterol, triglycerides), and fasting blood sugar levels were recorded for all participants. BMD at the lumbar spine was determined using dual-energy X-ray absorptiometry (DEXA). The relationship between the risk factors of MetS and bone mineral density was analyzed by statistical methods. Results: There was no significant difference in risk factors of MetS between the groups. In correlation tests, waist circumference showed a significant association with body surface area (BSA) (r =-0. 242, P < 0. 001). Diastolic blood pressure was correlated with BSA (r = 0. 186, P < 0. 01) and bone mineral content (BMC) (r = 0. 161, P < 0. 05). However, multiple regression analysis showed no significant relationship between MetS risk factors and BMD. Conclusion: The risk factors of MetS did not affect BMD in menopausal Korean women. Follow-up studies with a larger study population are necessary size to allow the investigation of other research variables.

Background: Environmental pollution seriously damages not only the ecosystem but also the well-being of residents. There is an association between air pollution and residential health expenditures. The aim of this study was to identify the association between pollution control and residents’ health expenditures. Methods: Using the pilot project of the regional cooperative pollution control in 28 cities required by the Chi-nese government as the quasi-natural experiment setting and the panel data of residents’ health expenditures in China from 2014 to 2017, the impact of pollution control on residents’ health expenditures was systematically explored through difference-in-difference approach. Results: Air quality of the 28 cities that adopted the regional cooperative pollution control policy improves sig-nificantly, thus indicating that this policy effectively solves the self-interest issue of local governments in pollu-tion control, and residents’ health expenditures consequently decrease. Conclusion: This study enriches the paradigm that analyzes the relationship between air pollution and residents’ health expenditures and reveals the mechanism through which the regional cooperative pollution control reduc-es residents’ health expenditures.

Background: Breast cancer is one of the most common cancers among women. Breast cancer treatment strate-gies in Nigeria need urgent strengthening to reduce mortality rate because of the disease. This study aimed to determine the relationship between the ages at diagnosis and established the prognostic factors of modality of treatment given to breast cancer patient in Nigeria. Methods: The data was collected for 247 women between years 2011-2015 who had breast cancer in two dif-ferent hospitals in Ekiti State, Nigeria. Model estimation is based on Bayesian approach via Markov Chain Mon-te Carlo. A multilevel model based on generalized linear mixed model is used to estimate the random effect. Results: The mean age of the patients (at the time of diagnosis) was 42. 2 yr with 52% of the women aged be-tween 35-49 yr. The results of the two approaches are almost similar but preference is given to Bayesian because the approach is more robust than the frequentist. Significant factors of treatment modality are age, educational level and breast cancer type. Conclusion: Differences in socio-demographic factors such as educational level and age at diagnosis signifi-cantly influence the modality of breast cancer treatment in western Nigeria. The study suggests the use of Bayes-ian multilevel approach in analyzing breast cancer data for the practicality, flexibility and strength of the method.

Background: To investigate the characterizations of CT (computed tomography) and MRI (magnetic resonance imaging) in patients with carotid atherosclerosis. Methods: A retrospective analysis was performed on the medical records of 264 patients with carotid atherosclerosis underwent CT and MRI in Linyi Central Hospital, Linyi, China from January 2010 to January 2016. Among them, 142 patients with ischemic stroke were in experimental group (test group), another 122 patients in control group. The lumen stenosis degree, plaque fibrous cap status, calcification information and vascular plaque hemorrhage in the carotid artery fork of patients detected by CT and MRI were collected. Results: The detection rate of the plaque calcification of patients detected by MRI was lower than that detected by CT in the experimental group (P<0. 05). Patients in the experimental group had higher average vascular stenosis degree detected by CT and MRI than those in the control group (P<0. 01). The average vascular stenosis degree of patients detected by MRI was higher than that detected by CT in the experimental group (P<0. 05). Patients in the experimental group had higher unstable fibrous cap number detected by CT and MRI than those in the control group (P<0. 01). Patients in the experimental group had significantly higher number of vascular plaque small focus hemorrhage than those in the control group (P<0. 05). Conclusion: Patients with carotid atherosclerotic complicated with stroke have higher plaque calcification number, vascular stenosis degree and unstable fibrous cap number. Both CT and MRI can better predict the risk of stroke.

Background: The work stress of civil servants has gradually increased as a result of the modernization of Chi-na’ s national governance system and capacity. However, research on the correlations among work stressors, work stress responses, and subjective well-being (SWB) of civil servants is scarce. Methods: In accordance with the current research status on work stress and SWB, a survey of 874 civil serv-ants in China was carried out from May to June 2018. The revised stress response questionnaire of civil serv-ants, work stressors questionnaire of civil servants, and a simplified edition of the SWB scale of China’ s urban residents were used in this study. Results: Superiors impose the major work pressure on civil servants, followed by interpersonal relationship, work particularity, career prospect, work task, perfectionism, and job responsibility. The work stressors of civil servants were significantly related to gender, age, marital status, working years, educational background, and position (P<0. 05). The work stressors of civil servants were significantly positively correlated with work stress responses (P<0. 05). The work stressors and work stress responses had a significantly negative correlation with SWB. Conclusion: SWB can be accurately predicted by work stressors and work stress responses. These findings can provide references and guidance for the society and government sectors to accurately understand and cope with the treatment of civil servants, formulate work stress management countermeasures, and create a high-level working environment for civil servants.

Background: We aimed to investigate the clinical value of detecting 14 food intolerances. Methods: A total of 312 patients with food intolerance enrolled in the Third Affiliated Hospital of Qiqihar Medical University (Qiqihar, China) from Feb 2016 to Feb 2017 were selected. ELISA was used to detect intol-erance specific IgG antibodies for 14 foods (pork, chicken, beef, shrimp, fish, crab, egg white/yolk, tomato, mushroom, milk, corn, rice, soybean, wheat). Results: The highest average positive rate of the patients was 42. 31% for the crab, followed by shrimp 21. 15%, egg white/yolk 18. 27% and milk 16. 99%. The positive rate from high to low was crab, shrimp, egg white/yolk, milk, fish, corn, soybeans, tomatoes, rice, mushrooms, wheat, pork, beef, chicken. There were significant differ-ences in the specific IgG antibody positive rates between shrimp, soybean and wheat in the skin symptoms group, gastrointestinal symptoms group, respiratory symptom group and nervous system symptom group (P<0. 05). There was a significant difference in the positive rate of specific IgG antibodies between shrimp, crab and egg white/yolk in the adolescent group, the middle-aged group and the elderly group (P<0. 05). Conclusion: The detection of food-specific IgG antibodies can help to determine which food intolerance caused the disease, and then adopt a fasting or diet method to avoid eating unsuitable foods and continually damaging the body, thus maintaining good health. The detection method provides a new idea for the diagnosis and prevention of diseases.

Background: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population. Methods: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based on Iranian food habits and cooking methods. We recruited 244 healthy adults with a mean age of 42. 83 ± 0. 75 yrs. from healthy individuals who were friends or relatives of patients in the Cancer Institute of Iran from April 2011 to February 2012. We used the DHQ to assess dietary intakes through interviews as well as at least four 24-h recalls one in every season. Reliability was estimated by comparing data of DHQ with mean intake from 24-hour recalls using deattenuated and energy-adjusted Spearman correla-tion coefficients. We classified dietary intakes of two methods into three groups to probe if DHQ cor-rectly allocates subjects into different intake groups compared to reference method. The results are re-ported as percent of disagreement, adjacent agreement, and complete agreement. Results: Deattenuated spearman correlation ranged from 0. 18 for vitamin B12 and fat to 0. 60 for sugar. It ranged from 0. 13 for pantothenic acid to 0. 60 for sugar in men and from 0. 07 for fat to 0. 58 for sugar in females. The complete agreement of methods ranged from 51% for selenium to 36% for carotene in the entire sample, from 50% for energy to 31% for niacin in males and from 49% for sugar to 27% for vita-min B12 in females. Conclusion: The DHQ is a valid tool for assessing most nutrients intake among Iranian population. In addition, it is a proper instrument in categorizing individuals based on their dietary intakes.

Background: In this study, we used a variety of factors that affect urbanization in Iran to evaluate different provinces in Iran in terms of the level of urbanization. Methods: Using information from census 2011, we collected data on 33 indicators related to urbanization in 31 provinces in Iran. To rank the provinces we used density-based hierarchical clustering scheme. To determine similarities or differences between the provinces, the square of the Euclidean distance dissimilarity coefficient; Ward’ s algorithm was used to merge the provinces to minimize intra-cluster variance. One-way analysis of vari-ance (ANOVA) was used to determine the variance between the variables used to rank the provinces in terms of different levels of urbanization. Statistical analysis was performed using SPSS. Results: The provinces in Iran were combined with each other in 30 stages and classified into four levels. Tak-ing into account the variables used to rank the level of urbanization, Tehran, and Alborz provinces were at the highest level of urbanization. On the other hand, the provinces of Sistan and Baluchistan, Kerman, North Khorasan, South Khorasan, Hormozgan, and Bushehr were at the lowest level of urbanization. Conclusion: Identification of provinces at the same level of urbanization can help us to discover the strengths and weaknesses in the infrastructures of each of them. Given the differences between various levels of urbani-zation, the identification of factors that are effective in the process of urbanization can help to access more in-formation required for designing plans for the years to come.

Background: Some mosquito species which belong to the Culex. pipiens complex are primary vectors for West Nile virus, Sindbis, Dirofilaria immitis, and many arboviruses. Knockdown resistance (kdr) mutations in the volt-age-gated sodium channel (VGSC) gene of Cx. pipiens that is inherited, is one of the important threats for the efficacy of pyrethroids insecticides. Knockdown resistance (kdr) mutation, L1014F, is a well-defined mecha-nism of resistance to pyrethroids and DDT in many insect species. The aim of study was to determine the mechanisms of Insecticide resistance in this species Methods: Specimens of Cx. pipiens, the major vector of West Nile virus, were obtained in Tehran, Iran by col-lecting larvae from polluted wastewater in Qarchak of Tehran. In 2016 Insecticide susceptibility tests were per-formed according to WHO methods with deltamethrin 0. 05%. We focused on determination of this point mu-tation in the VGSC gene of Cx. pipiens by Real-time PCR. Results: Our results revealed high levels of resistance to deltamethrin 0. 05%. The lethal times i. e. LT50 and LT90 for deltamethrin were 2. 1530 and 8. 5117 h respectively. The result of Real-time PCR confirmed the pres-ence of resistant genotype in all the members of tested population. This study is the first report on kdr geno-typing of Cx. pipiens from Tehran and our results on the VGSC gene in position L1014F confirmed the TTA to TTT nucleotide change. Conclusion: This finding will provide a clue for management of insecticide resistance in mosquito which are vectors of arboviruses and decision for replacement of novel approach for vector control.

Background: The aim of this study was to assess associations of Citrobacter freundii foodborne outbreaks with environmental factors in various regions of Yazd Province, Iran, 2012– 2016. Methods: The public health surveillance data were used for one period of five years reported foodborne disease outbreaks in various regions of the Province. Multilevel regression statistical method was used to analyze associa-tions of climatic and demographic variables with outbreaks. Significant associations were tested using likelihood ratio tests. Results: Results showed a significant association between C. freundii outbreaks and air dust conditions, age groups and various regional cities. Conclusion: The current study revealed necessity of etiologic agent identification for use in foodborne disease outbreak guidance in future outbreaks. Systemic surveillance schemes can help prevent and control similar sce-narios using reports of environmental effects on foodborne disease outbreaks.

Background: Metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, consider as a manifestation of obesity. However, a proportion of obese patients do not develop MetS. The aim of our study was to deter-mine whether concentration of plasma adiponectin and leptin differ between metabolic unhealthy obese (MUO) patients and comparable age-and sex-matched control groups. Methods: In this case-control study, we assigned 51 obese patients with MetS (MUO) in cases group and 102 metabolic healthy obese (MHO) and normal weight metabolic healthy subjects matched for age and gender to cases in control groups. The study was conducted between December 2014 and February 2016 in the Endocri-nology Research Center of Tehran University of Medical Sciences, Tehran, Iran. We measured serum adi-ponectin, leptin, their ratio, and body composition in all subjects. Results: No significant differences were observed between MHO and MUO in term of total fat mass and trunk fat (P>0. 05). Compared to MHO and normal weight metabolic healthy subjects, MUO subjects had low-er levels of plasma adiponectin (P<0. 001) and lower plasma adiponectin to leptin ratio (P<0. 001) and a higher level of plasma leptin (P<0. 002). A Receiver Operator Characteristic curve was used to identify the ability of adiponectin and leptin level to predict the MetS. The area under the Receiver Operator Characteristic curve was 0. 66 (P<0. 01), 0. 73 (P<0. 001) and 0. 75 (P<0. 001) for leptin, adiponectin, and adiponectin/leptin ratio levels respectively. Conclusion: Our study introduced adiponectin and leptin as indicator of MetS and obesity respectively.

Background: Web is considered an important tool for formal and informal communication and cooper-ation among members of the community including researchers. Universities’ websites played a significant role in the development of social structure through the creation of cyberspace. We aimed to evaluate the growth and Webometrics rankings of the country’ s medical universities web sites base on interventional approach. Methods: This interventional study assessed Iranian universities of medical sciences’ websites from the periods of Jan 2015, Jul 2015 and Jan 2016. Medical universities websites were ranked based on four Webometrics indicators; PRESENCE, VISIBILITY, OPENNESS, and EXCELLENCE. To enhance the ranking of websites, 4 strategies were introduced in 3 seminars conducted from Jan to Jul 2015. In-formation needed from these 30 medical universities were obtained from Webometrics Ranking of World Universities based on 4 indicators and were collected in 2 steps (before and after introduction of strate-gies) Results: About 21% to 70% of the country’ s medical universities have increased ranking after the inter-ventions while 9% to 30% obtained a downward trend in their rankings, Tehran University of Medical Sciences obtained the highest rank followed by Shahid Beheshti University of Medical Sciences and the third rank was obtained by Shiraz University of Medical Sciences. Conclusion: The presence of websites play a vital role in the academic community. Doubtlessly, the idea of designing and launching a website without any knowledge of the principles and standards would be problematic and impossible.

Background: Considering the importance of high out-of-pocket (OOP) payment (OOPP), as a marker of health system performance, and affordability of medications in the elderly, this study was conducted to deter-mine these issues. Methods: In this cross-sectional study, prescriptions of patients aged 65 yr or older from 5 university-affiliated pharmacies in Tehran, Iran were evaluated from Jan to Mar 2014. Prescriptions were selected from four insur-ance organizations. We used the prescriptions data regarding patients’ demographics and the prescribers as well as the sales data for OOP. Affordability was calculated by considering the daily salary of an unskilled worker. Results: Totally, 1467 prescriptions were analyzed. Mean age of patients was 73. 89(6. 66) yr. Mean (SE) of re-imbursable and OOPP of the prescriptions were 203820 (10831) and 230252 (10634) IRR (Iranian Rials) re-spectively (equivalent to 81. 6 (4. 33) and 92. 17 (4. 33) US$ respectively). Subspecialists imposed higher expendi-tures for patients and insurance organizations. Patients referred to the ophthalmologists paid less OOP. Nearly 50% of the total prescription costs was paid as OOP. The mean OOPP was averagely equal to 1. 41(0. 065) daily salary. These prescriptions were unaffordable for 36. 2% of patients. Conclusion: The OOPP was higher than the insurance goal of 30% for outpatients in Iran. More than one-third of elderly patients could not afford their single prescription. Due to the health consequences of the unaf-fordability of medications, corrective actions are needed by the insurance organizations and the health system.

Background: Both genetic and environmental factors influence, susceptibility to autoimmune disorders includ-ing Behcet’ s disease (BD). FCRL3 (Fc receptor like 3 genes), a novel immunoregulatory gene, has recently been reported as a new promising candidate gene for general autoimmunity. This study was conducted to explore the potential association of FCRL3 polymorphisms with BD. Methods: This study was conducted from 2010 to 2015 in Tehran University of Medical Sciences, Tehran, Iran. Four single-nucleotide polymorphisms of FCRL3 (rs7528684, rs11264799, rs945635, and rs3761959) were genotyped in 220 patients and 220 healthy controls. Typing of the polymorphisms in this case-control study was carried out using polymerase chain reaction-restriction fragment length polymorphism analysis. Results: Analysis of the alleles revealed a significantly lower frequency of the A allele at the-169 site (rs7528684) in BD patients compared with that in controls (P=0. 000, 66. 4% versus 82%, χ 2= 30. 23). Moreover, a significant lower frequency of AA genotype and higher frequency of GG genotype was recorded for rs7528684. There was also relationship between posterior uveitis as a clinical sign of disease and polymorphism of allele A at the-169 site (P=0. 015). Conclusion: This study revealed a significant difference in both allele and genotype frequency at position-169 of FCRL3 gene between Iranian patients with BD and normal subjects. These data suggest FCRL3 gene poly-morphisms might be the autoimmunity risk factor for BD.

Background: We aimed to determine strength, weakness, opportunities and threats analysis and intended to present strengths, weaknesses, opportunities and threats matrix model for appropriate implementation of Fami-ly medicine program in Iran. Methods: This was a descriptive-analytical and cross-sectional study. All attending physicians in 30 health care centers of Tehran University of Medical Sciences, Tehran, Iran were asked to present and prioritized their views about strengths, weaknesses, opportunities, and threats factors of family medicine program in Iran in 2015. Then, the prioritization of these factors was showed by weighted score of each factor. Finally, the respondents determined four groups of TOWS model including SO, ST, WO, and WT strategy for development of family medicine in Iran. Results: Totally, the respondents expressed 44 factors as strengths, weaknesses, opportunities, and threats of family medicine program and prioritized these factors and suggested 30 TOWS matrix strategy for efficient implementation of this program. Conclusion: There were many internal and external factors that impress the implementation of family medi-cine program. There is a gap between the ideal and the current situation of this program. We suggest the health care system policy makers notice the TOWS matrix strategies determined for improvement of family medicine program in Iran.

Background: Insomnia is an important problem in medical sciences students and has implications for their educational progress. The current study aimed to estimate the prevalence of sleep disorders and investigating the impact of sweet almond on quality of sleep in students of the Tehran University of Medical Sciences (TUMS), Tehran, Iran who live in dormitories. Methods: This is a before-after study conducted in 2017. At first, using the ISI questionnaire prevalence of sleep disorders was determined. Sweet almond was the study intervention. Each day, 10 almonds were given to 446 students for 14 d. At the end of the second week, again ISI questionnaire was filled. SPSS was used to ana-lyze data. The McNemar, Wilcoxson Signed Ranks, and Repeated Measures tests were used. Results: Out of 442 participants, 217 (49. 1%) were female. Before intervention, 343 (77. 6%) had insomnia and 99 (22. 4%) had normal sleep. After intervention, 306 (69. 2%) had insomnia and 136 (30. 8%) had normal sleep. Having sweet almond for two weeks is associated with reducing insomnia (P<0. 05). Investigating the almond impact in different categories also showed that it has a reducing impact on severe, mild, weak and normal sleep categories (P<0. 05). Conclusion: Sweet almond has impacts on quality of sleep of those students of the TUMS that are living in dormitories. Intervention programs to improve quality of sleep are necessary and with regard to the high preva-lence of insomnia, students must be protected, guided and consulted.

Background: This study aimed to provide tailored transferrable lessons for expanding population coverage through a descriptive lens by reviewing the population coverage policies, reforms and strategies in selected na-tions. Methods: In this comparative short communication, 14 countries with different status of population coverage and political economy that had successful experiences with coverage expansion were selected and categorized in four groups to study their approaches to reach Universal Health Coverage (UHC). Results: Although each country needs to tailor its policies and reforms based on its own contextual factors, the legal right of citizens to social security and health protection are enshrined in most countries' Constitution. Some countries adapted political and economic reforms to evolve their Social Health Insurance schemes. Na-tional laws to push governments to adapt UHC as a national strategy for ensuring that every resident is enrolled in health insurance schemes are key policies to reach UHC. Conclusion: A series of reforms are required to provide total population coverage through various approaches. To create an effective insurance coverage, physical merger of all insurance funds is not necessarily required. Further, the share of GDP for health is not a definite indicator to reach UHC. Finally, strong political commit-ment and citizens’ participation are the key issues in reaching UHC, while considering the poorest, remote and neglected population really matters.

Herein we report three married women referred to Dermatology Clinic of Loghman Hakim Hospital, Tehran, Iran in 2017 for evaluation and treatment of genital warts. Two patients were complaining of flat-topped papules on their labia major and the third one was presented with asymptomatic papillary projections on her vestibule and inner aspect of both labia minora. Histological examination revealed the diagnosis of syringoma, lymphangioma circumscriptum (LC) and vestibular papillomatosis respectively. Familiarity with these uncommon conditions which clinically mimic genital warts helps to prevent labeling a patient with sexually transmitted disease before histological confirmation and prevent unnecessary treatment.

Myiasis is a parasitic infestation of human and animal tissues caused by larva of several fly species. Nosocomial myiasis is a type of myiasis that patient acquires infestation after admission to hospital and prevention of this infes-tation should be one of hospital authorities concerns. Therefore, we report a case of nosocomial oral myiasis caused by Lucilia sericata in a woman aged 78-yr-old hospitalized in a Heart Center in north of Iran Aug 2015. The significance of fly extermination in hospital was highlighted and emphasized. Besides, the etiology and different aspects of infestation were discussed elaborately.

Norwegian scabies (hyperkeratosis scabies) is an acute form of skin disease seen in immune-compromised pa-tients. This study aimed to describe two cases of Norwegian scabies from Ahvaz, southwest of Iran in 2015. Two patients included a 55 year old man with renal transplant history and a 49 yr old man with diabetic mellitus and autoimmune disease, complained of dermatitis lesions and itching with sever hyperkeratosis, several macula and papules on neck and armpits for one-month duration were referred to a Iran Zamin Medical Diagnostic La-boratory in Ahvaz, Southwestern Iran in 2015. Patients were referred for fungal examination. Scraping from the crusted lesions of skin and slide preparation with 20% KOH was done. Microscopic examination presented that huge infestation of Sarcoptes scabiei in all forms of parasite included adult female, nymph stage and eggs. One of the patients spouse was also infested by Sarcoptes and appeared mild clinical symptoms. The disease was diag-nosed with Norwegian scabies and the patients were successfully treated with topical 5% permethrin ointment for two weeks continuously. Overall, Norwegian scabies should be considered in immune-compromised pa-tients with contaminated areas.

Dear Editor-in-Chief: Recently, studies on the impact of economic growth on health outcomes have generated vari-ous conflicting results. In particular, these results get clear with regard to cardiovascular disease (1). Socioeconomic level affects the increase in cardi-ovascular disease prevalence (2). Nevertheless, the degree of impact of socioeconomic level and cardiovascular disease on study findings can be controlled through statistical or measurement methods. For instance, vascular stiffness meas-urements such as pulse wave velocity can inde-pendently predict the risk of cardiovascular dis-ease (3)....

Dear Editor-in-Chief: Medical and demographic analysis is one of the most important methods in assessment of the population health status. When characterizing the public health and demographic determinants, such environment of human activities as provi-sion of the person with the right to life and health is also in question.....

Dear Editor-in-Chief: Being socially included means being able to ful-ly and productively participate in economic, so-cial and cultural life, and also to enjoy the standard of living, that is, the well-being that is considered normal in a developed community (1).

Dear Editor-in-Chief: In compliance with the valid legislation of the Slovak Republic, the Emergency Medical Ambu-lance Services is divided into Emergency Health Services (EHS) managed by professional non-medical personnel, and Emergency Medical Ser-vices (EMS) managed by a specialized doctor. Several of the emergency medical services studies have been conducted (1-3)....

Dear Editor-in-Chief: Toxoplasmosis the zoonotic disease with world-wide distribution is life-threatening in congenital from and in immunocompromised patients (1). According to seroepidemiological studies, 18%-85% of infection is reported from different parts of Iran (2, 3). Both humoral and cellular immune systems are involved in T. gondii infection (4). In addition regulation role in calcium and phospho-rus metabolism, vitamin D is an immune-modulator (5)....

Dear Editor-in-Chief Locating airport requires a wider range of studies than other transportation models because avia-tion has been one of the vibrant industries and predicting required future information of that is very complicated (1). Therefore, the current study checked and developed the criteria for locating airports in Tehran Province, Iran. Besides the desirability of various zones of the province in terms of airport establishment were evaluated.....

Dear Editor-in-Chief: Nowadays pesticide residues in agricultural prod-ucts have become an important challenge and a serious threat to human food security and health. Reduction of pesticides residues should be taken into consideration by public health authorities because of environmental and health problems. The harmful effects of pesticides in humans have included cancer, congenital anomalies, heart dis-ease, Parkinson's disease and Alzheimer's disease (1). However the use of pesticides in the world has been rising ever since, for example, from 1960 to 2000 its consumption has been growing around 20 times, and from 2002 to 2007 has been increased 0. 7 billion tons (2).....