Medical Journal of The Islamic Republic of Iran
Year:2015 | Volume:29 | Issue:1|Papers Count:68

Background: Effective leadership is essential to passing through obstacles facing the health field.The current health care system in Iran has major problems and gaps in the field of effective leadership.The aim of this study was to evaluate hospital managers’ leadership style through selfassessment and to determine the correlation between leadership styles with healthcare executives’leadership readiness and leadership effectiveness.Methods: In this cross-sectional study a self-administered questionnaire completed by all internal healthcare executives of all teaching and non-teaching hospitals affiliated to Iran University of Medical Sciences. Questionnaire was composed to determine demographic information, leadership style questions, leadership effectiveness and leadership readiness. Descriptive statistics and Pearson correlation coefficient were used for data analysis.Results: According to the findings, the dominant style of healthcare executives was transformational leadership style (with a score of 4.34). The leadership effectiveness was estimated at about 4.36 that shows the appropriate level of leadership effectiveness. There was a significant correlation (correlation coefficient of 0.244) between leadership readiness and transformational leadership style (p<0.05). Also, there was a significant correlation between leadership effectiveness with transformational (0.051) and transactional (0.216) styles.Conclusion: There was a correlation between leadership readiness and leadership effectiveness with leadership styles. Application of this research will be crucial to universities and healthcare executives.This study suggests that strengthening the scientific basis is essential for leadership readiness and leadership effectiveness in healthcare system.

Background: Ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles are used as blood pool contrast agent for magnetic resonance angiography and perfusion imaging. Our aim in this study was to investigate the effect of the two coating types of iron oxide nanoparticles on the relationship between nanoparticles concentration and signal intensity (SI) in T1-weighted MR images.Methods: Different concentrations of the polyethylene glycol (PEG), and carboxydextran-coated iron oxide nanoparticles were imaged using inversion recovery Turbo-FLASH (Turbo fast low-angle shot) pulse sequence with inversion times (TIs) of 300-900 ms (interval of 100 ms). The maximum non-linear and linear relationship between the corrected SI (after non-uniformity correction) and the concentration of the two coated nanoparticles were calculated in T1-weighted images.Results: The maximum non-linear relationship between the corrected SI and the concentration of the PEG, and carboxydextran-coated nanoparticles were obtained at concentrations of 400 and 200mmol Fe/L at a TI of 900 ms, respectively. In addition, the maximum linear relationship between the corrected SI and the concentration of the PEG, and carboxydextran-coated nanoparticles (R2=0.99) appeared at 228.184 and 205.654 mmolFe/L with a TI of 300 ms, respectively.Conclusion: The maximum non-linear corrected SI of the carboxydextran-coated nanoparticles was slightly higher than that of the PEG-coated nanoparticles at similar TIs. However, the PEG-coated nanoparticles were better than the carboxydextran-coated nanoparticles as a T1 contrast agent for perfusion measurements.

Background: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran.Methods: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling.Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating.Results: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628).Conclusion: Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals.

Background: Adolescence is a sensitive period of acquiring normal and abnormal habits for all of life. The study investigates determinants of responsibility for health, spiritual health and interpersonal relations and predictive factors based on the theory of planned behavior in high school girl students in Tabriz.Methods: In this Cross-sectional study, 340 students were selected thorough multi-stage sampling.An author-made questionnaire based on standard questionnaires of Health Promotion and Lifestyle II (HPLPII), spiritual health standards (Palutzian & Ellison) and components of the theory of planned behavior (attitudes, subjective norms, perceived behavioral control, and behavioral intention) was used for data collection. The questionnaire was validated in a pilot study. Data were analyzed using SPSS v.15 and descriptive and analytical tests (Chi-square test, Pearson correlation co-efficient and liner regression test in backward method).Results: Students’ responsibility for health, spiritual health, interpersonal relationships, and concepts of theory of planned behavior was moderate. We found a significant positive correlation (p<0/001) among all concepts of theory of planned behavior. Attitude and perceived behavioral control predicted 35% of intention of behavioral change (p<0.001). Attitude, subjective norms, and perceived behavioral control predicted 74% of behavioral change in accountability for health (p<0.0001), 56% for behavioral change in spiritual health (p<0.0001) and 63% for behavioral change in interpersonal relationship (p<0.0001).Conclusion: Status of responsibility for health, spiritual health and interpersonal relationships of students was moderate. Hence, behavioral intention and its determinants such as perceived behavioral control should be noted in promoting intervention programs.

Background: Fourniers gangrene caused by synergic aerobic and anaerobic organism is a life threatening disorder.Methods: The medical records of 8 among 839 patients admitted to imam ali general hospital Zahedan university of Medical Sciences with fourniers gangrene during the 10 months period between 2012 and 2013 were reviewed.Results: The most common etiology and presentation were abscess and perianal pain respectively. Mixed bacterial flora was common finding in patient. Single debridement was carried out in 2 patients and repeated procedure was needed in 6.Conclusion: This disease is characterized with high mortality of up to 75% but in our study the rate was 37.5%. In other studies diabetes mellitus was found to be the common condition related to fourniers gangrene but in our study the common etiology was perianal abscess. Fourniers gangrene should be rule out in any patient with perianal pain and flulike, swelling skin.

Background: Mental health literacy is an individual’s knowledge and belief about mental disorders which aid their recognition, management and prevention. The aim of this study was to investigate mental health literacy among students of Tehran University of Medical Sciences.Methods: In this cross-sectional study, data were collected by the anonymous self-administered questionnaires and finally 324 students participated in the study. Random cluster sampling was used.Questions were in different areas of the mental health literacy for depression include recognition of disorder, intended actions to seek help and perceived barriers, beliefs about interventions, prevention, stigmatization and impact of media. T-test was used for statistical analysis.Results: The mean (±SD) age was 23.5±2.8. The participants were 188 (58.1%) females and 136 (41.9%) males. In response to the recognition of the disorder 115 (35.6%) students mentioned the correct answer. In help-seeking area, 208 (64.3%) gave positive answer. The majority of affected students sought for help from their friends and parents. Stigma was the greatest barrier for seeking help. Television and Internet were the most common sources of information related to mental health.Conclusion: Generally students’ mental health literacy on depression was low in some areas. Appropriate educational programs specifically for reducing mental disorders stigma seems necessary.Organizing networks of co-helper students for mental health could be considered.

Background: To estimate and compare prevalence of overweight and obesity among adult people across the 22 districts of Tehran in 2011.Methods: This was a cross-sectional study using data on 47, 406 women and 47, 525 men aged≥ 15 years from a large population-based survey (Urban HEART-2). Age-standardized prevalence (ASP) of overweight (25≤BMI<30) and obesity (BMI≥30) were estimated for the Tehran’s districts. Pearson Chi2 tests and logistic regression were used to examine any significant differences in prevalence of these disorders across sociodemographic groups.Results: ASPs of overweight were 36.5% and 32.0 % among men and women, respectively (p<0.001). These figures for obesity were 10.7% and 15.3% among men and women, respectively (p<0.001). Crude prevalence of overweight and obesity rose with age up to the age of 54 years and decreased thereafter. Across education groups, the lowest prevalence of overweight/obesity was seen among most educated people. The results showed that being young, single and student were associated with lower odds of overweight/obesity.Conclusion: This study showed a high prevalence of overweight and obesity among adult in Tehran.There were significant associations between sociodemographic characteristics and prevalence of overweight/obesity among adults in Tehran. The results of this study might be used in identifying high risk groups of overweight and obesity in Tehran.

Background: Proanthocyanidin is a potent bioactive antioxidant naturally occurring in grape seed and acts as reactive oxygen species (ROS) scavenger. The aim of this study was to investigate the effects of proanthocyanidinin in experimental ovarian torsion injury.Methods: Twenty four rats were randomly divided into three groups (n=8). Group 1: the laparotomy group, group 2: ovarian torsion group, and group 3: intervention group administered proanthocyanidinin of 50 mg/kg before bilateral ovarian ischemia and reperfusion. Histologic examination and scoring was done at the end of the experiment. Statistical analyses were performed using the SPSS v.19.Results: Ovarian histopathologic findings of all three groups were significantly different in terms of hemorrhage (p<0.001), edema (p=0.001) and vascular dilatation (p<0.001). Pathologic changes induced by I/R were reduced in ovaries of rats administered proanthocyanidin, in particular, hemorrhage, edema and vascular dilatation.Conclusion: Proanthocyanidin, known as free radical scavenger and antioxidant, is protective against tissue damage induced by ischemia and/or ischemia/reperfusion in rat ovaries.

Background: Heavy menstrual bleeding of endometrial origin (HMB) is a major healthcare problem in premenopausal women and affects several aspects of women’s health and quality of life (QoL). The aim of this study was to compare the efficacy of Persian Golnar (PG) and tranexamic acid (TA) on heavy menstrual bleeding of endometrial origin (HMB) and patients’ QoL.Methods: A double-blind randomized controlled trial with parallel design and block randomization technique was conducted. A total of 94 women with HMB were randomly assigned to take either PG or TA for 5 days from day 1 of menses for three consecutive menstrual cycles. Blood loss was measured by the pictorial blood loss assessment chart (PBAC). Hematological assessments were made before the intervention and after treatment. QoL as a secondary outcome was evaluated using SF-36 and the menorrhagia questionnaire (MQ). Statistical analysis was performed using t-test, paired ttest, χ2 test, Mann–Whitney test, and Wilcoxon signed-rank test.Results: In each group, 38 women (80.8%) completed the 3-month follow-up. Both PG and TA reduced blood loss. PBAC mean (SD) score was reduced from 304.92 (176.17) and 304.44 (192.72) to 164.60 (100.24) and 143.13 (96.07) after the third treatment cycle, respectively (p<0.001). Furthermore, mean hemoglobin, Hb (SD) concentrations in the PG and TA groups increased significantly from 12.06 (0.86) and 11.53 (0.86) mg/dl to 13.02 (0.82) and 12.72 (0.88) mg/dl (p<0.001). QoL was significantly improved in both groups (p<0.001). However, there were no significant differences between the groups after the intervention.Conclusion: The results of the present study demonstrate the efficacy of PG in treating HMB in terms of clinical and QoL indicators.

Background: Multiple sclerosis (MS) is a chronic neurological disease that affects brain and spinal cord. The infratentorial region contains the cerebellum and brainstem. Vestibular evoked myogenic potentials (VEMPs) are short-latency myogenic responses. Cervical vestibular evoked myogenic potential (cVEMP) is a manifestation of vestibulocolic reflex and ocular vestibular evoked myogenic potential (oVEMP) contributes to the linear vestibular–ocular reflex. The aim of this study was to evaluate cVEMP and oVEMP in MS patients with and without infratentorial plaques and compare the findings with normal controls.Methods: In this cross-sectional study, latency and amplitude of cVEMP and oVEMP were recorded in 15 healthy females with mean age of 31.13±9.27 years, 17 female MS patients with infratentorial plaque (s) and mean age of 29.88±8.93 years, and 17 female MS patients without infratentorial plaque (s) and mean age of 30.58±8.02 years. All patients underwent a complete clinical neurological evaluation and brain MRI scanning. Simple random sampling method was used in this study and data were analyzed using one way ANOVA through SPSS v22.Results: The latency of N1-P1 and P13 in MS participants with and without infratentorial plaques were significantly prolonged compared to normal controls (p<0.001). Additionally latency of P13-N23-N1 and P1 in MS patients with infratentorial plaques were significantly prolonged compared to patients without infratentorial plaques subjects (p<0.001).Conclusion: Abnormality of both cVEMP and oVEMP in MS patient with infratentorial plaque are more than that of MS patient without infratentorial plaque. Recording both ocular and cervical VEMPs are appropriate electrophysiologic methods assessing the function of both ascending and descending central vestibular pathways.

Background: Considering the increasing incidence of coronary artery stenosis and its related complications, the importance of its etiology and inconsistent reports we aimed to determine the relationship between oxysterol, serum levels and severity of coronary atherosclerosis and effect of statins on oxysterol.Methods: A total of 85 patients referred to Taleghani Hospital, Tehran, Iran during 2011-2012 with coronary artery stenosis more than 75%, as determined by angiography, participated in the current study. Their demographic information and history of smoking and taking atorvastatin was carefully recorded. Two milliliters of venous blood was obtained from each patient. The serum oxysterol level of samples was measured using the enzyme-linked immunosorbent assay (ELISA) method. Statistical analysis was performed using SPSS v.19.Results: Eighty five patients completed the study. Mean age of patients was 64.4 years; 51 (60%) were male; 55 (68%) had acute coronary syndrome and 30 (32%) had chronic stable angina.Mean±SD of plasma level of oxysterol was 24.8±0.2 pmol/ml. The normal range of oxysterol level was 13pmol/ml. Mean±SD of plasma oxysterol level in patients under statin therapy was 24.4±2.1 pmol/ml. In patients without receiving statins, plasma oxysterol level was 26.38±1.6pmol/ml.Conclusion: Findings of the present study indicated significant correlation between serum oxysterol and severity of coronary artery stenosis. It also demonstrated that receiving atorvastatin is associated with significant reduction of plasma oxysterol level.

Background: Controlling the hemodynamic situation of patients who have spinal operation is of prime importance, and maintaining the heart rate and blood pressure in normal or low- normal levels in these patients can reduce their bleeding loss. One of the commonly used drugs for this purpose is remifentanil. Another sedative-hypnotic-analgesic drug, with acceptable effects is dexmedetomidine.The aim of this study was to compare the effect of dexmedetomidine with remifentanil in spinal operation.Methods: In a double blind randomized clinical trial, using random sampling method, 60 patients with the age range of 15-65 years who were candidates for posterior spinal fusion operation were included. Induction of anesthesia was performed, and both groups received isoflurane 1% during the surgery. Remifentanil was injected via infusion pump in one group. The patients in the trial group received dexmedetomidine. As trial outcomes, heart rate and blood pressure were measured before, after induction and during the operation. Pain score, sedation score and the need to analgesic therapy were recorded in the recovery room and the ward. Independent sample t-test and chi-square were used for statistical analysis.Results: Dexmedetomidine had a significant lowering impact on intraoperative blood pressure and heart rate compared to remifentanil (p<0.001). The mean of sedation scores after extubation in patients who received dexmedetomidine was significantly higher than the sedation scores in patients who received remifentanil (p<0.001). The mean of post-extubation and recovery pain score in patients taking remifentanil was significantly higher than patients taking dexmedetomidine (p<0.05).Conclusion: Dexmedetomidine in patients with spinal operation is associated with lower postoperative pain score and intraoperative bleeding. Hemodynamic effects are significantly better in patients received dexmedetomidine.

Background: Gestational diabetes mellitus (GDM) is common during pregnancy. This survey wasdesigned based on the frequency of GDM among an urban population according to the American Diabetes Association (ADA) and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.Methods: We included all pregnant women who were admitted to a gynecology clinic from September 2012 until May 2013. The fasting blood sugar (FBS) was measured. Those having FBS≥ 126 mg/dl were excluded from the study. All women underwent a standard OGTT (oral glucose tolerance test) by ingesting 75g of glucose in the 24th to 32nd week of their pregnancy.Results: Two hundred ninety pregnant women with a mean±SD age of 27.72±5.091 years were included in the study. The mean±SD FBS, blood glucose one hour and two hours after ingesting 75g of glucose were 82.48±9.41, 146.86±34.22 and 114.21±27.79 mg/ dl, respectively. Based on the criteria of the ADA, 9.3% (n=27) of the admitted patients suffered from GDM. For the IADPSG and the WHO, those numbers were 31% (n=90) and 15.2% (n=44), respectively.Conclusion: The prevalence of GDM was 1.5-times and 3 times higher when the IADPSG based data were compared to those of the WHO or the ADA.

Background: Reproductive health problems affect youths in all countries. There is an urgent need to enhance youths reproductive health services to provide a healthy life for this group. In this regard, the present study aimed to evaluate the Reproductive Health Peer Education Program based on the opinion of university students.Methods: This interventional study was conducted in Qazvin University of Medical Sciences through the peer education method. The participants of this study were 24 peer educators who received training in a 40 hour peer educator training course. The peer education program was implemented in the university. In order to evaluate this community- based intervention, 329 students were selected through the stratified sampling method and their opinion was assessed. Descriptive statistical methods were used by SPSS software for data analysis.Results: The results of the study revealed that peer education was accepted by 64.7% (n=213) of the students, according to their opinion. The educational priorities of the students were as follows: pre-marriage counseling (78%, n=166); STI/AIDS (17%, n=36); and contraception (5%, n=11).The peer education program was recognized as the most required reproductive health service in the university by 55.3% (n=118) of the students. They believed that the most important duties of the peer educators were: education (33.5%, n=71); counseling (30.4%, n=65); referring to a counseling center (21.6%, n=46) and referring to a therapeutic center (14.5%, n=31). Also, the students stated that confidentiality (53%, n=113), suitable communication (26%, n=55) and sufficient knowledge (21%, n=45) were desired characteristics for the peer educators.Conclusion: According to the students' opinion, peer education could provide suitable reproductive health services and could also be beneficial for reproductive health promotion and might reinforce positive behaviors in youths. Reproductive health peer- counseling is a sensitive process, and it is best to be conducted under the supervision of specialists.

Background: Epidemiological changes leading to chronic diseases are becoming more important day by day. Hypertension is also known as a chronic disease. Worldwide prevalence of hypertension have caused serious complications. The disease has become a health problem in all communities.This research aims at analyze the correlation between compliance with the treatment regimen and health locus of control in hypertension patients.Methods: In this study, 130 patients diagnosed with high blood pressure have been included using convenience sampling. Information has been gathered including demographic data, compliance with the treatment regimen and health locus of control. The patient's blood pressure was measured twice and the mean was compared with the first blood pressure recorded in medical records. Data were analyzed using SPSS 17.Results: The results showed that there is a direct correlation between the adherence to the treatment regimen with internal health locus of control. In patients with internal health locus of control, better compliance with treatment regimen was detected.Conclusion: Health locus of control is associated with treatment regimen. Considering health locus control can help nurses and managers in their health programs and also can motivate patients to participate in their self-care and improve patients care quality.

Background: Implementing community-based psychiatric services is one of the priorities of the WHO/EMRO mental health programs. This study presents an aftercare service, as a community based-service, for patients with severe mental illness (SMIs).Methods: In this randomized controlled clinical trial design, 176 patients, who attended selective hospitals with SMI, were allocated into three groups: clinical case managers provided by general practitioners, nurses and the control group (usual treatment). The clients and their caregivers received monthly home visits (education and treatment supervision). The effectiveness of the intervention was measured by indicators of psychopathology such as scores of YOUNG, caregivers’ knowledge and satisfaction with the services. Health-related quality of life (SF-36) was considered as the primary outcome variable. Data were collected at baseline and at 12 months follow-up. Direct and indirect medical costs were obtained through a periodic completion of questionnaires and interviews by caregivers.Cost effectiveness ratio was estimated as cost per QALY gained in each group. SPSS 16.0 was used in this survey and statistical methods were chi-square, ANOVA, Scheffe as post-Hoc test and paired sample t-test with 95% confidence interval and 0.05 significance level.Results: The results of our study revealed that the score of YOUNG, caregivers’ knowledge and satisfaction with service were improved in both intervention groups after 12 months. Improvement in health-related quality of life was observed in the general practitioner and nurse group. The incremental cost effectiveness ratio was 5740807 IRR and 5048459 IRR per QALYs gained in the general practitioner and nurse groups, respectively.Conclusion: The model of aftercare services provided by trained nurses is the most cost- effective and feasible model for Iran’s socio-economic conditions with low resource allocations.

Background: Heavy exercise cause muscle damage associated with production of inflammatory agents. The purpose of present study was to determine the effect of acute and 14-day Coenzyme Q10 supplementation on inflammatory, blood lactate and muscle damage in male middle-distance runners.Methods: Eighteen male middle-distance runners in a randomized and quasi experimental study were allocated into two equal groups: supplement group (n=9, Coenzyme Q10: 5mg/kg/day) and placebo group (n=9, Dextrose: 5mg/kg/day). After acute (1day) and 14-day supplementation, all subjects were participated in a training like running (competitive 3000 meters). Blood samples were obtained in the four phases: one hour before and 18-24 hours after two running protocols. Lactate, serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP) and creatine kinase (CK) were analyzed. Repeated ANOVA and Bonferuni as a post hoc tests were used to determine the changes in four stages. Differences between groups were determined by t-test.Results: The results showed that acute and short-term Coenzyme Q10 supplementation had not significant effect on basal parameters. The acute coenzyme Q10 supplementation attenuated only the exercise-induced increase in response of the plasma CRP. The short-term (14-day) coenzyme Q10 supplementation attenuated the exercise-induced increase in response of the lactate, serum interleukin-6, tumor necrosis factor-alpha, and CRP in male middle-distance runners. However, the acute and short-term coenzyme Q10 supplementation had not any significant effect on the exerciseinduced increase response of total serum creatine kinase.Conclusion: Based on the present results, it can be concluded that the 14-day coenzyme Q10 supplementation (5mg.kg-1.day-1) is more effective than the acute supplementation to overcome the exercise-induced adverse responses in some oxidative, inflammatory and biochemical parameters.Therefore, short-term coenzyme Q10 supplementation is recommended to reduce exercise-induced adverse consequences.

Background: Diarrhea is a leading cause of mortality and morbidity during the early life period especially in developing countries. Micronutrients deficiencies have been proposed either as a risk factor or a consequence of diarrhea. Association studies highlight the relation of vitamins and minerals’deficiencies with acute diarrhea. In this regard we aimed to evaluate the status of vitamins A and D, and zinc serum levels in children with acute diarrhea.Methods: In this cross sectional study performed in a referral teaching hospital, we measured and compared baseline vitamin A, 25-hydroxy vitamin D (25 (OH) D), and zinc serum levels in 25 children admitted with acute diarrhea and 25 other children who were admitted for undergoing elective surgeries.Results: 25- (OH) D levels were significantly lower in the diarrhea group (p=0.03). We were unable to demonstrate a significant difference in the levels of vitamin A and zinc between the case and control groups (p=0.14 and p=0.07, respectively).Conclusion: We observed lower serum 25 (OH) D levels in children with acute diarrhea. Whether this finding indicates a premorbid risk factor or simply a consequence of diarrhea needs further studies.Regardless of the cause and effect relationship, supplementation with vitamin D in acute diarrhea remains as a plausible consideration.

Background: The effect of psychosocial work environment on personal and organizational aspects of employees is well-known; and it is of fundamental importance to have valid tools to evaluate them. This study aims to evaluate the reliability and validity of the Persian version of Copenhagen Psychosocial Questionnaire (COPSOQ).Methods: The questionnaire was translated into Persian and then back translated into English by two translators separately. The wording of the final Persian version was established by comparing the translated versions with the original questionnaire. One hundred three health care workers completed the questionnaire. Chronbach’s alpha was calculated, and factor analysis was performed.Results: Factor analysis revealed acceptable validity for the five contexts of the questionnaire.Cronbach’s alpha ranged from 0.73 to 0.82 in different contexts.Conclusion: This study revealed that the Persian version of COPSOQ is a reliable and valid instrument for measuring psychosocial factors at work.

Background: Intimate partner violence (IPV) and risky sexual behaviors are serious and overlapping public health problems that disproportionately affect drug-involved women. Despite the fact that drug-using women experience extensive IPV, to date, no studies have investigated the association of IPV and risky sexual behaviors among drug-using women in Iran.Methods: Drug-using women (N=120) were recruited from a rehabilitation center in Tehran from March to October, 2009. The Revised Conflict Tactics Scale (CTS2), a standardized questionnaire, was used to collect data regarding violence. We used t-test and logistic regression models to explore the relationship between IPV domains and specific sexual risk behavior outcomes using SPSS 21.Results: The means (sd) for CTS2 domains were as follows: negotiation 4.29 (1.55), psychological violence 2.55 (1.51), sexual violence 0.37 (1.00), physical abuse 1.17 (1.49), injury 2.18 (1.97), and the mean total score was 1.69 (0.96). We found significantly higher injury scores, but lower sexual abuse scores among women with sexually-transmitted infection (STI) compared to women without STI (p-values 0.030 and<0.0001, respectively). In addition, we found that psychological abuse was positively associated with STI (p-value 0.03) and increased condom use (p=0.010), possibly mediated through an increased likelihood of having multiple partners.Conclusion: The findings revealed that in Iran drug-involved women experience high rates of IPV and that IPV is associated with increased risky sexual behavior. Implication: Preventive interventions for violence that are integrated within drug treatment programs, as well as harm reduction programs are highly recommended.

Background: Knee osteoarthritis (OA) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair, standing, walking and climbing stairs. Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocols in combination to conventional conservative therapy for knee OA.Methods: It was a single blind RCT study with a 12-months follow-up. Totally, 56 patients with knee OA were assigned into 2 random groups. The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs (NSAIDs) and 10 sessions acupuncture and physiotherapy modalities. Non-exercise group received similar treatments except exercise program. The changes in patients’ pain and functional status were evaluated by visual analog scale (VAS), knee and osteoarthritis outcome score (KOOS) questionnaire and functional tests (4 steps, 5 sit up, and 6 min walk test) before and after treatment (1 and 3 months after intervention), and 1 year later at the follow-up.Results: The results showed that the patients with knee OA in exercise group had significant improvement in pain, disability, walking, stair climbing, and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group. At third follow up (1 year later) there was significant difference between groups in VAS and in three items of KOOS questionnaire in functional status.Conclusion: Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy, acupuncture, and modalities for knee OA.

Background: Catheter ablation is widely used for treatment of atrial fibrillation. The use of fluoroscopic and non-fluoroscopic mapping systems in catheter ablation is common. This study conducted to investigate the safety and effectiveness of Navx non-fluoroscopic mapping system.Methods: In this study, the appropriate electronic databases including Cochrane Library and Ovid Medline searched until August 2013 using free text and MeSH. Systematic reviews, health technology assessment reports in which systematic review was conducted and controlled trials with the sample size of 100 patients and more were included into the study. Results of included studies were analyzed qualitatively.Results: Seven papers were included in this study. According to these studies, non-fluoroscopic guidance systems may reduce the exposure to radiation compared to fluoroscopic system. NavX system has minimum exposure time. Non-fluoroscopic guidance systems are safer than fluoroscopic guidance system. NavX system reduces the procedure and fluoroscopy time. There was no significant difference between two systems, NavX and Carto, based on their safety and effectiveness.Conclusion: Ensite NavX system is relatively safer and more effective than fluoroscopic guidance systems for treating the cardiac arrhythmia.

Brief Communication Toxoplasmosis is an important infectious disease caused by Toxoplasma gondii, an obligatory intracellular protozoan parasite.Oocysts which are shedding by recently infected cats, as definitive hosts, are infective for intermediate hosts (all warmblooded animals and humans) after taking short sporulation period in the environment (1, 2). The other routs of transmission are congenital transmission and recently recrudescence on internal infections reported in sheep (3-8).

Background: Melanoma causes the greatest morbidity and mortality of all skin cancers. Mucosal melanoma is a rare but highly aggressive neoplasm. According to previous studies the prevalence of KIT mutations in acral lentiginous and mucosal melanomas is relatively low (less than 15–20%), but it can have profound therapeutic implications for localized high risk or metastatic diseases. Our goal was to evaluate c-Kit expression in different types of primary and metastatic melanoma to discriminate potential candidates for targeted therapy.Methods: We designed a cross-sectional study and selected 50 cases of malignant melanoma (primary, metastatic cutaneous, and mucosal) from the affiliated hospitals of Shiraz University of Medical Sciences in the period of 2008 to 2012. Immunohistochemistry for KIT expression was performed.Multistage sampling method was selected for sampling and chi-square test was used for statistical analysis.Results: In our study, male to female ratio was 1.77. The male sex was correlated with higher tumor stage (p<0.05).62% (n=31) of cases showed at least 5% of KIT-positive cells, consist of 18% (n=9) with 5–50%, 16% (n=8) with 51–95%, and 28% (n=14) of cases showed more than 95% of cells expressing KIT. But in 38% (n=19) of cases KIT expression was less than 5% of positive cells.Tumor stage was positively correlated with tumor cell immunoreactivity and intensity (p<0.05).Metastatic melanoma showed lower percentage (43%) of positivity. Intensity of staining and percentage of positive cells were positively correlated (p<0.001).Conclusion: In primary melanomas, significant KIT expression was found by immunohistochemistry, which may be useful to screen the patients for advising to KIT mutation analysis and targeted therapy.

Background: It is well known that the hippocampus, the CA1 Pyramidal cells in particular, is selectively vulnerable during global cerebral ischemia. Recently, it is observed that pentoxifylline has a neuroprotective effect. This study explored the pharmacological relationship between ischemiainduced cell death of the hippocampus and the efficacy of a vasodilator agent (pentoxifylline) in the prevention of delayed neuronal death.Methods: This experimental study was performed on 4 groups: control, ischemia, experimental (200mg/kg pentoxifylline injection one hour prior to and one hour following ischemia) and vehicle (normal saline). Transient global ischemia was induced by bilateral common carotid arteries occlusion.To investigate the apoptotic bodies and caspase-3 activities as a central role in the execution phase of apoptosis, the brains were prepared for the TUNEL technique.Results: Pentoxifylline administration limited apoptosis and caspase-3 activities in rats’ hippocampi.Our data showed no significant difference between the number of apoptotic bodies in the CA1 region of the hippocampus in the control and pentoxifylline -treated groups (p=0.994). The results of one- way ANOVA revealed that that ischemia significantly increased caspase-3 levels in the hippocampus (p<0.05); however, the level of caspase-3 in pentoxifylline -treated rats was less than the ischemic group.Conclusion: These results suggest that the neuroprotective effect of pentoxifylline (200mg/kg) may be accompanied by a reduction in ischemic damage within the CA1 region of the hippocampus in rats subjected to transient global cerebral ischemia.

Background: Osteoarthritis is a disabling musculoskeletal disease with no definite treatment. This study compared the effect of Platelet-rich plasma (PRP) and Transcutaneous Electrical Nerve Stimulation (TENS) plus exercise in the treatment of patients with knee joint osteoarthritis.Methods: 54 eligible patients with knee osteoarthritis were randomly allocated into two groups.(IRCT2012110611382N) Group A (27 patients) received 2 injections of PRP (4 weeks apart) and group B (27 patients) received 10 sessions of TENS as well as exercise during the study period.Clinical outcome was evaluated using the Knee injury and Osteoarthritis Outcome Scores (KOOS) questionnaire before the treatment, 4 weeks, and 8 weeks after that the treatment. Pain was also assessed using a visual analog scale (VAS). Time to an intolerable knee pain during treadmill workout was also evaluated using an objective test.Results: In the PRP group, the mean KOOS symptom score improved significantly from baseline to the end of study, while the change was not significant over this period for the group B. In both groups, significant reductions were observed in VAS scores from baseline till the end of study. The mean time to feel intolerable knee pain during treadmill work out of PRP group increased significantly from baseline to week 4, but no significant changes were found in this parameter over the time of study in the group B.Conclusion: Intraarticular injection of PRP is an effective, safe method for short-term treatment of patients with knee joint osteoarthritis.

Background: Arteriovenous Fistula (AVF) is the ideal method of vascular access for patients on maintenance hemodialysis (HD). Therefore it is an important part of treatment in HD. There are several observations that indicate the role of inflammation in failure of AVF. The aim of this study was to evaluate the hematologic and inflammatory biomarkers in early AVF failure.Methods: This case-control study included 110 ESRD patients, whom were undergone AVF creation, divided in two groups. About 700 radius-cephalic AVF were created during these two years.We found 55 cases with AVF failure. In this study, we compared those 55 failures with 55 functional AVF which were selected using randomized sampling from the rest of patients according to age, gender, and AVF location. Levels of serum C-reactive protein (CRP) were checked in both groups to evaluate the relation between AVF failure and CRP level before surgery.Results: The mean±SD age of the patients was 49.7±17.28 years. CRP was positive in 34 patients (61.8%) with unsuccessful fistula function, while only 4 (7.3%) of those with successful AVF had positive CRP and the rest had negative CRP. The difference between the two groups of patients was strongly significant (p<0.001). Statistically, there was not any significant difference between the average of age (p: 0.580) of patients in the control and experimental groups. However, the gender (p: 0.832) discrepancies was not meaningful between the groups.Conclusion: AVF thrombosis is one of the main complications after AVF creation. Therefore, it is recommended to check CRP before AVF surgery to prevent possible failure of the fistula function.

Background: Ergonomic training had been implemented for prevention or reduction of neck and shoulder complaints among workers. The purpose of the present study was to assess the role of ergonomic training intervention on decreasing the prevalence of neck and shoulder complaints among workers of an automobile factory.Methods: Within the present randomized clinical trial, the role of three ergonomic training methods on the prevalence of neck and shoulders pain among 503 workers of an automobile factory (Response rate: 94.23%) was assessed. The eligible workers were randomly allocated into the following three interventional (pamphlet, lecture, workshop) groups and one control group. The Nordic questionnaire was used to assess the prevalence of neck and shoulder complaints. We followed and assessed the prevalence of neck and shoulders complaints among the study employees before and one year after the intervention. We used chi-square and Mann-Whitney tests to compare the prevalence of neck and shoulder complaints between the trial and control groups. A two-tailed P-value less than or equal to 0.05 was considered statistically significant.Results: The prevalence of neck and shoulders complaints among the study employees at the recent week (p=0.002) and year (p=0.02) had been significantly decreased in the study employees after participating in the study workshop. The prevalence of neck and shoulders complaints at the recent week and year did not significantly changed in the study employees after receiving the pamphlet and lecture as ergonomic trainings.Conclusion: Workshop as an ergonomic training method had an effective and powerful role on decreasing the prevalence of neck and shoulders complaints among workers.

Background: Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced.Methods: This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers.Results: The medians of the numbers of papers and books during a 5-year period were 150.5 and 2.5 respectively. The median of the "articles per researcher" was 19.1. Based on multiple linear regression, younger age centers (p=0.001), having a separate budget line (p=0.016), and number of research personnel (p<0.001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0.004).Conclusion: The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers.

Background: Prostate cancer is one of the leading causes of cancer deaths among men. New gene expressed in prostate (NGEP), is a prostate-specific gene expressed only in normal prostate and prostate cancer tissue. Because of its selective expression in prostate cancer cell surface, NGEP is a potential immunotherapeutic target.To target the NGEP in prostate cancer, it is essential to investigate its expression in prostate cancer cells.Methods: In the present study, we investigated NGEP expression in LNCaP and DU145 cells by real time and RT-PCR, flow cytometric and immunocytochemical analyses.Results: Real time and RT-PCR analyses of NGEP expression showed that NGEP was expressed in the LNCaP cells but not in DU145 cells. The detection of NGEP protein by flow cytometric and immunocytochemistry analyses indicated that NGEP protein was weakly expressed only in LNCaP cell membrane.Conclusion: Our results demonstrate that LNCaP cell line is more suitable than DU145 for NGEP expression studies; however, its low-level expression is a limiting issue. NGEP expression may be increased by androgen supplementation of LNCaP cell culture medium.

Background: The effectiveness of classic standard triple therapy regimen of helicobacter pylori (H. pylori) eradication has decreased to unacceptably low levels, largely related to development of resistance to metronidazole and clarithromycin. Thus successful eradication of H. pylori infections remains challenging. Therefore alternative treatments with superior effectiveness and safety should be designed and appropriately tested in all areas depending on the native resistance patterns. Furazolidone has been used successfully in eradication regimens previously and regimens containing furazolidone may be an ideal regimen.Methods: H. pylori infected patients with proven gastric or duodenal ulcers and /or gastric or duodenal erosions at Imam Khomeini Hospital in Sari/Northern Iran, were randomly allocated into three groups: group A (OABF) with furazolidone (F) (200 mg bid.), group B (OABM-F) metronidazole (M) (500 mg bid.) for the first five days, followed by furazolidone (F) (200 mg bid.) for the second five days and group C (OAF) with furazolidone (F) (200 mg tid.). Omeprazole (O) (20 mg bid.) and amoxicillin (A) (1000 mg bid.) were given in all groups; bismuth (B) (240 mg bid.) was prescribed in groups A & B. Duration of all eradication regimens were ten days. Eight weeks after treatment, a 14C-urea breath test was performed for evaluation of H. pylori eradication.Results: A total of 372 patients were enrolled in three groups randomly (124 patients in each group); 120 (97%) patients in group A (OABF), 120 (97%) in group B (OABM-F) and 116 (93%) in group C (OAF) completed the study. The intention-to-treat eradication rates were 83.7% (95% CI=77.3–90.4), 79.8% (95% CI=72.6–87), and 84.6% (95% CI=78.2–91.1) and per-protocol eradication rates were 86.6% (95% CI=80.5–92.8), 82.5% (95% CI=75.6–89.4), and 90.5% (95% CI=85.1–95.9) for groups OABF, OABM-F, and OAF, respectively. No statistical significant differences were found in case of severe drug adverse effects between the above mentioned three groups (p>0.05). The most common side effects, namely nausea and fever, occurred in all groups, but more frequently in group C (OAF) (p<0.05).Conclusion: In developing countries such as Iran, furazolidone-based regimens can substitute clarithromycinbased regimens for H. pylori eradication because of a very low level of resistance, low cost and high effectiveness.Considering per-protocol eradication rate of ten days OAF regimen, and the acceptable limit of ninety percent, we recommend this regimen in developing countries such as Iran to be substituted of classic standard triple therapy. In order to minimize rare serious adverse effects, one week high dose OAF regimen should be taken into consideration in other studies.

Background: Patients with spinal cord injury (SCI) have a lower health related quality of life (HRQOL) compared to both healthy controls and the normal population. The aim of this study was to compare HRQOL between two groups of veteran and non-veteran SCI patients.Methods: All male paraplegic non-veterans who had sustained complete SCI before 1988 and were residents of Tehran province (Iran), and a similar group of SCI veterans who consecutively participated in a health screening program were enrolled in this study. Patients fewer than 35 and older than 65 years of age were not included in this study. The participants were interviewed based on the Persian version of SF-36 questionnaire by two psychologists. Eight sub-scales and two physical and mental component summaries of the instrument were assessed. We used chi-square, odds ratio, Mann-Whitney U, independent t-test and linear regression for analysis.Results: Overall, 25 veterans and 22 non-veterans were enrolled in the study. The mean age, time since injury and the presence of comorbid illnesses were not significantly different between the two groups (P>0.05). A greater number of veterans were married (p=0.003) and employed (p=0.047).On average, veterans had more years of formal education than non-veterans (p=0.001). The mean (SD) bodily pain sub-scale was 72.73 (31.253) for non-veterans and 49.7 (28.287) for veterans (p=0.011). Absence of comorbid illnesses was associated with a better physical component summary (p<0.001). Employment was associated with a better mental component summary (p=0.022).Conclusion: We did not find any differences in HRQOL between the two groups except for the bodily pain sub-scale. Further studies with larger sample sizes are recommended.

Background: Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metabolic syndrome, is not only the result of changes in genetic, diet or physical activity, but also an imbalance of micro flora may play an important role. Therefore, alteration of micro flora using pre/probiotic is considered as a new strategy for treatment of metabolic disorders.Methods: The current study is a triple blind randomized controlled trial.46 patients from both sexes, who fulfilled inclusion criteria, randomly categorized into intervention or placebo group. The intervention and placebo groups consumed 2 probiotic capsules or 2 placebo capsules during 3 months, respectively. Both groups received a weight loss diet, according to their adjusted ideal body weight. Anthropometric, body composition, blood pressure and nutritional measurements were done in the beginning, at 6th week, and at the end of the study. T-test and paired-t test were used for statistical analysis.Results: 40 patients completed the study. BMI, WC, HC, fat mass, lean mass and blood pressure were reduced in all participants (p<0.05). Systolic blood pressure in symbiotic group was less than placebo group, significantly (p<0.05). The trend of weight loss in symbiotic group continued at least for 12 weeks while it was stopped at week 6 in placebo group.Conclusion: Symbiotic supplement with the weight loss diet had synergistic effects on improvement in systolic blood pressure and anthropometric measurements. Based on our findings, symbiotic can postpone plateau phase of weight loss and it may prevent resistance to further weight loss.

Background: Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation.Methods: In this clinical trial study, among patients referring to the Colorectal Clinic of Hazrat Rasoul Hospital, 22 subjects were randomly assigned into two equal groups (n=11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients’ symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent _t-test and Mann-Whitney test.Results: Paradox index (p<0.001), perineal descent index (p<0.001), depression (p<0.1), physical function (p<0.001), vitality (p<0.001) and role emotion (p<0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapy SDT group.Conclusion: Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient’s quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy.

Background: The positive impacts of exercise therapy on patients’ cognitive problems still remain unknown. This study was a pilot intervention to examine the effects of combined exercise on the cognitive problems of patients with multiple sclerosis (MS) in Iranian MS Society over 2012 to 2013.Methods: This quasi-experimental research was carried out in the form of a pretest/posttest study.Forty two patients with MS were selected from those visiting the rehabilitation center of Iranian MS Society, using non-probability convenience sampling. The Expanded Disability Status Scale (EDSS) of each patient was recorded before the intervention and Brief Repeatable Battery of Neuropsychological (BRB-N) test was administered before and after the intervention. The data were analyzed using the analytical tests such as Wilcoxon test.Results: Of 21 participants, 17 subjects (82%, n=14) female with mean (±SD) age of 37 (±9.98) years and mean (±SD) EDSS of 2.35 (±0.90) completed all stages of the study. Changes in long-term storage and permanent long-term retrieval of information after the intervention were statistically significant (p<0.001). In addition, the change in the average of total delay after the intervention was also significant by 1.11 (p<0.001).Conclusion: Our study confirmed the possibility of change in the cognitive abilities of MS patients through physical interventions. This finding emphasizes the necessity of more clinical examinations and increases the hopes for new rehabilitation methods for the disorder.

Background: Proper rotation of components in total knee arthroplasty (TKA) will largely affect the postoperative outcome. Ethnical variation may affect rotational profile. We aimed to evaluate distal femur rotation in Iranian population using transepicondylar axes.Methods: From a total of 450 knee CT scans and via consecutive sampling, 150 qualified subjects with normal lower extremities alignment were selected comprising 96 (64%) males and 54 (36%) females aging 17-80 years.The posterior condylar angle and condylar twist angles were defined as angles between either surgical epicondylar axis (line connecting lateral epicondylar prominence and the medial sulcus) or clinical epicondylar axis (line connecting most prominent points of both epicondyle) and posterior conylar line. Data were compared among genders.Results: Average age of our samples was 43 years (ranging 11-80). Mean (±sd) values for posterior condylar angle and condylar twist angles were 2.35o(±1.34) and 5.77o (±1.70), respectively. The former variable was not discernible in twenty of our subjects because of obscure medial sulcus. Our findings were totally appeared similar to studies from other ethnicities and the observed minor differences may have originated from amount of osteoarthritis and malalignment.Conclusion: Overall, Iranian distal femur rotational profile was similar to other reports. Some minor observed differences may be partially due to samples’ age and different amount of knee osteoarthritis. It is proposed to rely on several methods for determining rotational profile while performing TKA. Moreover, preoperative computed tomography should be fully scrutinized especially in severely osteoarthitic knees.

Background: Work is the key component for most people in regard to financial, social and wellbeing matters.Employment is an important factor underpinning mental health disorders. However, unemployment remains an unsolved issue worldwide. Numerous studies have focused on employment outcomes in people with severe mental illness (SMI) but, only a few have explored their perspective on employment. Therefore, this study aimed to clarify the meaning of work among clients with SMI in Iran.Methods: A qualitative research approach was used to conduct this research. Ten participants who were consumers of mental health services took part in this study. Data were analyzed by inductive content analysis approach.Results: Four themes emerged from data including: acquiring identity, work as a drive, passing the time and financial independence.Conclusion: Meaning of work in studied people with SMI was probably similar to the general population. The different finding in this study refers to the dominancy of family relationships and spiritual believes which could cover some problems and in turn affect the meaning of work. Highlighting these meanings could direct mental health professionals to better planning for their clients have better understanding of their clients’ work future and in turn provide more precise plan for them.

Background: Simvastatin is a widely used medication in cardiac care. Here we evaluate the role of ATP sensitive potassium (KATP) channels in simvastatin induced renal protection after renal ischemia/ reperfusion (I/R) injury.Methods: A total of 81 male Wistar rats, were treated with simvastatin (10 and 20mg/kg/day; gavage, one week). Some groups received glibenclamide (KATP channel inhibitor; 5mg/kg) before ischemia (45min) and reperfusion (24h). Finally the kidneys were processed for histological analysis and measurement of biochemical parameters including tissue malondialdehyde (MDA), blood urea nitrogen (BUN), fractional excretion of sodium (FENa), creatinine clearance rate (CCr) and Bcl2-associated X protein (Bax) expression.Results: IR significantly increased serum Cr (p<0.01) and BUN levels (p<0.01), elevated FENa (p<0.01) and tissue MDA (p<0.01), and decreased CCr (p<0.01) and induced histological damage.Bax pro-apoptotic protein was upregulated in renal tissue after I/R injury and downregulated in simvastatin pretreated group. Simvastatin at doses of 10 and 20mg/kg/day significantly reduced serum Cr and BUN levels (p<0.05 vs. IR group), tissue MDA contents and FENa (p<0.05 vs. I/R) and increased CCr (p<0.05 vs. IR). Renal tissue injury was improved only in simvastatin 20mg/kg/day group (p<0.05). Glibenclamide significantly abolished protective effects of simvastatin and increased serum Cr and BUN and FENa and decreased CCr (p<0.05). It also abolished the effects of simvastatin on tissue injury and MDA contents and downregulated the Bax protein after IR injury (p<0.05).Conclusion: Opening of KATP channels is essential for simvastatin-induced renal protection against I/R injury.

Background: Hyperhomocysteinemia is a risk factor for cardiovascular disease particularly in patients with end stage renal disease (ESRD). Vitamin B12 supplementation on its own still remains as a controversial issue for clinicians in decreasing the level of homcysteine in this group of patients.Methods: Using all randomized controlled trials (RCTs), clinical trials and pre-post-trial studies found during January 1999 to March 2014, we conducted a systematic review which assessed the effects of vitamin B12 in decreasing homocysteine levels in patients with ESRD.Results: The findings of this study revealed that, overall, the greatest effect of B12 supplementation on decreasing homocysteine levels in patients with ESRDs occurred when it was combined with folate supplementation.It was also demonstrated that injection treatments might be more beneficial than oral intake treatments.Conclusion: More rigorous studies are needed to draw a firm conclusion about B12 therapy and the level of homocyteine in patients with ESRD.

Background: Educational clinical environment has an important role in nursing students' learning.Any difference between actual and expected clinical environment will decrease nursing students’interest in clinical environments and has a negative correlation with their clinical performance.Methods: This descriptive cross-sectional study is an attempt to compare nursing students' perception of the actual and expected status of clinical environments in medical-surgical wards.Participants of the study were 127 bachelor nursing students of Iran University of Medical Sciences in the internship period. Data gathering instruments were a demographic questionnaire (including sex, age, and grade point average), and the Clinical Learning Environment Inventory (CLEI) originally developed by Professor Chan (2001), in which its modified Farsi version (Actual and Preferred forms) consisting 42 items, 6 scales and 7 items per scale was used. Descriptive and inferential statistics (t-test, paired t-test, ANOVA) were used for data analysis through SPSS version 16.Results: The results indicated that there were significant differences between the preferred and actual form in all six scales. In other word, comparing with the actual form, the mean scores of all items in the preferred form were higher. The maximum mean difference was in innovation and the highest mean difference was in involvement scale.Conclusion: It is concluded that nursing students do not have a positive perception of their actual clinical teaching environment and this perception is significantly different from their perception of their expected environment.

Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it.Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis.Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats.Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students.

Background: Oral lichen planus (OLP) has been classified as a pre-malignant condition. Matrix metalloproteinase-13 (MMP-13) or collagenase-3 may play a key role in cancer development. The aim of this study was to compare serum and saliva MMP-13 between patients with oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC).Methods: This cross sectional study was performed on 30 patients with OLP (8 reticular and 22 erosive forms) and 20 patients with OSCC (6 in low stage and 14 in advanced stage) who were selected randomly. The study was conducted at the Cancer Department, Clinic of Oral Medicine, Tehran University of Medical Sciences. The serum and saliva MMP-13 were assayed by ELISA method.Statistical analysis of the Student’s t-test, ANOVA and Pearson correlation coefficient was performed.Results: There were no significant differences in mean saliva and serum levels of MMP-13 between patients with OSCC and OLP and their subgroups. Serum MMP-13 correlated significantly with unstimulated (r=0.307, p=0.048), but not with stimulated, saliva MMP-13.Conclusion: Serum and saliva MMP-13 levels appear to be statistically similar in OLP and OSCC.

Background: Factor VII concentrates are used in patients with congenital or acquired factor VII deficiency or treatment of hemophilia patients with inhibitors. In this research, immunoaffinity chromatography was used to purify factor VII from prothrombin complex (Prothrombin-Proconvertin-Stuart Factor-Antihemophilic Factor B or PPSB) which contains coagulation factors II, VII, IX and X. The aim of this study was to improve purity, safety and tolerability as a highly purified factor VII concentrate.Methods: PPSB was prepared using DEAE-Sephadex and was used as the starting material for purification of coagulation factor VII. Prothrombin complex was treated by solvent/detergent at 24°C for 6 h with constant stirring. The mixture of PPSB in the PBS buffer was filtered and then chromatographed using CNBr-activated Sepharose 4B coupled with specific antibody. Factors II, IX, VII, X and VIIa were assayed on the fractions. Fractions of 48-50 were pooled and lyophilized as a factor VII concentrate. Agarose gel electrophoresis was performed and Tween 80 was measured in the factor VII concentrate.Results: Specific activity of factor VII concentrate increased from 0.16 to 55.6 with a purificationfold of 347.5 and the amount of activated factor VII (FVIIa) was found higher than PPSB (4.4-fold).Results of electrophoresis on agarose gel indicated higher purity of Factor VII compared to PPSB; these finding revealed that factor VII migrated as alpha-2 proteins. In order to improve viral safety, solvent-detergent treatment was applied prior to further purification and nearly complete elimination of tween 80 (2 mg/ml).Conclusion: It was concluded that immuonoaffinity chromatography using CNBr-activated Sepharose 4B can be a suitable choice for large-scale production of factor VII concentrate with higher purity, safety and activated factor VII.

Background: Cancer is not merely an event with a certain end, but it is a permanent and vague situation that is determined by delayed effects due to the disease, its treatment and its related psychological issues. The aim of this study was to examine the effectiveness of the mindfulness-based stress reduction program and conscious yoga on the mental fatigue severity and life quality of women with breast cancer.Methods: This was a quasi-experimental study with a pre-test, post-test and control group. In this study, 24 patients with the diagnosis of breast cancer were selected among the patients who referred to the Division of Oncology and Radiotherapy of Imam Hossein hospital in Tehran using available sampling method, and were randomly assigned into the experimental and control groups. All the participants completed the Fatigue Severity Scale, Global Life Quality of Cancer Patient and Specific Life Quality of Cancer Patient questionnaires. Data were analyzed by multivariate repeated measurement variance analysis model.Results: Findings revealed that the mindfulness-based stress reduction treatment significantly improved the overall quality of life, role, cognitive, emotion, social functions and pain and fatigue symptoms in global life quality in the experimental group. It also significantly improved the body image, future functions and therapy side effects in specific life quality of the experimental group compared to the control group. In addition, fatigue severity caused by cancer was reduced significantly.Conclusion: The results showed that the mindfulness - based stress reduction treatment can be effective in improving global and specific life quality and fatigue severity in women with breast cancer.

Background: CT scan and nuclear medicine exams deliver a great part of medical exposures. This study examined professional radiation hazards in CT scan and nuclear medicine workers.Methods: In a cross sectional study 30 occupationally exposed workers and 7 controls (all from personnel of a laboratory) were selected. Physical dosimetry was performed for exposed workers.Blood samples were obtained from the experimental and control groups. Three culture mediums for each one were prepared in due to routine chromosome analysis using G-banding and solid stain.Results: There were significant increased incidence of chromatid gap (ctg) and chromatid break (ctb) with mean±SD frequencies of 3±0.84 and 3.1±1.40 per 100 cells respectively in the nuclear medicine workers versus controls with mean±SD frequencies of 1.9±0.69 and 1.3±0.84 for ctg and ctb, respectively. Chromosome gaps (chrg) were higher significantly in the nuclear medicine population (2.47±0.91) than in controls (1.4±0.9) (p<0.05). In CT scan group the ctg and ctb were increased with a mean±SD frequency of 2.7±0.79 and 2.6±0.91 per 100 cells respectively compared with control group. The mean±SD frequencies of the chrb were 2.0±0.75 and 0.86±0.690 per 100 cells for exposed workers and control group, respectively.Conclusion: This study showed chromosome aberrations in peripheral lymphocytes using solid stain method are reasonable biomarker reflecting personnel radiation damage.

Background: Routine repeat testing of critical laboratory values is very common these days to increase their accuracy and to avoid reporting false or infeasible results. We figure that repeat testing of critical laboratory values has any benefits or not.Methods: We examined 2233 repeated critical laboratory values in 13 different hematology and chemistry tests including: hemoglobin, white blood cell, platelet, international normalized ratio, partial thromboplastin time, glucose, potassium, sodium, phosphorus, magnesium, calcium, total bilirubin and direct bilirubin. The absolute difference and the percentage of change between the two tests for each critical value were calculated and then compared with the College of American Pathologists/Clinical Laboratory Improvement Amendments allowable error.Results: Repeat testing yielded results that were within the allowable error on 2213 of 2233 specimens (99.1%). There was only one outlier (0.2%) in the white blood cell test category, 9 (2.9%) in the platelet test category, 5 (4%) in the partial thromboplastin time test category, 5 (4.8%) in the international normalized ratio test category and none in other test categories.Conclusion: Routine, repeat testing of critical hemoglobin, white blood cell, platelet, international normalized ratio, partial thromboplastin time, glucose, potassium, sodium, phosphorus, magnesium, calcium, total bilirubin and direct bilirubin results does not have any benefits to increase their accuracy.

Background: Complications of Ventolin as the most common drug used for bronchiolitis are widely known. The present study was conducted to determine the efficacy of hypertonic saline 3%, compared with Ventolin, for treatment of acute bronchiolitis in children.Methods: This double-blinded clinical trial study was conducted in Hajar Hospital, Shahrekord, Iran, from 2011 to 2012. A total of 70 patients under the age of two years with bronchiolitis were divided into two groups of 35 each. Ventolin nebulizer and hypertonic saline 3% nebulizer three times per day were administered in the first (Ventolin) and second (Hypersaline) group, respectively.The length of recovery was compared between the two groups. The data were analyzed by SPSS software (version 22) using chi-square, t-test, paired t-test, and Mann-Whitney.Results: The mean±SD length of recovery was 4.14±0.9 and 3.06±0.6 in the Ventolin and hypersaline groups, respectively. The mean duration of recovery was significantly lower in the hypersaline group (p<0.001).Conclusion: Hypertonic saline 3% nebulizer has more pleasant therapeutic effects on acute bronchiolitis than Ventolin. Therefore, use of hypertonic saline 3% nebulizer is recommended for the treatment of acute bronchiolitis in children under two years old.

Background: Evaluation of intra-city roads in terms of environmental factors of motor vehicle injuries can help us to better identify these factors and the share of each of the factors in injuries.Therefore, this study was conducted to determine the high injury areas and the risk factors of motor vehicle crashes resulting in injury and death in Tehran, the capital city of Iran, from November 2011 through February 2012.Methods: In this cross sectional study, the locations of the motor vehicle injuries resulting in injuries and deaths were obtained from police stations in Tehran. The coordinates of the injuries locations were extracted and entered into the Arc-GIS software to overlay the different layers of geographical data and extract the risk map.Results: A total of 4257 motor vehicle injuries were evaluated in this study. Forty-two injuries (1%) resulted in death and 4215 injuries (99%) resulted in injury. The traffic districts 5 and 21 had the highest frequency of injuries resulting in death. The type of the motor vehicle resulting in injury or death was motorcycle in 2330 injuries (54.73%).Conclusion: The frequency of traffic injuries is more in the west and northwest areas of Tehran, and it is caused more by motorcycles in terms of traffic and motor injuries resulting in injury and death. It is useful to conduct more studies to better identify these factors considering their importance in traffic injuries.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is the most common childhood neurological disorder. This disorder is more prevalent in some chronic diseases. The aim of this study was to investigate ADHD in children with early stages of chronic kidney disease (CKD) and to compare it with healthy children.Methods: Seventy five 5-16-year-old children with early stages of CKD (stage 1, 2 and 3) and 75 healthy children without CKD were included in this case – control study as case and control groups, respectively. The participants were selected from those children who were referred to the pediatric clinic of Amir Kabir Hospital of Arak (Iran) in the form of simple probability and based on inclusion and exclusion criteria. ADHD was diagnosed using Conner's Parent Rating Scale – 48 (CPRS-48) and DSM-IV criteria and was confirmed by a psychologist consultant. Data were analyzed by Binomial test in SPSS18.Results: ADHD inattentive type was observed in 8 cases (10.6%) with CKD and 2 controls (2.6%) (p=0.109).Moreover, in the case and control groups, 7 (9.3%) and 6 (8%) children were affected by ADHD hyperactiveimpulsive type (p=0.997), and 9 (12%) and 12 (16%) children were affected by ADHD mixed type (p=0.664), respectively.Conclusion: No differences were found between the prevalence of ADHD in the children with early stages of CKD and the control group. However, due to the importance of the relationships between different types of psychiatric disorders and CKD and lack of enough evidence concerning the relationship between ADHD and different stages of CKD in children, conducting further studies in this field is recommended.

Background: We conducted a comprehensive bibliometrics analysis to calculate the H, G, M, A and R indicators for all Iranian biomedical research centers (IBRCs) from the output of ISI Web of Science (WoS) and Scopus between 1991 and 2010. We compared the research performance of the research centers according to these indicators.Methods: This was a cross-sectional and descriptive-analytical study, conducted on 104 Iranian biomedical research centers between August and September 2011. We collected our data through Scopus and WoS. Pearson correlation coefficient between the scientometrics indicators was calculated using SPSS, version 16.Results: The mean values of all indicators were higher in Scopus than in WoS. Drug Applied Research Center of Tabriz University of Medical Sciences had the highest number of publications in both WoS and Scopus databases. This research center along with Royan Institute received the highest number of citations in both Scopus and WoS, respectively. The highest correlation was seen between G and R (.998) in WoS and between G and R (.990) in Scopus. Furthermore, the highest overlap of the 10 top IBRCs was between G and H in WoS (100%) and between G-R (90%) and H-R (90%) in Scopus.Conclusion: Research centers affiliated to the top ranked Iranian medical universities obtained a better position with respect to the studied scientometrics indicators. All aforementioned indicators are important for ranking bibliometrics studies as they refer to different attributes of scientific output and citation aspects.

Background: AUB is a common cause of women’s referring to gynecologists. Although hysteroscopy is known as the gold standard technique for diagnosing the cause of AUB, sonohysterography is less invasive, and it is performed by general gynecologists. The purpose of this study was to evaluate the diagnostic performance of sonohysterography compared to the results of the endometrial biopsy, guided by hysteroscopy in premenopausal women with AUB.Methods: This cross- sectional Study was conducted at the gynecological clinic of Roointan -Arash women's Hospital from February 2011 to February 2012. The study participants were 90 premenopausal female patients, who visited the clinic for AUB, for whom, hormonal, iatrogenic and systemic causes were ruled out. They underwent sonohysterography and hysteroscopy and endometrial biopsy.The results of sonohysterography and pathological reports of endometrial biopsy were compared, and the diagnostic accuracy of sonohysterography for normal endometrium, endometrial polyps, sub mucosal fibroids and endometrial hyperplasia was evaluated.Results: The diagnostic accuracy of sonohysterography was found to be 89.1% for the normal endometrium, 90% for endometrial polyps, 99% for sub mucosal fibroids and 94.4% for endometrial hyperplasia.Conclusion: Sonohysterography is an accurate, non-invasive and cost-effective method for diagnosing AUB causes compared to hysteroscopy and endometrial biopsy. Therefore, as an initial diagnostic step, it can replace the alternative and less accurate methods such as transvaginal ultrasound, blind endometrial curettage or more costly and invasive methods such as hysteroscopy requiring anesthesia.

Background: Infection with parvovirus B19 may cause fetal losses including spontaneous abortion, intrauterine fetal death and non-immune hydrops fetalis. The aim of this study is to determine the frequency of parvovirus B19 in formalin fixed placental tissues in lost fetuses using real-time PCR method.Methods: In this cross-sectional study, 100 formalin fixed placental tissues with unknown cause of fetal death were determined using real-time PCR method after DNA extraction.Results: Six out of 100 cases (6%) were positive for parvovirus B19 using real-time PCR. Gestational age of all positive cases was less than 20 weeks with a mean of 12.3 weeks. Three cases have a history of abortion and all of positive cases were collected in spring. Mean age of positive cases were 28 years.Conclusion: Parvovirus B19 during pregnancy can infect red precursor cells and induces apoptosis or lyses these cells that resulting in anemia and congestive heart failure leading to fetal death. Management of parvovirus B19 infection in pregnant women is important because immediate diagnosis and transfusion in hydropsic fetuses can decrease the risk of fetal death.

Background: Visual attention is known as a critical base for learning. The purpose of the present study was to design, develop and evaluate the test-retest and internal consistency reliability as well as face, content and convergent validity of the computer- based selective visual attention test (SeVAT) for healthy first-grade school children.Methods: In the first phase of this study, the computer-based SeVAT was developed in two versions of original and parallel. Ten experts in occupational therapy helped to measure the content validity using the CVR and CVI methods. Face validity was measured through opinions collected from 10 first-grade children. The convergent validity of the test was examined using the Spearman correlation between the SeVAT and Stroop test. In addition, test-retest reliability was determined by measuring the intra-class correlation (ICC) between the original and parallel versions of the SeVAT in a single session. The internal consistency was calculated by Cronbach's alpha coefficients. Sixty first grade children (30 girls/30boys) participated in this study.Results: The developed test was found to have good content and face validity. The SeVAT showed an excellent test-retest reliability (ICC=0.778, p<0.001) and internal consistency (Cronbach's Alpha of original and parallel tests were 0.857 and 0.831, respectively). SeVAT and Stroop test demonstrated a positive correlation upon the convergent validity testing.Conclusion: Our results suggested an acceptable reliability and validity for the computer-based SeVAT in the assessment of selective attention in children. Further research may warrant the differential validity of such a test in other age groups and neuro-cognitively disordered populations.

Background: The Rosemary extract (RE) possesses various antioxidant, cytoprotective and cognition-improving bioactivities. In this study, we postulated which doses of RE have a more effect on the hippocampus of middle-aged rats.Methods: In this experimental study, thirty-two middle-aged male Wistar rats were fed by different doses (50, 100 and 200 mg/kg/day) of RE (containing 40% carnosic acid) or distilled water for 12 weeks. The effects of different RE doses on learning and spatial memory scores, hippocampal neuronal survival, antioxidant enzymes and lipid peroxidation amount were evaluated by one and two way analysis of variance (ANOVA).Results: It seemed that RE (100mg/kg) could recover the spatial memory retrieval score (p<0.05).The amount of activity of SOD, GPx and CAT enzymes in the hippocampus of animals of the RE (100mg/kg) group showed a significant increase compared to the normal group (p<0.01), (p<0.01) and (p<0.05), respectively. Also, the amount of activity of GPx in the RE (50 mg/kg) group of animals showed a significant increase compared to the normal group (p<0.05). No significant difference was found between the groups in the MDA level.Conclusion: The results revealed that rosemary extract (40% carnosic acid) may improve the memory score and oxidative stress activity in middle aged rats in a dose dependent manner, especially in 100mg/kg.

Background: Nursing education can maintain its dynamic quality when it moves toward innovation and modern methods of teaching and learning. Therefore, teachers are required to employ up to date methods in their teaching plans. This study evaluated the effects of e-learning, lectures, and role playing on nursing students’ learning, retention, and satisfaction.Methods: Sixty nursing students were selected as an experiment and control groups during two consecutive semesters. The educational content was presented as e-learning and role playing during one semester (experiment group) and as lectures in the next semester (control group). A questionnaire containing three parts was used to assess demographics, learning and satisfaction statuses. The questionnaire also included a final openended question to evaluate the students’ ideas about the whole course.Results: The mean scores of posttest were 16.13 ± 1.37 using role playing, 15.50 ± 1.44 using e-learning and 16.45 ± 1.23 using lectures. The differences between the mean scores of posttest and pretest were 12.84 ± 1.43, 12.56 ± 1.57, and 13.73 ± 1.53 in the mentioned methods, respectively. Lectures resulted in significantly better learning compared to role playing and e-learning. In contrast, retention rates were significantly lower using lectures than using role playing and e-learning. Students’ satisfaction from e-learning was significantly lower than lecturing and role playing.Conclusion: Due to the lower rates of retention following lectures, the teachers are recommended to use student-centered approaches in their lectures. Since students’ satisfaction with e-learning was lower than the other methods, further studies are suggested to explore the problems of e-learning in Iran.

Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointestinal tract or even the colon. In this article, we will review the current updates on rectal cancer including epidemiology, risk factors, clinical presentations, screening, and staging. Diagnostic methods and latest treatment modalities and approaches will also be discussed in detail.

Background: Suicide prevention is one of the priorities in policies of Iranian Ministry of Health and Medical Education (MHME). The suicide prevention program had two main parts of identifying and treatment of the depressed and suicide high risk individuals by Primary Health Care (PHC) network.The main aim of this study was to evaluate the results of integration of the program into PHC network in two cities with moderate to high rate of suicide with diverse socio-cultural backgrounds.Methods: This work as a field trial study was conducted in Nahavand and Savojbolagh from April 2010 to March 2011 (12 months). A screening tool was designed. Required capacities such as treatment, referral and registration system were provided six months before the main study. The intervention phase (for one year) including the treatment process and five consultation sessions was conducted to identify depressed people and individuals with high risk of suicide. The data were analyzed by Chi square test.Results: After one year of intervention, the rate of committing suicide became 4.98 and 3.36 per one hundred thousand population in Nahavand and Savojbolagh, respectively (16 and 1.6 per 100, 000 in the year of before intervention respectively, 2009-2010). The female: male ratio of committing suicide was 2: 1 in Nahavand and 1: 1 in Savojbolagh. The most common method of committing suicide was drug intoxication in both cities. The identified cases by health workers at rural setting were 33 to 44 per 1000, in which 1.3 cases per 1000 population had been approved by general physicians.Conclusion: This study approved the feasibility and efficacy of integration of suicide prevention program into PHC. The increased rate of suicide in Savojbolagh could be related to low rate of screening and lack of treatment facilities (hospitalization and electroconvulsive therapy (ECT), and part-time psychiatrist. Increasing the PHC capacities could improve the health network efficiency to identify and manage depressed and at risk of suicide individuals. Screening tool/s and method have to be improved to provide better results.

Background: Toll- like receptors (TLRs) play an important role in the recognition of DAMPs and PAMPs and induction of inflammation. Previous studies demonstrated that depression and anxiety can influence the expression levels of immune related molecules. Our previous study revealed that mRNA levels of IRAKIRAK4, TRAF3 and IRF7 were significantly decreased in chronic HBV infected (CHB) patients when compared to healthy controls. Therefore, the aim of this study was to evaluate the effects of depression and anxiety on the expression levels of these molecules in CHB patients.Methods: Sixty CHB patients participated in this study and filled out the standard questionnaires; and the expression of IRAK4, TRAF3 and IRF7 were examined using Real-Time PCR techniques.Results: The results of this study demonstrated that expression of IRAK4, TRAF3 and IRF7 did not differ between patients with various stages of depression and anxiety (all p>0.05).Conclusion: According to the results, it seems that declined expression of IRAK4, TRAF3 and IRF7 in CHB patients were not related to depression and anxiety, and other factors including genetic and immunoregulatory effects of HBV may be responsible for the declined expression of these molecules.

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.

Background: Cardiovascular diseases refer to a group of diseases that affect the cardiovascular system; principally cardiac diseases, vascular diseases of the brain and kidney and peripheral arterial diseases which are caused by various factors. Considering the importance of nutrition education, especially the intake of fruits and vegetables, this study was performed to determine the effect of health education, Based on the Health Belief Model, on the improvement of intake of fruits and vegetables aiming at preventing cardiovascular diseases among high school girls in the city of Shahre-Kord, Iran.Methods: This was a quasi-experimental intervention study, in which 120 female students of high schools in Isfahan were selected through convenient sampling and were divided into two groups of experimental (60) and control (60). The instruments for data collection were the Health Belief Model and FFQ questionnaires. The HBM questionnaire was completed three times (before, immediately and two months after the intervention) and the FFQ questionnaire was completed two times (before and two months after the intervention) by the students. After the pre-test, six educational sessions were provided for the experimental group. Finally, data were collected and analyzed by SPSS 16 (ttest, paired t-test and repeated measure ANOVA).Results: There were no differences between the two groups in terms of demographic variables. Before the intervention, there were not any significant differences between the scores of different structures of this model between the two groups (p>0.05); however, after the intervention, significant differences were found between the experimental and control groups in the levels of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy and performance (p<0.001).Conclusion: According to the results, the intervention had a positive impact on the improvement of intake of fruits and vegetables among the students.

Background: Recently, quality is a serious concern in development of organizations. There are various indicators to assess quality and the purpose of this study was to identify the main indicators for quality measurement of Iranian health centers.Methods: This qualitative study was conducted in three stages: first, review of the literature was performed to identify different indicators for quality measurement in health centers; second, a tworound Delphi process was used with participation of 18 experts in both rounds; third, Analytical Hierarchy Process (AHP) method was applied to give weights to each indicator.Results: Twenty-seven indicators were identified from the literature review stage. The Delphi method reduced the list to 4 indicators. Developing a quality plan in the health center had the highest weight (38%) and percentage of followed complaints the lowest (12%). The consistency rate was 7.2% indicating appropriateness of the data.Conclusion: This list of indicators can be used as a template for measuring quality of health centers in Iran and possibly in other developing countries.

Background: Hepatitis B Virus (HBV) causes acute and chronic liver disease worldwide. HBV has eight genotypes (A to H) which is the reflection of its genome with their characteristic geographical distribution. Each genotype could have different pathogenic and therapeutic characteristics. There have been few records on HBV genotyping in general population from our region. This study aimed to determine hepatitis B genotypes using sequencing in the general population of Shahrekord, a Southwestern region of Iran.Methods: A total of 3000 serum samples (cluster sampling method) were enrolled from general population tested for HBsAg using ELISA. Using appropriate extraction kit, HBV DNA was extracted from HBsAg positive samples and each was subjected to nested PCR for detection of HBV DNA. Finally, using sequencing, the samples were used for HBV genotyping. Data were analyzed by SPSS 19 using descriptive statistics, chi square, and Fisher’s exact test. P-value<0.05 was considered as the level of significance.Results: Out of 3000 serum samples, 40 (1.3%) were positive for HBsAg. HBV DNA was detected in 10 out of 40 (25%) of the samples studied. Genotype D was the predominant HBV type found in all of these 10 HBV positive samples.Conclusion: Genotype D is probably the predominant HBV type in our region.

Background: Myocardial Infarction (MI) is a main cause of death and disability worldwide, which involves a number of genetic, physiopathologic and socio-economic determinants. The aim of this study was to assess the patterns of association between education, wealth and some other risk factors with non-fatal MI in Tehran population.Methods: Data derived from a second round of large cross-sectional study, Urban HEART-2, conducted in Tehran in 2011. Out of 118542 participants, all 249 self-reported incident cases of nonfatal MI were selected as the case group. A number of 996, matched on age and sex, were selected as controls. Principle component analysis (PCA) was used to calculate wealth index and logistic regression model to assess relations between the study variables.Results: Mean (SD) age of participants was 60.25 (12.26) years. A total of 870 (69.9%) of the study subjects were men. Education, wealth status, family violence, hypertension and diabetes were observed as independent predictors of non-fatal MI. Overall, as the level of education increased, the odds of non-fatal MI decreased (p<0.001). We observed an almost J-shaped association between wealth status and non-fatal MI. No significant associations were found between marital status, BMI and current smoking with non-fatal MI (p<0.05).Conclusion: We found different patterns of association between education and wealth with nonfatal MI among Tehran adults. Lower risk of non-fatal MI is linked to high educated groups whereas economically moderate group has the lowest risk of non-fatal MI occurrence.