CONTEXT:The incidences of both gastroesophageal reflux disease (GERD) and metabolic syndrome (MetS) have increased in recent years, and it has been suggested that there is a probable association between the two. The aim of this review is to clarify whether or not MetS is a risk factor for the incidence of GERD.EVIDENCE AQUISITION:We searched the PubMed, ProQuest, Ovid, Science Direct, and Google Scholar databases up to February 2015 regarding the relationship between GERD and MetS as found in observational studies. Any studies that evaluated the association between the components of MetS and GERD, as well as any studies examining the association of MetS with Barrett's esophagus or esophageal carcinoma, were excluded.RESULTS:Thirteen studies met the eligibility criteria. The results of nine studies suggested that there was a higher prevalence of MetS among patients with GERD (P < 0.05) and, thus, it could be considered as an independent risk factor for the incidence of GERD. However, in the one study was not observed significant association between GERD and MetS (P = 0.71). Two studies in which the prevalence of GERD was compared between individuals with and without MetS showed a higher prevalence of GERD in patients with MetS (P < 0.05). However, this finding was not observed in a similar study conducted among female participants, which reported that the different types of MetS were not important factors with regard to the prevalence of erosive esophagitis (P = Not significant).CONCLUSIONS:It can be concluded that MetS may increase the risk of GERD. Consequently, there might be potential benefits to treating the metabolic abnormalities in these patients.
BACKGROUND:The consumption of different types of fast food is increasingly growing in all parts of the world, both in developed and developing countries. Because of the changes and transitions in the lifestyle and dietary habits of people, an increasing number of people from different age groups, particularly adolescents and young adults, are inclined toward consuming fast food.OBJECTIVES:The objective of this study was to investigate the factors influencing fast-food consumption among adolescents in Tehran, Iran.PATIENTS AND METHODS:The present qualitative study was conducted in 2012 - 2013 in Tehran, the capital of Iran. To achieve the objective of this study, 42 adolescents were enrolled in this study through a purposive sampling method, and the required data was collected via individual semi-structured in-depth interviews. Data collection and analysis were carried out simultaneously, and the collected data was analyzed via a thematic content analysis and using MAXQDA 10 software.RESULTS:In this study after coding the transcribed interviews, the findings were categorized into three main themes as follows: personal views, social factors, and family factors. Each theme included several categories and subcategories, and the coded sentences and phrases were placed under each category and subcategory.CONCLUSIONS:The results of this study showed that the number of factors promoting fast-food consumption appeared to be more than the inhibiting factors and that the diverse factors at the individual and social level influenced fast-food consumption among adolescents.
Background: There are very limited data for Iranian populations on the predisposing genetic factors for acute coronary syndrome (ACS). Objectives:The objective of the present study was to investigate the association of the angiotensin II type 1 receptor (AT1R) gene polymorphism and ACS in an Iranian population.Patients and Methods: This cross-sectional study was conducted among 263 subjects (97 men and 166 women).Patients (n = 128) aged 30 -80 years with chest pain were recruited from the emergency department of Ghaem Hospital (Mashhad, Iran).A 12-lead electrocardiograph plus creatine kinase MB (CK-MB) levels were used as the basis for the diagnosis of myocardial ischemia.The control group was selected from age-matched healthy subjects (n = 135).Non-enzymatic kits were used for extraction of DNA from blood samples.Polymerase chain reaction (PCR) was performed to amplify the DNA fragments.For restriction fragment length polymorphism (RFLP) determination, the DdeI enzyme was used to digest the amplified DNA fragments.Statistical analyses were performed using SPSS version 13.0.Results: There was no statistical difference in the genotype frequency of patients and healthy subjects with regard to age and gender (P > 0.05).Conclusions: The AT1R A1166C polymorphism appeared not to be associated with the presence of ACS in the population studied.
Background: There is a strong relationship between physical inactivity and low-grade inflammation and its adverse health outcomes, particularly cardiovascular disease. The level of anti-inflammatory and pro-inflammatory cytokines may be changed by exercise. Objectives: The aim of the present study was to determine the response of certain inflammatory biomarkers to exercise with differences in maximal oxygen consumption (VO2max). These biomarkers were IL-1β, TNF-α, hs-CRP, IL-6, sICAM-1, IL-10, and ratios of TNF-α/IL-10 and IL-6/IL-in circulating peripheral blood (PB). Materials and Methods: In a semi-experimental study, twenty male students who performed regular football exercise at least three days a week, for two years, were selected by easy sampling at Shahid Chamran university of Iran. Subjects were then randomly assigned to two groups: the protocol of the first group was 30 minutes of running at a speed of 65% of VO2max, and the second group performed six periodic repetitions with three minutes at a speed of 85% of VO2max with a 90-second rest between the repetitions. Blood samples were taken at baseline, immediately after the exercise and at rest. Cytokine levels were quantified by the Sandwich enzyme-linked immunosorbent assay (ELISA) method. Results: The first protocol resulted in a decrease of serum IL-1β to 3.77 ± 0.28 pg/mL at rest, from 4.33 ± 0.28 at baseline and 4.32 ± 0.34 immediately after exercise (P = 0.008 and P = 0.013, respectively). There was also a decrease in the level of sICAM-1 to 260.11±15.64 ng/mL at rest, from 329.58 ± 20.82 at baseline and 302.7 ± 20.49 post exercise (P = 0.013 and P = 0.038, respectively). On the other hand, IL-6 and ratio of IL-6/IL-10 increased to 6.55±0.84 pg/mL and 2.12 ± 0.37 immediately after exercise from baseline (2.73 ± 0.58 and 1.16 ± 0.33) and rest (2.49 ± 0.45 and 0.95 ± 0.19) in the second protocol (P = 0.001 and P = 0.001, respectively for IL-6, and P = 0.047 and P = 0.024, respectively for IL-6/IL-10). Conclusions: The data of the present study demonstrated that a single bout of exercise with higher-intensity induces a transient increase in some proinflammatory markers, and lower-intensity can reduce these biomarkers.
Dear Editor, Depression, common throughout the world, is a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings, and sense of well-being (1, 2). Depression is typically thought of as strictly biochemical or as rooted in emotions. However, nutrition can play a key role in the onset as well as the severity and duration of depression (3, 4). Selenium is an essential trace element that may alter levels of neurotransmitters in the brain (5). Several studies have suggested that a diet high in selenium significantly improves mood scores (6, 7). The purpose of this study was to investigate the relationship between selenium and depression, assessed by the Beck’s scores of subjects living in Mashhad, in northeastern Iran. This work began in 2007 - 2009, when 7,172 subjects (2,725 males and 4,447 females) were recruited from an urban population in and around Mashhad, using a stratified-cluster method that was derived from the Mashhad stroke heart atherosclerosis disorder (MASHAD study). None of the subjects had a past history of a cardiovascular event (e.g. unstable angina, Myocardial infarction (MI) or stroke), heart failure, or peripheral vascular disease, including transient ischemic attack, or a history of any previous cardiovascular interventions or surgery. Persons with any major comorbidity, such as cancer or autoimmune, infectious, and inflammatory diseases, were excluded. All subjects gave informed, written consent to contribute to the survey, which was approved by the Mashhad University of Medical Science Ethics Committee. In this study, symptoms of depression were assessed using the beck depression inventory (BDI). This questionnaire contained 21 items and measured the severity of several symptoms associated with depression. Participants answered each question using a 4-point scale, from 0 to 3. If the subject’s total score was under 14, the subject was regarded as non-depressed (normal), while those scoring 14 - 19 were considered to be mildly, 20 - 28 moderately, and > 29 severely depressed, respectively (8, 9). Dietary intake was assessed by means of a questionnaire that was designed based on a 24h dietary recall; dietary analysis was performed using Diet Plan 6 software (Forestfield Software Ltd., Horsham, West Sussex, UK). The means (and SD) for age were 49.3 ± 8.2 years for the male and 48.1 ± 8.0 years for the female subgroups. Multiple logistic regression analysis was performed to assess the relative importance of the selected parameters in determining the presence of moderate and severe depression. Total energy-adjusted intake of selenium proved to be a significant predictor of moderate depression (Table 1 ; P < 0.001), with selenium being negatively associated with the relative risk of a high depression score. Interventional studies with selenium have revealed that selenium improved mood and diminished anxiety (10). In another study, low selenium status was associated with a significantly greater incidence of depression and other negative mood states, such as anxiety, confusion, and hostility (11). Our project confirmed that selenium intake is associated with the low risk of depression. Table 1. Regression Logistic Between Severe and Moderate Depression Subjects With Selenium in Both Crude and Energy-Adjusted Nutrient Intake
Background: Obesity, particularly morbid obesity, has various physical and mental complications.Excessive daytime somnolence (EDS) is a sleep disorder that reduces individuals' performance capability and the accuracy of their short-term memory and causes learning problems.This retrospective study aimed to document the presence of EDS in a sample of obese patients in comparison to patients with a normal weight.Objectives: This article compares the excessive daytime sleepiness of obese and non-obese patients in the minimally invasive surgery research center in Tehran, Iran.Patients and Methods: In this case-control study, we compared excessive daytime sleepiness in 55 obese patients who were candidates for laparoscopic surgery, with a body mass index (BMI) of equal to or greater than 30 kg/ m 2 , with 55 controls with a normal BMI (19.5 -24.9 kg/ m 2 ).The process of selecting the control group in our case-control study is matching in group levels, so that the controls are similar to the case group with regard to certain key characteristics, such as age, sex, and race.The sleep assessment was based on the Epworth sleepiness scale (ESS) questionnaire.Analysis of variance (ANOVA) was used to compare the means of quantitative data, such as the ESS score of groups.Results: Sleepiness was not affected by gender in cases or controls.The sleepiness prevalence was 29 (52.7%) in the cases group and 17 (30.9%) in the control group (OR = 2.493 (95% CI 1.144 -5.435)).The mean ESS scores in cases and controls were 7.82 ± 3.86 and 10.54 ± 6.15, respectively (P = 0.007).Moreover, the prevalence of sleepiness and the mean ESS scores in class III of obesity differed significantly from the controls (16 (57.1%) vs. 17 (30.9%))(OR = 2.980 (95% CI 1.162 -7.645)) and (11.04 ± 5.93 vs. 7.82 ± 3.86) (P = 0.013), respectively.Conclusions: Our findings suggest a strong relationship between EDS and obesity, particularly morbid obesity.Therefore, physicians must be familiar with EDS as a mixed clinical entity indicating careful assessment and specific treatment planning.
Background: Individuals suffering from chronic low back pain (CLBP) experience major physical, social, and occupational disruptions.Strong evidence confirms the effectiveness of Alexander technique (AT) training for CLBP.Objectives: The present study applied an integrative model (IM) of behavioral prediction for improvement of AT training.Methods: This was a quasi-experimental study of female teachers with nonspecific LBP in southern Tehran in 2014.Group A contained 42 subjects and group B had 35 subjects.In group A, AT lessons were designed based on IM constructs, while in group B, AT lessons only were taught.The validity and reliability of the AT questionnaire were confirmed using content validity (CVR 0.91, CVI 0.96) and Cronbach's α (0.80).The IM constructs of both groups were measured after the completion of training.Statistical analysis used independent and paired samples t-tests and the univariate generalized linear model (GLM).Results: Significant differences were recorded before and after intervention (P < 0.001) for the model constructs of intention, perceived risk, direct attitude, behavioral beliefs, and knowledge in both groups.Direct attitude and behavioral beliefs in group A were higher than in group B after the intervention (P < 0.03). Conclusions:The educational framework provided by IM for AT training improved attitude and behavioral beliefs that can facilitate the adoption of AT behavior and decreased CLBP.
BACKGROUND:Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is suggested that selenium (Se), an essential trace element, has a protective role against oxidative stress. Decreased intraoperative Se levels might be an independent predictive factor for postoperative multiorgan failure. In spite of its proposed advantages, however, the optimal timing and dosage are not well known.OBJECTIVES:To determine whether 600 µg of intravenous Se administration before induction of anesthesia for CABG surgery could attenuate inflammatory reactions in an Iranian population.METHODS:This randomized triple-blind clinical trial took place in the department of cardiac surgery of an academic hospital affiliated with Guilan University of Medical Sciences (GUMS) from May 2015 to September 2015. Eighty-eight eligible patients scheduled for elective on-pump CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received either an intravenous bolus of 600 µg Se before induction of anesthesia, or normal saline as a placebo. We had four measurement time-points: just before induction of anesthesia (T0), immediately after the end of CPB (T1), 24 hours after surgery (T2), and 48 hours after surgery (T3). Interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) serum levels were measured using the enzyme-linked immunosorbent assay (ELISA).RESULTS:Data from a total of 81 patients were analyzed: group S (n = 41) and group C (n = 40). There was no significant difference between the two groups with regard to baseline characteristics. In both groups, CPB caused markedly increased IL-6, TNF-α, and CRP plasma concentrations compared with baseline (P = 0.0001). However, the pattern of changes was not significantly different between group S (P = 0.068) and group C (P = 0.26). The IL-6 and TNF-α change trends were significant in each group (P=0.0001). However, comparing the two groups showed no significant difference. With regard to IL-6, there was no significant difference between the two groups at the time-points of T1 (P = 0.34), T2 (P = 0.17), and T3 (P = 0.056), and the same was found for TNF-α at T1 (P = 0.34), T2 (P = 0.17), and T3 (P = 0.056). With regard to CRP, the trend of the changes was significant in each group (P = 0.0001). However, comparing two groups showed a borderline significant difference between them at T1 (P = 0.039), but not at T2 (P = 0.075) or T3 (P = 0.11).CONCLUSIONS:This study revealed that the administration of 600 μg of intravenous Se immediately before induction of anesthesia was safe, but when compared to a placebo, no predominant clinical effects or modifications in the systemic inflammatory response induced by on-pump CABG were observed.
Context In order to gain a more detailed insight into the concept of spiritual health, a hybrid model of concept analysis was used to remove some of the ambiguity surrounding the conceptual meaning of spiritual health in Islamic and Iranian contexts. The purpose of this study was to clarify the meaning and nature of the spiritual health concept in the context of the practice of Islam among Iranian patients. Evidence Acquisition The current concept analysis was undertaken according to the modified traditional hybrid model, which consists of five phases: theoretical phase, initial fieldwork phase, initial analytical phase, and final fieldwork and final analytical phase. In the theoretical phases of the study, the concept of spiritual health was described based on a literature review of publications dealing with the Islamic viewpoint (years: from 2013 to 2014, Databases and search engines: Pubmed, SID, Magiran, Noormax, Google Scholar, Google and IranMex, Languages: English and Persian, Keywords: spiritual health AND (Islam OR Quran), spirituality AND (Islam OR Quran), complete human AND Islam, healthy heart (Galb Salim) AND Islam, healthy life (Hayat tayebeh) AND Islam, calm soul (Nafse motmaeneh) And Islam and healthy wisdom (Aghle Salim) AND Islam). Purposive sampling was conducted and nine participants were selected. Semi-structured interviews and observations were conducted periodically for data collection after obtaining informed consent. Observational, theoretical, and methodological notes were made. Then, using MAXQUDA 7 software, the data were analyzed using qualitative content analysis. Results The relevant literature in the theoretical phase uncovered the attributes of the concept of spiritual health, including love of the Creator, duty-based life, religious rationality, psychological balance, and attention to afterlife. These attributes were explored in depth in later stages. Finally, the definition of spiritual health was developed. Conclusions Islam has a unique perspective on spiritual health as it encompasses all aspects of human beings. Thus, it is necessary to carefully study the difference between the Islamic concept of spiritual health and that of other religions and ideologies to design suitable and useful nursing care for Iranian patients that satisfy their spiritual needs.
Background: It is estimated that about 15% (10% - 30% in most of the studies) of the total adult population has some aspects of the Chronic Venous Insufficiency (CVI). Frequency of the Peripheral Arterial Disease (PAD) in the adult population is 3% - 4%. Studies dealing with etiopathogenesis of leg ulcers show that between 10% and 18% of all ulcers are of mixed, arterial-venous origin. Objectives: The purpose of this study was to find out if there is a higher frequency of PAD among CVI patients in comparison with the control group, as well as to discover some common risk factors for CVI and PAD. Patients and Methods: This cross-sectional descriptive study was conducted at the dermatovenereological clinic, clinical center of Vojvodina, Serbia. A total of 162 examinees were included. All patients were examined for the existence of CVI and staged according to CEAP (Clinical, etiology, anatomy and patophysiology) classification. In this way, 3 groups were formed: Patients with the mild forms of CVI (stage 1 - 4 by CEAP classification), 57 patients; patients with the severe forms of CVI (stage 5 and 6 by CEAP classification), 55 patients; control group (no CVI), 50 patients. Also, the Ankle Brachial Pressure Index (ABPI) was assessed in all subjects, and its value of ≤ 0.9 was set as criteria for diagnosis of PAD. The same sample was divided according to the presence of PAD into two groups. The most important risk factors for CVI and PAD were identified for each patient through complete examination, medical record and appropriate questionnaire. Results: Our results showed that the risk factors for CVI were high Body Mass Index (BMI), hypertension, predominantly standing position during work and positive family history for CVI. In the same sample it was found that 28 (17.28%) patients had PAD. Relevant risk factors for PAD in the present study were: high BMI, hypertension, diabetes and a positive family history for PAD. Comparison of frequency of PAD among patients with severe forms of CVI and control group showed that this difference was statistically significant (P = 0.0275; OR 3.375; 95% CI 1.125 - 10.12). After multivariate analyses, adjusted odds ratio OR was still statistically significant. Conclusions: The peripheral arterial disease is more frequent in patients with the severe form of CVI, than in patients without CVI. Concomitant risk factors for CVI and PAD were high BMI and hypertension. In each patient with severe CVI it is necessary to determine the ABPI, in order to exclude the presence of PAD.
Background: Renal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality. Objectives: This study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC. Methods: In this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases). Results: There were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05). Conclusions: There were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.
BACKGROUND:Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women.OBJECTIVES:The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran.MATERIALS AND METHODS:This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis.RESULTS:Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system.CONCLUSIONS:The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.
BACKGROUND:There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision.OBJECTIVES:The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran.MATERIALS AND METHODS:This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them.RESULTS:The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information.CONCLUSIONS:It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran.
BACKGROUND:Salvia, known as Maryam Goli in the Persian language, is an important genus that includes approximately 900 species in the Lamiaceae family. There are 58 Salvia species growing naturally in Iran, including Salvia chloroleuca Rech. f. and Allen., which grows wild in the northeastern and central parts of the country.OBJECTIVES:This study was designed to determine the chemical composition, in vitro antioxidant activity, and total phenol content of various extracts of S. chloroleuca.MATERIALS AND METHODS:Dried aerial parts of the plant were crushed, then sequentially extracted with n-hexane, ethyl acetate, and methanol. The fractions of S. chloroleuca were subjected to silica gel column chromatography and Sephedex LH-20. The antioxidant activities of these extracts were measured by ferric reducing antioxidant power (FRAP), and the total phenolic contents of the extracts were evaluated using Folin-Ciocalteu reagent.RESULTS:The separation and purification processes were carried out using different chromatographic methods. Structural elucidation was on the basis 1H-NMR and 13C-NMR spectral data, in comparison with that reported in the literature. The isolated compounds were salvigenin (1), luteolin (2), cirsiliol (3), β-sitosterol (4), and daucosterol (5). Ethyl acetate extract displayed the highest level of total antioxidants and total polyphenols compared to the other analyzed extracts (n-hexane and methanol). In the FRAP assay, ethyl acetate extract had the highest (230.4±10.5) FRAP value, followed by methanol (211.4 ± 8.3) and n-hexane (143.4 ± 12.04). Total phenol contents were calculated to be 13.8 ± 0.3, 58.25 ± 0.05, and 43.48 ± 0.38 mg of gallic acid/100 g in the n-hexane, ethyl acetate, and methanol extracts, respectively.CONCLUSIONS:The above-mentioned compounds were isolated for the first time from S. chloroleuca. The antioxidant activity of this plant could be in part related to isolated flavonoids and sterols. The results of this study indicated that S. chloroleuca could be an important dietary source of phenolic compounds with high antioxidant capacity.
Background Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight status of the residents. Objectives To assess the relationship between general and central obesity and the neighborhood environment in two ethnic groups (Azeri Turks and Kurds) living in Urmia city, Northwestern Iran. Patients and Methods In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and a health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with general and central obesity was analyzed by a logistic regression model. Results Three common neighborhood environments were identified: 1) modern-affluent, 2) central-high access and 3) marginal. These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results. However, after adjustment for educational level, the association was not significant. Conclusions The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity
PhD Student, Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran Associated Professor, Evidence-Based Care Research Centre, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran Associate Professor in Health Services Management, Management and Social Determinant of Health Research Center, School of Health, Mashhad University of Medical Sciences, Department of Health Care Management
BACKGROUND:Melanoma Inhibitory Activity 3 regulates the plasma level of LDL cholesterol. The c.3169 + 315G > A single-nucleotide polymorphism of the MIA3 gene has been reported to be associated with serum coronary artery disease (CAD). However, there have been no studies analyzing the association of this polymorphism with CAD in Iranian individuals with CAD.OBJECTIVES:Therefore, in the present study we have investigated the potential protective effect of the rs3008621 MIA3 polymorphism in 188 subjects with and without CAD.MATERIALS AND METHODS:Genotyping of the MIA3 gene was undertaken using TaqMan real-time PCR in all subjects. Anthropometric and biochemical features, including HDL, LDL, and TG were assessed in all subjects.RESULTS:The CAD patients had significantly (P < 0.05) higher BMI and significantly higher levels of TG, LDL, SBP, and DBP, while the level of HDL was lower compared to that of the control group. the MIA3 gene polymorphism was not associated with CAD in our population sample.CONCLUSIONS:The MIA3 polymorphism is unlikely to play an important role in CAD in the Iranian population. However, further studies are needed in a larger population to confirm this.
INTRODUCTION:Crimean-Congo hemorrhagic fever (CCHF) is a severe infectious disease that is not endemic in the United Arab Emirates (UAE).CASE PRESENTATION:We report two cases of confirmed CCHF diagnosed in Dubai, UAE, during Hajj season 2010. Both patients presented with an acute history of high-grade fever, skin rash, and hematemesis.CONCLUSIONS:In spite of maximal supportive measures and intravenous ribavirin therapy, both patients died within a few days from start of illness. More than 250 health care workers came into variable degrees of contact with the index cases, and none of them developed signs or symptoms suggestive of acquiring the illness. Health care workers from nonendemic regions should be aware of zoonotic hemorrhagic fevers imported via infected cattle and ticks and be able to diagnose and properly manage suspected cases in a timely manner. In addition, proper infection-control measures should be undertaken to prevent nosocomial spread of infection.
Background Observational studies indicate a positive association between homeopathy and pain relief and quality of life improvement in women with dysmenorrhea. However, there are no interventional studies in this area. Objectives To evaluate an association between homeopathy and pain relief and quality of life improvement in a double-blind placebo-controlled randomized trial with 2 parallel arms. Methods Fifty-four students with primary dysmenorrhea residing at the dormitories of the Tabriz University of Medical Sciences, Iran, who had moderate or severe menstrual pain, were randomized to receive either homeopathic remedy or placebo. The homeopath and participants were blinded to treatment assignment. Primary outcomes were pain intensity and quality of life assessed using a 10-cm visual analog scale and short-form 36 (SF-36), respectively, and the secondary outcome was number of analgesic pills used. Results Each group comprised 27 students; eventually, 26 in the homeopathic and 21 in the placebo group were followed up. There was no significant difference between the groups for either pain intensity (adjusted difference: -0.44; 95% CI: -1.43 to 0.54) or any other outcomes. Compared with the baseline scores, statistically significant improvements were observed in pain intensity (P = 0.021) and physical health (P = 0.020) scores only in the homeopathic group; and in the mental health score in both groups (P = 0.014 in the homeopathy group and P = 0.010 in the placebo group). Conclusions This study could not show any significant effect of homeopathy on primary dysmenorrhea in comparison with placebo. Considering the possible effect of the homeopath and the homeopathic remedies prescribed on the results of such interventions, further studies are needed to help us arrive at a conclusion.
BACKGROUND:When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed.OBJECTIVES:This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC).MATERIALS AND METHODS:This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods.RESULTS:Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment.CONCLUSIONS:With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.
