Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents / 예방의학회지

Objectives@#Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran. @*Methods@#Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority. @*Results@#Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources. @*Conclusions@#Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households / 예방의학회지

Objectives@#Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. @*Methods@#This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. @*Results@#Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. @*Conclusions@#In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

The Most Important Social Determinants of Slum Dwellers’ Health: A Scoping Review / 예방의학회지

Objectives@#Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants. @*Methods@#This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness. @*Results@#Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles,7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers. @*Conclusions@#This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.

Immune checkpoints in targeted-immunotherapy of pancreatic cancer: New hope for clinical development

Immunotherapy has been recently considered as a promising alternative for cancer treatment. Indeed, targeting of immune checkpoint (ICP) strategies have shown significant success in human malignancies. However, despite remarkable success of cancer immunotherapy in pancreatic cancer (PCa), many of the developed immunotherapy methods show poor therapeutic outcomes in PCa with no or few effective treatment options thus far. In this process, immunosuppression in the tumor microenvironment (TME) is found to be the main obstacle to the effectiveness of antitumor immune response induced by an immunotherapy method. In this paper, the latest findings on the ICPs, which mediate immunosuppression in the TME have been reviewed. In addition, different approaches for targeting ICPs in the TME of PCa have been discussed. This review has also synopsized the cutting-edge advances in the latest studies to clinical applications of ICP-targeted therapy in PCa.

The Most Important Social Determinants of Slum Dwellers’ Health: A Scoping Review / 예방의학회지

Objectives@#Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants. @*Methods@#This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness. @*Results@#Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles,7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers. @*Conclusions@#This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.

Association of preoperative hemoglobin a1c with in-hospital mortality following valvular heart surgery

Abstract Objective: To determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort. Methods: In this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups. Results: Two hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively) Conclusion: This study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.

Contextual and Individual Determinants of Mental Health: A Cross-sectional Multilevel Study in Tehran, Iran / 예방의학회지

Objectives@#Our aim was to answer the following questions: (1) Can mental health variance be partitioned to individual and higher levels (e.g., neighborhood and district); (2) How much (as a percentage) do individual-level determinants explain the variability of mental health at the individual-level; and (3) How much do determinants at the neighborhood- or district-level explain the variability of mental health at the neighborhood- or district-level? @*Methods@#We used raw data from the second round of the Urban Health Equity Assessment and Response Tool in Tehran (in 2012-2013, n=34 700 samples nested in 368 neighborhoods nested in 22 districts) and the results of the official report of Tehran’s Center of Studies and Planning (in 2012-2013, n=22 districts). Multilevel linear regression models were used to answer the study questions. @*Results@#Approximately 40% of Tehran residents provided responses suggestive of having mental health disorders (30-52%). According to estimates of residual variance, 7% of mental health variance was determined to be at the neighborhood-level and 93% at the individual-level. Approximately 21% of mental health variance at the individual-level and 49% of the remaining mental health variance at the neighborhood-level were determined by determinants at the individual-level and neighborhood-level, respectively. @*Conclusions@#If we want to make the most effective decisions about the determinants of mental health, in addition to considering the therapeutic perspective, we should have a systemic or contextual view of the determinants of mental health.

Efficient drug and gene delivery to liver fibrosis: rationale, recent advances, and perspectives

Liver fibrosis results from chronic damages together with an accumulation of extracellular matrix, and no specific medical therapy is approved for that until now. Due to liver metabolic capacity for drugs, the fragility of drugs, and the presence of insurmountable physiological obstacles in the way of targeting, the development of efficient drug delivery systems for anti-fibrotics seems vital. We have explored articles with a different perspective on liver fibrosis over the two decades, then collected and summarized the information by providing corresponding  and  cases. We have discussed the mechanism of hepatic fibrogenesis with different ways of fibrosis induction in animals. Furthermore, the critical chemical and herbal anti-fibrotics, biological molecules such as micro-RNAs, siRNAs, and growth factors, which can affect cell division and differentiation, are mentioned. Likewise, drug and gene delivery and therapeutic systems on  and  models are summarized in the data tables. This review article enlightens recent advances in emerging drugs and nanocarriers and represents perspectives on targeting strategies employed in liver fibrosis treatment.

Evaluation of outcomes in fissurectomy and V-Y advancement flap for the treatment of chronic anal fissure / Avaliação de desfechos na fissurectomia e retalho de avanço em V­Y para o tratamento de fissura anal crônica

ABSTRACT Chronic anal fissure is difficult to treat. Surgery is usually recommended in the case of drug therapeutic failure. Fecal incontinence in patients with weaker sphincters (multipara older patients with a history of pelvic surgery etc.) is a major reason for rejecting surgery. Such these patients should be underwent fissurectomy and V-Y advancement flap in which sphincterotomy is not required. In this prospective study, we determined the outcomes and complications of fissurectomy and V-Y advancement flap in both groups of patients with low and high anal sphincter tones.

RESUMO A fissura anal crônica tem tratamento difícil. A cirurgia geralmente é recomendada em caso de falha do tratamento medicamentoso. A incontinência fecal em pacientes com esfíncteres mais fracos (pacientes multíparas mais velhas com história de cirurgia pélvica etc.) é uma razão importante para a rejeição da cirurgia. Esses pacientes devem ser submetidos a fissurectomia e retalho de avanço em V-Y no qual a esfincterotomia não é necessária. Neste estudo prospectivo, determinamos os desfechos e complicações da fissurectomia e o retalho de avanço em V-Y em ambos os grupos de pacientes com tônus baixo e alto do esfíncter anal.

Prevalence and clinical features of Cryptosporidium infection in hemodialysis patients

Aim: This cross-sectional study aims to assess the prevalence of Cryptosporidium in hemodialysis patients compared with healthy individuals in central Iran from August 2014 to January 2015

Background: Cryptosporidiosis is a major cause of acute and persistent diarrhea with significant morbidity and mortality in immunocompromised patients such as those undergoing renal dialysis

Methods: Three stool samples were collected from 330 hemodialysis patients and 150 healthy individuals on 3 consecutive days. The samples were screened for Cryptosporidium infection using formalin-ether sedimentation and modified Ziehl-Neelsen staining. Demographic variables as well as risk factors were recorded

Results: Out of 330 dialysis patients and 150 healthy individuals, 10 [3%] and 1 [0.7%] were infected with Cryptosporidium, respectively. We found statistically significant differences between infection and place of residency, hygiene status, education level, diarrhea, and abdominal pain in the two groups [p<0.05]. On the other hand, there was no relationship between infection and sex, contact with domestic animals, fever, vomiting, nausea, flatulence, anorexia, duration of dialysis and underlying disorders in the two groups. Also, there was a statistically significant difference between age and infection in hemodialysis patients [p=0.003]. A higher infection rate was observed in patients under 20 years of age

Conclusion: Risk factors for Cryptosporidium infection must be controlled. We strongly recommended that stool samples from such patients, especially those with severe or prolonged diarrhea, should be examined with modified Ziehl-Neelsen staining for appropriate and timely treatment

Phylogeography, genetic variability and structure of Acanthamoeba metapopulations in Iran inferred by 18S ribosomal RNA sequences: A systematic review and meta-analysis

OBJECTIVE@#To verify phylogeography and genetic structure of Acanthamoeba populations among the Iranian clinical isolates and natural/artificial environments distributed in various regions of the country.@*METHODS@#We searched electronic databases including Medline, PubMed, Science Direct, Scopus and Google Scholar from 2005 to 2016. To explore the genetic variability of Acanthamoeba sp, 205 sequences were retrieved from keratitis patients, immunosuppressed cases and environmental sources as of various geographies of Iran.@*RESULTS@#T4 genotype was the predominant strain in Iran, and the rare genotypes belonged to T2, T3, T5 (Acanthamoeba lenticulata), T6, T9, T11, T13 and T15 (Acanthamoeba jacobsi). A total of 47 unique haplotypes of T4 were identified. A parsimonious network of the sequence haplotypes demonstrated star-like feature containing haplogroups IR6 (34.1%) and IR7 (31.2%) as the most common haplotypes. In accordance with the analysis of molecular variance, the high value of haplotype diversity (0.612-0.848) of Acanthamoeba T4 represented genetic variability within populations. Neutrality indices of the 18S ribosomal RNA demonstrated negative values in all populations which represented a considerable divergence from neutrality. The majority of genetic diversity belonged to the infected contact lens and dust samples in immunodeficiency and ophthalmology wards, which indicated potential routes for exposure to a pathogenic Acanthamoeba sp. in at-risk individuals. A pairwise fixation index (F) was from low to high values (0.02433-0.41892). The statistically F points out that T4 is genetically differentiated between north-west, north-south and central-south metapopulations, but not differentiated between west-central, west-south, central-south, and north-central isolates.@*CONCLUSIONS@#An occurrence of IR6 and IR7 displays that possibly a gene flow of Acanthamoeba T4 occurred after the founder effect or bottleneck experience through ecological changes or host mobility. This is the first systematic review and meta-analysis providing new approaches into gene migration and transmission patterns of Acanthamoeba sp, and targeting at the high-risk individuals/sources among the various regions of Iran.

Phylogeography, genetic variability and structure of Acanthamoeba metapopulations in Iran inferred by 18S ribosomal RNA sequences: A systematic review and meta-analysis

Objective To verify phylogeography and genetic structure of Acanthamoeba populations among the Iranian clinical isolates and natural/artificial environments distributed in various regions of the country. Methods We searched electronic databases including Medline, PubMed, Science Direct, Scopus and Google Scholar from 2005 to 2016. To explore the genetic variability of Acanthamoeba sp, 205 sequences were retrieved from keratitis patients, immunosuppressed cases and environmental sources as of various geographies of Iran. Results T4 genotype was the predominant strain in Iran, and the rare genotypes belonged to T2, T3, T5 (Acanthamoeba lenticulata), T6, T9, T11, T13 and T15 (Acanthamoeba jacobsi). A total of 47 unique haplotypes of T4 were identified. A parsimonious network of the sequence haplotypes demonstrated star-like feature containing haplogroups IR6 (34.1%) and IR7 (31.2%) as the most common haplotypes. In accordance with the analysis of molecular variance, the high value of haplotype diversity (0.612–0.848) of Acanthamoeba T4 represented genetic variability within populations. Neutrality indices of the 18S ribosomal RNA demonstrated negative values in all populations which represented a considerable divergence from neutrality. The majority of genetic diversity belonged to the infected contact lens and dust samples in immunodeficiency and ophthalmology wards, which indicated potential routes for exposure to a pathogenic Acanthamoeba sp. in at-risk individuals. A pairwise fixation index (F

Two-dimensional and volumetric airway changes after bimaxillary surgery for class III malocclusion

OBJECTIVES: Any change in maxilla and mandible position can alter the upper airway, and any decrease in the upper airway can cause sleep disorders. Thus, it is necessary to assess airway changes after repositioning of the maxilla and mandible during orthognathic surgery. The purpose of this study was to evaluate linear and volumetric changes in the upper airway after bimaxillary surgery to correct class III malocclusion via cone-beam computed tomography (CBCT) and to identify correlations between linear and volumetric changes. MATERIALS AND METHODS: This was a prospective cohort study. CBCTs from 10 class III patients were evaluated before surgery and three months after. The Wilcoxon one-sample test was used to evaluate the differences in measurements before and after surgery. Spearman's rank correlation coefficient was used to test the correlation between linear and volumetric changes. RESULTS: The results show that the nasopharyngeal space increased significantly, and that this increase correlated with degree of maxillary advancement. No significant changes were found in volumes before and after surgery. A correlation was found between linear and volumetric oropharyngeal changes. CONCLUSION: Bimaxillary surgical correction of class III malocclusion did not cause statistically significant changes in the posterior airway space.

Changes in blood insulin resistance, GLUT4 & AMPK after continuous and interval aerobic training in normal and diabetic rats.

Objectives: Diabetes mellitus is now seen as a worldwide epidemic disease with prevalent and incidence data. Exercise training is known to promote beneficial changes in diabetic patient.Materials & Methods: A number of 60 male rats weighing 180 to 310 grams, 13 weeks old were divided into six groups. The exercise protocol was aerobic training for six weeks. In this study, factors like Insulin resistance, glucose transporter type 4 and AMP-activated protein kinase were measured. The data were analyzed using one-way analysis of variance test in P< 0.05 level. Results: The results showed a significant difference in insulin resistance (P=0.001, F5, 37= 10.80), Glucose transporter type 4 (P=0.001, F5, 37= 20.14) and AMP-activated protein kinase (F5, 37 = 16.2, P= 0.001) levels among different groups. There was no significant difference between the impact of continuous and interval training on these indices (P=1.00).Conclusions: The continuous and interval training by increasing the Glucose transporter type4 protein content and AMP-activated protein kinase lead to reduced blood glucose levels and improved insulin resistance. Furthermore, we could use conducting interval training as a therapeutic approach to manage diabetes for the participants who were not able to perform the continuous training due to fatigue.

The effect of canine disimpaction performed with temporary anchorage devices (TADs) before comprehensive orthodontic treatment to avoid root resorption of adjacent teeth

ABSTRACT Objective: The aim of this study was to evaluate the movement of impacted canines away from the roots of neighboring teeth before full-mouth bracket placement, performed by means of TADs to decrease undesired side effects on adjacent teeth. Methods: The study sample consisted of 34 palatally impacted canines, being 19 in the experimental group and 15 in the control group. In the experimental group, before placement of brackets, the impacted canine was erupted by means of miniscrews. In the control group, after initiation of comprehensive orthodontics, canine disimpaction was performed by means of a cantilever spring soldered to a palatal bar. At the end of treatment, volume of lateral incisors and canine root resorption were measured and compared by means of a CBCT-derived tridimensional model. Visual Analogue Scale (VAS) score, bleeding on probing (BOP) and gingival index (GI) were recorded. Clinical success rate was also calculated. Results: The volume of root resorption of lateral teeth in the control group was significantly greater than in the experimental group (p < 0.001). At the end of treatment, VAS score, GI and BOP were not significantly different between the two groups. Conclusion: Based on our results, it seems that disimpaction of canines and moving them to the arch can be done successfully carried out with minimal side effects by means of skeletal anchorage.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar o uso de dispositivos de ancoragem temporária (DATs) para a movimentação de caninos impactados, afastando-os das raízes dos dentes vizinhos, antes da colagem dos braquetes em todos os dentes, com o objetivo de minimizar os efeitos colaterais indesejáveis nesses dentes adjacentes. Métodos: a amostra consistiu de 34 caninos impactados por palatino, sendo 19 no grupo experimental e 15 no grupo controle. No grupo experimental, antes da colagem dos braquetes, os caninos impactados foram tracionados utilizando-se mini-implantes. No grupo controle, após o início do tratamento ortodôntico, a desimpacção dos caninos foi realizada com uma mola em cantiléver soldada a uma barra transpalatina. Ao fim do tratamento, os valores referentes à reabsorção radicular nos incisivos laterais e caninos foram medidos e comparados por meio de modelos tridimensionais reconstruídos a partir de TCFCs. Foram também registrados os escores relativos à dor sentida pelos pacientes, usando uma escala visual analógica (VAS); além do Índice de Sangramento à Sondagem (ISS) e do Índice Gengival (IG). O índice de sucesso clínico também foi calculado. Resultados: o volume de reabsorção radicular nos incisivos laterais no grupo controle foi significativamente maior do que no grupo experimental (p < 0,001). Ao fim do tratamento, não houve diferença significativa entre os dois grupos quanto aos escores relativos à VAS, ao IG e ISS. Conclusão: esses resultados sugerem que a desimpacção de caninos e a movimentação deles para a arcada dentária podem ser realizadas, com sucesso e com mínimos efeitos colaterais, por meio da ancoragem esquelética.

Helicobacter pylori and migraine: is eradication of helicobacter pylori effective in relief of migraine headache?

Background: Association between Helicobacter pylori [HP] infection and migraine and the effect of HP eradication on relief of migraine headache have been studied but the results are controversial

Objectives: To evaluate the effect of HP eradication in treatment of patients affected by migraine

Materials and Methods: Eighty consecutive HP infected patients affected by migraine without aura were enrolled in this clinical trial. They have referred to an endoscopy clinic for work-up of HP infection from October 2013 to November 2014. Patients were randomly assigned in 2 groups using 2 different regimens; Group A: migraine treatment and a 14-day triple therapy for HP infection and Group B: migraine treatment without HP eradication. The mean duration [hour], headache severity [MIDAS] and the frequency [per month] of clinical headache attacks were calculated upon enrollment in the study and at 6 months and 12 months after treatment. All data were analyzed using SPSS version 16. Comparison of categorical variables across the groups was performed using Chi-square test

Results: In group A, HP infection was eradicated in 34 of 40 patients [85%]. After treatment in eradicated patients compared with the control group there was significant decrease in severity and frequency [but not in duration] of the migraine attacks at 6 months [p<0.001] and significant decrease in intensity, frequency and duration of the migraine attacks at 12 months [p<0.001]

Conclusion: HP should be considered and examined in migranous patients and eradication treatment can be beneficial for relief of clinical attacks

viability of mouse spermatogonial germ cells on a novel scaffold, containing human serum albumin and calcium phosphate nanoparticles

In spermatogenesis, spermatogonial cells differentiate to the haploid gametes. It has been shown that spermatogenesis can be done at in vitro condition. In vitro spermatogenesis may provide an open window to treat male infertility. The aim of this study was to evaluate the effects of a novel scaffold containing human serum albumin [HSA]/tri calcium phosphate nanoparticles [TCP NPs] on the mouse spermatogonial cell line [SCL]. First, TCP NPs were synthesized by reaction of calcium nitrate and diammonium phosphate at pH 13. Then, serial concentrations of TCP NPs were separately added to 500 mg/mL HSA, and incubated in the 100[degree]C water for 30 min. In the next step, each scaffold was cut [2x2mm], placed into sterile well of microplate, and then incubated for 1, 2, and 3 days at 37[degree]C with mouse SCL. After incubation, the cytotoxicity of the scaffolds was evaluated by different tests including 3-[4,5-dimethylthiazol-2-yl]-2, 5-diphenyl-tetrazolium bromide [MTT] assay, lactate dehydrogenase [LDH] assay, vital staining, and cell counting. On the other hand, the release of TCP NPs and HSA from the scaffolds was measured. Based on microscopic observation, the size of cavities for all scaffolds was near 200-500 micro m, and the size of TCP NPs was near 50-100 nm. All toxicity tests showed that the increase of TCP concentration in the scaffold did not affect mouse SCL. It means that the percentage of cell viability, LDH release, vital cells, and cell quantity was 85%, 105%, 90%, and 110%, respectively. But, the increase of incubation time led to increase of LDH release [up to 115%] and cell count [up to 115%]. Also, little decrease of cell viability and vital cells was seen when incubation time was increased. Here, no release of TCP NPs and HSA was seen after increase of TCP concentration and incubation time. It can be concluded that the increase of TCP concentration in HSA/TCP NPs scaffold does not lead to cytotoxicity. On the other hand, the increase of incubation time leads to increase of mouse SCL cell death. In this study, it was found that TCP NPs and HSA could not release from the scaffolds. In future, both proliferation and differentiation of mouse SCL on HSA/TCP NPs scaffold must be checked over more wide incubation times