Iranian health research networks and vision of Iran by 2025: a case of virtual health network in EMRI

The present paper aims to explore the role of Health Research Networks [HRN] in facilitating and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025. Aiming to the main function of HSR to achieve the targeted conducting of health sciences research; more cooperation and coordination between health science researchers; avoid parallel investigations; and optimum utilization and appropriate distribution of resources, in 2000 the deputy of Research and Technology of Ministry of Health and Medical Education defined and developed a comprehensive HRN. There are currently 27 research networks operating under the supervision of the Deputy of Research and Technology at MOHME. All of the HRN policies are following based on their strategic planning's which are extracted from national visions of Iran by 2025. Promoting the current position needs a reliable and feasible new strategies. The present article introduces the lessons learned of our experience in virtual web-based health research networking in Endocrinology and Metabolism Research Institute [EMRI]

[Effects of vitamin E supplementation on activity of serum paraoxonase, SOD, GPX enzymes and lipid profiles in beta major thalassemia patients]

In pathogenesis of beta major thalassemia, tissue damage is occurring due to oxidative stress. The present study was designed to evaluate the effects of vitamin E supplementation on serum Paraoxonase, SOD, GPX enzyme activity and lipid profiles in beta major thalassemia patients. In this clinical tiral study, Sixty [25 males, 35 females] beta major thalassemia patients with age >/= 18 years who had criterias to enter the study, were selected randomely in two groups. The patients in interventional group, vitamin E at a dose of 400 mg/day were given for three months, with no supplementations in control group. The enzyme activities of paraoxonase, SOD, GPX and lipid profiles [LDL-c, HDL-c, triglyceride, total Antixidant Capacity] were measured prior and after 3 months in both case and control groups. Data analyzed by using paired t-test. Significant increases in serum levels of vitamin E, Paraoxonase activity, HDL cholesterol [P<0.001], BMI [P

[Prevalence of intra abdominal injuries due to penetrating trauma in Gorgan, Iran [2002-07]]

Trauma is the most common cause of death in all individuals between 1 and 44 years and the third most common cause of death regardless of age. The abdomen is the third most commonly injured region of the body. Some intra abdominal organ injured more than others, related to mechanism of injury, size and location of organ in abdominal cavity. This study was carried out to determine the prevalence of intra abdominal injuries due to penetrating trauma. This retrospective descriptive study was done on 114 patients admitted to 5 Azar hospital in Gorgan, Iran due to penetrating abdominal trauma during 2002-07. Gender, age, type of injury causes of trauma and hospitlalization period were obtained form patients files. 92.1% of patients were male. The mean age of subjects was 24.8 years [9-70 years] with highest frequency between 20-24 years. Two [1.8%] deaths directly related to abdominal stab wounds related to hemorrhagic shock. The most common cause of penetrating abdominal injury was knife wound [78.9%]. The mean time spent in hospital was 4.6 +/- 2.8 days. In 53 patients, cause of trauma were either related to pentration into peritoneum or passing through in. Small intestine injuries [14%], rupture of diaphragm and concurrent lung injuries [7%] were the common damage organs. This study showed that the knife was the main cause of abdominal penetrate trauma and peritoneum was the most common damage tissue

Relationship between consultation length and rational prescribing of drugs in Gorgan city, Islamic Republic of Iran

Doctors with longer consultation times tend to diagnose illnesses more precisely, prescribe fewer drugs and present better health advice to their patients. The aim of this study was to measure the average consultation time of general practitioners in Gorgan, Islamic Republic of Iran and to investigate the factors affecting consultation length, especially in relation to rational prescribing of drugs. Data were collected on 620 patient consultations with 62 randomly selected general practitioners. Mean consultation length was 6.9 [SD 2.6] minutes. Patient factors that were significantly associated with a longer mean duration of consultation time were; higher number of health problems, older age and fewer items of previously used drugs. Physician factors that were significantly associated with a longer mean consultation time were: younger age, higher numbers of items prescribed and injectable drugs prescribed, frequency of interruptions and higher workload

Total burden of esophageal cancer disability adjusted life years in Golestan Province during 1387

Maintenance of health and its fair and just promotion in any society is the responsibility and duty of its respective government. Appropriate financial allocations and prudent decisions in the health sector requires the definition of an index that would reveal the loss resulting from early deaths of any cause and originate from disabilities due to nonfatal outcomes. The disability adjusted life years [DALY] index has such a characteristic. Esophageal cancer is the third prevalent cancer of the gastrointestinal tract. In Golestan Province, among the variety of cancers, it is the third leading cause of death and its incidence rate in the province is the highest in the country. In this study we try to compute the burden of this cancer. In this manner, while estimating the importance of this disease in Golestan Province, we aim to pave the way for scientific and effective assessments of this disease and determine an action plan for its containment. In this cross-sectional study, we used Dismod II software that has been designed for cancer modeling in populations. With this software, we computed the burden of cancer for the year 1387 in Golestan Province. The data needed as input for Dismod II included the population of the province, mortality and incidence rates that originated from esophageal cancer, all which were obtained from the 1385 census, Mortality Registry System, Cancer Registry' System and expert panel views. Total burden of esophageal cancer according to DALY in Golestan Province during 1387 was 2992/48 years in the total population. Amongst males, it was 1533/65 years and 1408/46 years in females due to years of lost life [YLL]. As a result of years lived with disability [YLD], it was 25/54 years in males and 24/84 years in females. The burden of esophageal cancer per 1000 population of Golestan Province equaled 1 /76 years for females and 1/88 years for males. The peak age of esophageal cancer burden was in the age groups of 60 to 80 years and above 80 years. The relative high burden of esophageal cancer in Golestan Province compared to other parts of the country is justifiable due to the existence of the highest incidence rate in this province. Therefore, we believe that esophageal cancer should be one of the highest priorities of the health system of the province. However, the final and definitive judgment is contingent upon computations of the burden of other cancers and diseases at the provincial level and its respective rankings

Hepatitis B vaccination coverage among Iranian children aged 15-26 months in 2006

This study in 2006 estimated the hepatitis B virus [BHV] vaccination coverage in the Islamic Republic of Iran at the national and district levels in urban, rural and remote populations of 41 university health service areas. Of 21 905 children recruited to the study, vaccination coverage based on vaccination card records was 100% in 14,15 and 10 of the 41 university areas for the 1st, 2nd and 3rd doses of HBV respectively. National levels of HBV1, HBV2 and HBV3 coverage were 98.9%, 98.8% and 98.4% respectively. The lowest HBV vaccination coverage rate was 90.7% [in a remote district]. HBV vaccination coverage was at an acceptable level in Iranian children

[Tissue trans-glutaminase antibody in inflammatory bowel disease in golestan province, Northern Iran [2005-08]]

Celiac is a hereditary disease presented with chronic inflammation of small intestine. Several studies supposed a relationship between Celiac disease and Inflammatory Bowel Disease [IBD]. Tissue trans-glutaminase antibody is one of the best serological markers in Celiac disease. This study was designed to evaluate the association of Celiac and IBD using tissue trans-glutaminase antibody. In this descriptive study 127 confirmed IBD patients who were referred by gastroentrologists 2005-08 enrolled into the study. A questionnaire was completed and tissue trans-glutaminase antibody was evaluated with ELISA method with a Cut-off=12 U/ml. Among 127 referred patients, serum samples of 102 patients were collected. Mean +/- SD of age was 36.17 +/- 15.2 years and 48% were males. Ulcerative colitis, Crohn's disease and other colitis were observed in 76 [74.5%], 7 [6.9%] and 19 [18.6%] of patients, respectively. Tissue trans-glutaminase antibody was positive [19.8 U/L] in one 46-years-old male patient with ulcerative colitis. Tissue trans-glutaminase antibody titer was not significantly different between IBD patients and controls, thus it seems not appropriate to suggest as one of the routine tests in IBD patients

Evidence-based approach to HIV/AIDS policy and research prioritization in the Islamic Republic of Iran

In formulating the second national strategic plan for prevention of HIV/AIDS in the Islamic Republic of Iran a more evidence-based approach was needed. This paper reports on a systematic review of the local evidence about the determinants of HIV/AIDS transmission in 3 categories: poor knowledge and negative attitudes about HIV transmission; injection drug use; and sexual promiscuity. Of 93 reports reviewed, 53 met the inclusion criteria. Information about the prevalence and magnitude of effect for the 3 risk determinants at the national and regional level was scarce. Heterogeneity between studies, even in the same sub-population, was significant. An improved research base and better sharing of information are needed within countries of the Eastern Mediterranean Region

[Behavioral disorders and related factors in school age children of Gorgan]

Acquiring information regarding the extend and prevalence of pediatric behavioral disorders and their predisposing factors is essential in improving psychological services and establishing preventive indicators for children's mental health. The present study was conducted to determine the prevalence of behavioral disorders of school age children and related epidemiological factors, in Gorgan city, in 2005-2006. A cross sectional study was carried out using multistage cluster sampling method to recruit 2600 school age children. Data were collected through Rutter's parent questionnaire [RA[2] a standard tool which parents completed. A cutoff point of 13 was considered and children with total score of 13 or more were regarded to be disordered. Descriptive statistics and odds-Ratio and chi-square tests were used to analysis the data. Most of the samples were female [52.8%], first child with mean age of 9.25 +/- 1.5, having both parents living with them [94.5%] and were studying in governmental schools [72.7%]. in view of the regarded cutoff point, 18.4% of children suffered from behavioral disorders. There was significant correlations between having behavioral disorder with being in single parent family, crowded and low income families, history of crisis during the previous year, job and education of the parents, and children schools [P<0.05]. Considering the higher prevalence of behavior disorders found in current study compare to many others, investigating the explanations and reasons for as well as providing educational and consultation services is necessary

Comparison of knowledge, attitude and practice of urban and rural households toward iron deficiency anemia in three Provinces of Iran

Lack of nutritional knowledge is one of the most important reasons of nutritional problems and consequently improper practice, which can lead to several complications. This study has been designed in order to compare knowledge, attitude and practices of the urban and rural households regarding iron deficiency anemia [IDA] in Boushehr, Golestan and Sistan and Balouchestan provinces in 2004. The sampling method at household's level in each province was the single-stage cluster sampling with equal size clusters. The necessary data were gathered with a structured questionnaire and via the interviews between the questioners and the eligible people in each household. Comparison of frequency of variables between urban and rural areas were tested by chi square test. A total of 2306 households were selected as overall sample size. In urban areas, people recognized iron food sources better than rural areas. Knowledge level of respondents about vulnerable group for IDA and the favorite attitude of households toward IDA were better in urban areas of Sistan and Blouchestan and Golestan provinces. In Sistan and Balouchestan and Golestan, rural households who drank tea immediately before or after meal was more than urban ones. The majority of pregnant and lactating mothers [except for rural areas of Bushehr] did not take iron supplement regularly. Less than 60 percent of children used iron drop regularly. Knowledge, attitude, and practice levels of households toward IDA were not acceptable. One of the best ways of improving nutritional practice is nutritional education with focus on applying available food resources

[ viewpoints of paramedics employed in Golestan province towards continuing education programs]

Retraining is an important way for professional development of health staff and keeping them up to date, and evaluation is one of the essential principles for enhancing the efficiency of these trainings. The aim of this study was to determine the viewpoints of paramedics employed in Golestan province towards continuing education programs. In this descriptive study, 274 samples were selected out of 1016 paramedics employed in clinics of the province, through systematic random sampling. The data gathering tool was a questionnaire. Data was analyzed by SPSS software using descriptive statistics, Chi[2], and independent T-test. Among the participants, 26.2%, 41.8%, 25.5% and 6.5% had very weak, weak, average, and desirable viewpoint towards the courses, respectively. As the motivation for participating in the courses, 55.5% mentioned achieving points for job promotion opportunities, 21.2% resorting and reviewing former information, 13.8% exchanging information and experiences with other colleagues, and 9.5% mentioned seeking solutions for their professional problems. Thirty one percent reported lack of equity and fairness in participating in the programs on behalf of their direct administrator and 33.9% stated that the planning for participation in these courses was not favorable. Participants had a weak or very weak viewpoint toward programs and regarded their motivation for participation in these programs as achieving points for job promotion. It is necessary for administrators to plan for changing the staffs viewpoint toward participation in continuing education programs

[Nitrate and nitrite level of drinking water and the risk of upper gastrointestinal cancers in urban areas of Golestan province, northeast of Iran]

Esophageal and gastric cancers are among prevalent cancers in the world and it is believed that nitrate and nitrite contaminations of drinking water are important factors in increasing the risk of these cancers. This study was designed to determine the correlations between these factors and upper gastrointestinal cancers. In this ecologic study, mean concentrations of nitrite and nitrate of drinking waters in Golestan urban areas were obtained during 2004-2005. All patients with esophageal and gastric cancers during this period who resided in urban areas were recruited to estimate the incidence rate and Age Standardized Rate [ASR] of these cancers. The province was divided into three regions of low, intermediate and high incidence based on 33% and 66% quartiles of both cancers. Spearman Correlation Coefficient and regression line were used to analyze data

[Inoperable esophageal cancer and outcome of palliative care in Golestan province, Iran]

Dysphagia is the most distressing problem in patients with advanced inoperable esophageal cancer. Palliative interventions like balloon dilation and stenting are used to improve quality of life and make patients enable to eat more comfortably. This study was designed to determine the outcome of palliative care in esophageal cancer patients referred to Gorgan and Gonbad gastrointestinal clinics, northeast Iran. This cross-sectional study was performed on inoperable esophageal cancer cases during 2005-2006. Demographic data were collected during the procedure and cases were followed every month for six months. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness. We recruited 39 cases into the study. Male to female ratio was 1.6 to 1 and mean age was 67.5 +/- 13.7 years. Twenty two patients had grade 3 dysphagia and other 17 had grade 4 at the begining of the study. Dilation was the most preferred method [89.7%] and stenting was performed in 4 [10/3%] cases. Decreasing dysphagia score was not related to palliation method used or pathologic type of carcinoma but it was showed to be related to the age of the patients significantly. Mean survival was significantly different between 2 groups [with and without dysphagia improvement in first month of follow-up]. Results of this study showed a lower survival rate after palliative care in advanced esophageal cancer cases, although dysphagia scores showed some improvement

comparative Monte Carlo study on 6MV photon beam characteristics of Varian 2 iEX and Elekta SL-25 Linacs

Monte Carlo method [MC] has played an important role in design and optimization of medical linacs head and beam modeling. The purpose of this study was to compare photon beam features of two commercial linacs, Varian 21EX and Elekta SL-25 using MCNP4C MC Code. The 6MV photon beams of Varian 21EX and Elekta Sl-25 linacs were simulated based on manufacturers provided information. Photon energy spectra and absolute absorbed dose values were calculated for field sizes of 10_10 and 20_20 cm2. Also, contamination electron spectra for field size of 20 _20 cm2 were scored for both linacs. Our results showed that the relative absorbed dose values and contamination electron spectrum were similar and comparable, but photon fluence and absolute absorbed dose values were 17% and 13% higher for Varian linac respectively for the field size of 10_10 cm2. Despite the differences in head components of two commercial linacs, their relative depth dose values were very close to each other. The absolute dose per incident electron showed some discrepancy, as well. Thus, this study suggests the use of absolute absorbed dose values as an invaluable factor when different linacs head are compared using Monte Carlo Method

Peak bone mass measurement in iranian healthy population

Osteoporosis is a disabling disease characterized by compromised bone strength, which predisposes a patient to increased risk of fracture. The aim of this study was evaluation the pattern of bone mass in Iranian healthy population. The study was performed between December 2000 and May 2001 on one thousand three healthy Iranian subjects who currently live in Tehran. They were selected randomly by cluster random sampling among men and women of 10-76 yr from 50 clusters. The volunteer people were referred to the Bone Mineral Density BMD unit of EMRC. The participants were recalled for three times and the response rate was 83%. BMD was measured by DXA using Lunar DPX-MD device. Females achieved maximum lumbar BMD up to 25-35. Femur BMD maximized in 30 to 35 and after 45 the intensity of bone loss increased. Female peak bone mass in lumbar region was 1.19 +/- 0.12 g/cm2and in femur was 1.02 +/- 0.12 g/cm2. Male peak bone mass in lumbar region occurred between ages 25-40 yr, Male's femur BMD maximized in 20-30. In male peak lumbar bone mass was 1.22 +/- 0.16 g/cm2 and femur was 1.08 +/- 0.15 g/cm2. Osteopenia was recognized in 50% and 48.8% of women above 50 in spine and total femur, respectively, however these percentages were 37.1% and 34.8% among male subjects. Iranian BMD values sufficiently different from other countries to warrant a separate reference sample with which to compare individuals for the purpose of diagnosing osteoporosis and osteopenia according to the WHO criteria

Epidemiology of neural tube defects in northern Iran, 1998-2003

We determined the rates of neural tube defects at a referral hospital in Gorgan, north Islamic Republic of Iran, and the relations of these abnormalities to sex, maternal ethnicity, maternal age and season. During 1998-2003, there were 109 cases among 37 951 births, a prevalence of 28.7 per 10 000 [24.8 and 32.8 per 10 000 among males and females respectively]. The rates in Turkmen, native Fars and Sistani ethnic groups were 40.5, 25.2 and 30.8 per 10 000 respectively. The rates of spina bifida and anencephaly were 16.3 and 11.3 per 10 000 respectively. The rate of affected newborns was highest in mothers aged over 35 years [50.7 per 10 000]. The peak prevalence was in December

[Prevalence of malnutrition in children under 2 years old and its relationship with mothers background variables in Golestan province]

WHO estimated almost 27% of under 5 years children suffered from under-weight. This study aimed at assessing anthropometric indicators [under-weight, wasting and stunting] in 0-24 months children at Golestan province and the relationship with the background variables of households. This cross-sectional study was done on 1473 children [under 2 years old] whom resided in urban and rural area. Samplimg method was single stage cluster sampling. Constitutional variables in child's mothers, age, educational level, job and child's weight and height are measured by structured questionnair. The data were analysed with chi square, chi square for trend and logistic regression. The under-weight, wasting and stunting [mild to severe] prevalence were 21.4% [CI 95%: 19.3-23.6], 16.5% [CI 95%: 14.7-18.5] and 31.4% [CI 95%: 29.1-33.8] respectively. Maximum sex difference in the malnutrition indicators were seen stunting [boys 14.3%, girls 7.2%] [p<0.05]. The prevalence of under-weight, wasting and stunting are positively correlated with increasing the children's age. The under-weight and stunting linear trend was significant [p<0.05]. The risk of under-weight children were 2.8 fold in illitraced mothers relative to mothers with highschool diploma [CI 95% for adjusted odds ratio: 1.1-7]. The risk was 1.5 fold in stunting [CI 95% for adjusted odds ratio: 0.5-4.3]. The under-weight and wasting [moderate to severe] prevalence are increased relatively ANIS study [1998], but stunting prevalence are not increased. The mothers' illitracy and very low educational level can be suspected risk factors for under-weight and stunting

[Determination of effectvie factors on preeclampsia severity; the application of classification and regression trees]

Despite advances in medical sciences, preeclampsia and eclampsia are still among chief causes of maternal mortality worldwide. In this study, we used classification and regression trees to investigate the role of certain inherent and maternity care factors in severe preeclampsia. This study was done on 1643 pregnant women admitted at 4 hospitals in Iran with one of the 53 maternity complaints were enrolled in this study during 2005. Variables of socioeconomic status, history of pregnancy and diseases, health care visits numbers awareness of warning signs, and the body mass index before pregnancy were recorded in the analysis model as predictors, and preeclampsia severity was entered as the dependent variable. A non-parametric method, known as the classification and regression tree was used to predict the studied consequence. Model validation was done using subsets of the study sample. The results were compared with logistic regression analysis. The incidence of preeclampsia among the studied patients was 5.2%. In model 1, variables of frequent headaches and epigastric pain during pregnancy, the number of previous pregnancies, and the amount of maternal care received were predictive of severe preeclampsia. In model 2, only frequent headaches and the number of previous pregnancies were found predictive. Sensitivity for model 1 and 2 was 47.8% and 39.1%, respectively, and specificity was 96.8% and 93.6%, respectively. In logistic regression analysis, only frequent headache was related to severe preeclampsia [OR=2.5, CI 95%: 1.3-5.0]. This study showed that using of variables that can be measured during maternity care visits to predict severe preeclampsia. Regarding the simple interpretation of tree models and their application in clinical decision making, which can be used in different levels of the health care system

[Gastrointestinal and abdominal Tuberculosis in Golestan-Iran: a 5-years report]

15-20% of TB cases are extra pulmonary tuberculosis [EPTB]. Abdominal TB is the most common type of extra intestinal TB. Signs and symptoms of abdominal TB are unspecific. In this study, we identified all GITB cases in Golestan province [Iran] between 1999 and 2003 and determined their demographic characteristics. We reviewed all new cases of TB reported during 1999-2003 from TB centers of Golestan province.Then EPTB and especially GI and abdominal TB cases were selected. We completed a questionnaire containing demographic information for each of them. The information entered the computer in SPSS-13 was used to analyze the data. 30 patients had been treated for GI and abdominal TB, most of them were females [22 cases, 73.3%]. Mean age of the patients was 32.03 +/- 13.73 with higher incidence in age before 40 years old [70%]. Most common complaints of the patients were fatigue, weight loss, anorexia, fever and abdominal pain, respectively. In 66.7% of patients the diagnosis was pathologically documented. Our data suggest that 38.46% of all TB cases in Golestan province were EPTB, and this scale is higher than other studies. In this study, 5.27% of EPTB cases were GI and abdominal TB, higher than the world reports [3%]

[Knowledge, Attitude and practice of households and health care staff towards nutrition and micronutrients (NUT-KAP) in provinces under the pilot study on flour fortification with Iron: study design and sampling method]

A [healthy human being] is the cornerstone of stable development in every country. Thus, an important part of the development process is the nutritional improvement of the society. Although a great proportion of the families' income is spent on food nutritional problems are still prominent in this country. This fact demonstrated that diets are mostly influenced by the education and knowledge of the households, rather than any new developments in food production. This study was designed to investigate the knowledge, attitude and practices of the households and health care provider regarding nutrition and micronutrients in provinces of Bousheher, Golestan, and Sistan and Balouchestan. The results of this study can help the Community Nutrition Office in the design and effective implementation of interventions aimed at improving nutritional health households. The sampling method for households was the single-stage cluster sampling with equal-sized clusters. The sampling method for health staff was stratified random sampling. The number of samples in each stratum was proportion to its size. A total of 2304 households and 360 health care workers were selected for this study. The data were gathered through a structured questionnaire and via interviews with eligible people in each household, and although some levels of health staff. At the level of the health staff, physicians and other health professionals, data collection was done through self-administrated questionnaires