فهرست مطالب

Archives of Iranian Medicine
Volume:19 Issue: 12, Dec 2016

  • تاریخ انتشار: 1395/10/22
  • تعداد عناوین: 14
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  • Aram Salih Mohammed Amin Kamali, Roya Sadeghi *, Azar Tol, Mahdi Yaseri Page 824
    Background
    Unhealthy lifestyles pose significant threat to public health. This study aimed to assess the validity and reliability of a Kurdish version of the HPLP-II instrument among Kurdish healthcare providers, whose society and culture differ from that of North America and Spain, where the instrument was developed.
    Methods
    The instrument was translated into Kurdish, back translated, and pilot tested to ascertain cultural sensitivity. It was then evaluated using a convenience sample of 460 healthcare providers in the Kurdistan region, northern Iraq using a principal components factor analysis.
    Results
    The order of factors was entirely identical to those isolated previously during the psychometric assessment of the English language version. The majority of our study participants were male (55%). In addition, 39.2% of participants were nurses. In addition, 42% of participants had less than five years of working experience. Furthermore, 82.1% of our study population held a high school diploma. The mean (SE) of Physical Activities dimension was low (15.3 ± 4.8) compared to Spiritual Growth dimension (24.5 ± 4.4). Moreover, the Cronbach's alpha coefficient for the overall HPLP-II questionnaire was 0.870; however, the nutrition dimension was low (0.622) compared to Physical Activities dimension (0.792). Furthermore, the correlation between items ranged from 0.099 to 0.611.
    Conclusions
    The Kurdish version of the HPLP-II demonstrated initial reliability and validity. It is a precious tool to evaluate and assess lifestyle and lifestyle interventions built to improve the health of Kurds.
    Keywords: Health promoting lifestyle (HPL), healthcare providers (HcPrs), reliability, validity
  • Haniye Sadat Sajadi, Mohammad Hadi * Page 832
    Background
    Decisions made by the governing body of a university would overshadow university governance. This study aimed to analyze the quantity and quality of decisions made by the three governing bodies (Board of trustees, Board of Chancellors and University council) of a medical university in Isfahan, Iran.
    Methods
    A mixed qualitative and quantitative approach was employed, with the quantitative part in cross-sectional format and the qualitative part in content analysis format. In the quantitative part, the number of meetings and resolutions of the governing bodies were collected through Isfahan University of Medical Sciences. In the qualitative part, the content of 3121 resolutions that were selected using stratified sampling method was analyzed.
    Results
    The results indicated the defensible numbers of meetings and resolutions of the boards of trustees and chancellors. The governing bodies’ resolutions were mostly operational in domain, administrative (boards of trustees and chancellors) and educational (university council) in nature, financing (board of trustees) and providing services (board of chancellors and university council) in function with the aim of responsiveness. The share of specific and single-department resolutions was greater compared to others.
    Conclusion
    Better monitoring and evaluation of the activity of governing bodies, redirecting the decisions made by governing bodies, reminding the position of the governing bodies and revising their duties and responsibilities are recommended for better governance of the medical university.
    Keywords: Academic medical centers, decision making, governing body, policy making
  • Farshad Sharifi, Hossein Fakhrzadeh, Mehdi Varmaghani, Seyed Masoud Arzaghi, Mahtab Alizadeh Khoei, Farshad Farzadfar*, Parisa Taheri Tanjani * Page 838
    Background
    The prevalence of cognitive impairment and dementia is increasing in Iran and the world. There is no study available on the prevalence of dementia at the national level in Iran. This study aimed to report the rate of dementia at the national level in Iran.
    Methods
    The National Elderly Health Survey (NEHS) was a cross-sectional study with multistage cluster random sampling on people aged ≥ 60 years in Iran. Dementia was diagnosed by trained general practitioners using Brief Cognitive Assessment Tool (BCAT). In this study, the dementia diagnosis rate was considered as the ratio of individuals previously diagnosed with dementia to individuals considered as dementia. Analyses were carried out using survey analysis method. The provincial rates were standardized based on the Iranian population in 2011 and the national rate was standardized based on WHO standard populations. Association between risk factors and dementia was assessed using a multivariable logistic regression model
    Results
    The overall crude prevalence of dementia among people aged ≥ 60 years was 7.9% (8.7% in women and 6.9% in men) and age standardized dementia prevalence rate in Iran based on WHO standard population was 8.1% (9.6% in women and 6.5% in men). The prevalence of dementia was observed as 3.7% among people aged 60–64 years, 6.2% in the age-group 65–69 years, 10.4% in the age-group 70–74 years, 14.4% in the age-group 75–79 years, and 13.0% in the age-group ≥ 80 years. West Azerbaijan had the lowest and North Khorasan had the highest age-sex adjusted prevalence rate of dementia. Our results indicated that only 21.2% of subjects with dementia were diagnosed. We observed that diabetes mellitus, depressed mood, illiteracy, and increased age were associated with dementia.
    Conclusion
    It seems that dementia is more common in Iran than many other countries. However, the rate of dementia diagnosis is much lower than that in developed countries.
    Keywords: Dementia, dementia diagnosis rate, Iran, prevalence
  • Aleksandra Klisic*, Jelena Kotur, Stevuljevic, Nebojsa Kavaric, Marija Matic Page 845
    Background
    We aimed to examine the relationship between high levels of cystatin C, retinol-binding protein 4 (RBP4) and cardiovascular risk score [determined by Framingham Risk Score (FRS)] in postmenopausal women.
    Methods
    A total of apparently healthy 129 postmenopausal women (mean age 57.1 ± 4.6 years) were included. Serum cystatin C, RBP4, glucose, lipid parameters, creatinine, uric acid and high sensitivity C-reactive protein (hsCRP) were determined. Anthropometric parameters and blood pressure were also obtained. FRS was calculated. Multiple linear regression analysis (MLR) was performed to identify independent factors affecting FRS and to estimate the final predictors of its variability. Receiver Operating Characteristic (ROC) curve analysis was used with the purpose of testing discriminatory potential of a group of parameters selected in MLR analysis, with FRS level as dependent variable.
    Results
    We found significantly higher levels of both proteins, cystatin C (P = 0.001) and RBP4 (P = 0.006), in the FRS higher (medium and high) risk groups (FRS ≥ 10%) compared to low risk FRS group (FRS
    Conclusion
    High cystatin C and retinol-binding protein 4 may contribute significantly to cardiovascular risk burden in addition to traditional cardiovascular markers.
    Keywords: Cystatin C, Framingham risk score, postmenopausal women, retinol, binding protein 4
  • Maryam Abbasi, Seyed Massood Nabavi *, Seyed, Mohammad Fereshtehnejad, Iman Ansari, Nikan Zerafatjou, Vahid Shayegannejad, Seyed Ehsan Mohammadianinejad, Mahdi Farhoudi, Abbas Noorian, Nazanin Razazian, Mahmoud Abedini, Fardin Faraji Page 852
    Background
    Many risk factors have been investigated in multiple sclerosis (MS); however, few studies have focused on the association between risk factors and the disease severity. The aim of our study was to evaluate the association between some of these risk factors and MS severity in a population sample of Iranian patients.
    Methods
    This cross-sectional study was conducted on 660 patients with MS. In addition to demographic variables, many potential risk factors were recorded. To compare the severity, progression index (PI) was calculated. This index is created by current Expanded Disability Status Scale (EDSS) /disease duration.
    Results
    Univariate analysis revealed that active smoking status is related with MS severity. (P-value = 0.012). Furthermore, our findings demonstrated that age at the disease onset [P
    Conclusion
    Due to high cost of MS care and its moderate to severe disability, identification of factors influencing the MS severity is important. Our results demonstrated that the major modifiable factors related with MS severity in Iranian population, some protective and some promotive, were smoking, education, marital status and occupation. Prospective studies on larger scale are needed for further proof of these results.
    Keywords: Multiple sclerosis (MS), risk factors, severity
  • Mojtaba Parsa*, Bagher Larijani, Kiarash Aramesh, Saharnaz Nedjat, Akbar Fotouhi, Mir Saeed Yekaninejad, Nejatollah Ebrahimian, Mohammad Jafar Kandi Page 861
    Background
    Fee splitting is a process whereby a physician refers a patient to another physician or a healthcare facility and receives a portion of the charge in return. This survey was conducted to study general practitioners’ (GPs) attitudes toward fee splitting as well as the prevalence, causes, and consequences of this process.
    Methods
    This is a cross-sectional study on 223 general practitioners in 2013. Concerning the causes and consequences of fee splitting, an unpublished qualitative study was conducted by interviewing a number of GPs and specialists and the questionnaire options were the results of the information obtained from this study.
    Results
    Of the total 320 GPs, 247 returned the questionnaires. The response rate was 77.18%. Of the 247 returned questionnaires, 223 fulfilled the inclusion criteria. Among the participants, 69.1% considered fee splitting completely wrong and 23.2% (frequently or rarely) practiced fee splitting. The present study showed that the prevalence of fee splitting among physicians who had positive attitudes toward fee splitting was 4.63 times higher than those who had negative attitudes. In addition, this study showed that, compared to private hospitals, fee splitting is less practiced in public hospitals. The major cause of fee splitting was found to be unrealistic/unfair tariffs and the main consequence of fee splitting was thought to be an increase in the number of unnecessary patient referrals.
    Discussion
    Fee splitting is an unethical act, contradicts the goals of the medical profession, and undermines patient’s best interest. In Iran, there is no code of ethics on fee splitting, but in this study, it was found that the majority of GPs considered it unethical. However, among those who had negative attitudes toward fee splitting, there were physicians who did practice fee splitting. The results of the study showed that physicians who had a positive attitude toward fee splitting practiced it more than others. Therefore, if physicians consider fee splitting unethical, its rate will certainly decrease. The study claims that to decrease such practice, the healthcare system has to revise the tariffs.
    Keywords: Fee splitting, Iran, kickback, medical ethics
  • Obaid Ullah, Aftab Khan, Arif Ambreen*, Israr Ahmad, Tasleem Akhtar, Amin Jan Gandapor, Arif Mehmood Khan Page 866
    Background
    Septicemia plays an important role in neonatal morbidity and mortality, especially in developing countries.
    Objective
    To investigate the bacterial pathogens causing neonatal sepsis and their antibiotic susceptibility profile.
    Methodology
    A total of 2,685 neonates aged 0–28 days were included in the study. Blood from each neonate was cultured and isolates were identified using standard biochemical tests. Antibiotic sensitivity pattern was analyzed using modified Kirby-Bauer disc diffusion method.
    Results
    Blood culture positivity was observed in 1,534 (57.1%) samples. Most of the cases (1089 counts - 71%) were of early onset sepsis while 445 (29%) were of late onset sepsis. The incidence of sepsis was higher in males 856 (55.8%) than females 678 (44.2%) with a 1:2 ratio. Similarly, 58.3% of septicemic patients were neonates with low birth weights. Twelve hundred and six (78.6%) isolates were gram negative while 328 (23.4%) were gram positive bacteria. E. coli was the dominant pathogen seen in 811 (52.8%) followed by Staphylococcus aureus 300 (19.5%), Pseudomonas 199 (13%), Klebsiella 102 (6.7%), Proteus 87 (5.7%), Staphylococcus epidermidis 28(1.8%) and Salmonella in 7 (0.5%) samples. All bacterial isolates showed high sensitivity to Imipenem, Enoxacin, Ofloxacin and Ciprofloxacin while low sensitivity was observed for other antibiotics (n = 16). The Proteus species showed high level of multiple resistances to all antibiotics (5.9%).
    Conclusion
    Imipenem, Enoxacin, Ofloxacin and Ciprofloxacin can be used as an effective antibiotic regimen for treatment of bacterial sepsis in neonates.
    Keywords: Antibiotic susceptibility, early, onset, late, onset, neonatal septicemia
  • Hooman Khademi, Farin Kamangar, Paul Brennan, Reza Malekzadeh* Page 870
  • Elnaz Vahidi *, Hadi Mirfazaelian Page 877
  • Elham Behrangi, Abbas Rasi, Bahamin Attar, Zahra Azizian Page 879
    We present a case of neutrophilic dermatosis of dorsal hands (NDDH), with lesions on the dorsal part of the hands with pustular features and histologic picture of vasculitis.This case highlights the notion that low dose oral steroid can offer a useful first therapeutic option for NDDH. Interstingly, in this case, a few additional lesions were located on the legs, making it different from some previously described cases of NDDH. As with other authors, we believe that this recently described neutrophilic dermatosis is a localized and acral variant of SS. To our knowledge, this is the first case report of NDDH from Iran.
  • Mojgan Shaiegan*, Ali A. Pourfatollah Page 882
  • Esmael Idani, Maryam Dastoorpoor *, Gholamreza Goudarzi, Narges Khanjani Page 884
  • Chiara Rosso, Gian Paolo Caviglia * Page 886