مجله پیاورد سلامت
سال سیزدهم شماره 2 (خرداد و تیر 1398)

The variety of sweets along with significant difference level of hygiene in the production, supplies and high potential contamination of sweets ingredients with Escherichia coli, led to investigate the frequency of broad-spectrum beta lactamase strains of E. coli in sweets and determine the presence of SHV, TEM and CTX-M genes. In this descriptive cross-sectional study, 150 confectionery samples were collected from traditional confectionery workshops in Yazd. Detection of E. coli strains was carried out by standard biochemical tests and antibiotic susceptibility test was performed using CLSI guidelines. Via combined ESBL disk method on the muller hinton agar medium producing strains were identified. All the ESBL producing strains were evaluated using the PCR test for the existence of SHV, TEM and CTX-M genes. In 30 isolates, (20%) E.coli was obtained. The results of antibiotic susceptibility test showed that the highest and the lowest antibiotic resistance was related to chloramphenicol l (22 isolates, 73.3%) and Imipenem (8 isolates, 26.6%). The results of the combined disk test was showed that only 9 isolates produced ESBL. The molecular analysis on considered genes indicated that 2, 4 and 3 isolates were positive for presence of TEM, SHV, and CTX-M genes, respectively. The prevalence of antibiotic-resistant isolates in traditional Yazd sweets in this study highlights the importance of more observing and control measures in the preparation and distribution of sweets.

Chronic myeloid leukemia(CML) is a clonal myeloproliferative disease, characterized by BCR/ABL translocation. Using tyrosine kinase inhibitors such as Imatinib, treatment for this disease has progressed remarkably. However, resistance to tyrosine kinase inhibitor is a major obstacle. Signal transducer and activator of transcription 3(STAT3) is an important transcription factor in proliferation and survival of several cancers. The aim of this study was to determine the expression of STAT3 and its role in drug resistant CML patients treated with Imatinib. Peripheral blood was collected from 71 CML patients in different phases of the disease and 10 healthy individuals. After extracting RNA and synthesizing cDNA, expression of STAT3 gene was measured using Real-Time PCR technique. The expression of STAT3 was normalized to ABL control gene. Then expression levels were compared with the control group. The results showed that expression of STAT3 in the diagnostic stage was significantly higher than healthy individuals(p=0.0001). STAT3 expression was not significantly different from MMR and the control group. STAT3 expression was significantly higher in non-mutated and mutated ABL kinase domain Imatinib resistant patients as compared to patitents in MMR stage (p=0.0014 & p=0.003). This difference was not significant between the two resistant groups. Blastic phase patients had no significant difference in the expression of STAT3 with the control group. Considering the results of this study and the role of STAT3 in cell proliferation and survival, the targeting of STAT3 seems to be an effective option in the treatment of resistant patients.

Hospital accreditation is an external evaluation strategy used to improve the quality and effectiveness of services. Accreditation surveyors are among the important factors affecting the validity of accreditation results. Since the effectiveness of an accreditation system depends on its surveyors, the aim of this study is to identify the evaluation criteria of hospital accreditation surveyors in Iran. This qualitative study was conducted in 2017 based on stakeholders’ views about the hospital accreditation program. Data were collected through semi-structured interviews and analyzed by thematic analysis method. Then the framework was designed and finalized with expert opinion. Forty-four criteria identified for the evaluation of hospital accreditation surveyors in Iran were classified into six domains: personality, experience, knowledge, attitude, skills, and organizational citizenship behavior. Accreditation surveyors should have an acceptable combination of such criteria. Evaluation of accreditation surveyors with these criteria will lead to their better performance and ultimately promote the validity of the accreditation results. These criteria also result in a native definition for “accreditation surveyor” that can be used by the directors of accreditation system of hospitals for the management of accreditation surveyors.

Stimulants are among the most dangerous substances because of their physical and psychological side effects. The process of treating stimulant abusers is so complicated that makes the treatment very difficult. The aim of the current study is to identify the bits of information needed for the design and development of a mobile application system and a web-based application program to improve the treatment management of stimulant abusers. 

This study is a cross-sectional study in which the community and the sample are matched. All participators work at Iranian National Center for Addiction Studies(INCAS) as stimulant abuse care givers. The data collection tool was a researcher made questionnaire based on the Likert scale, and its validity approved by experts. In addition, the reliability determined by Cronbach alpha method with the score 0/74 analyzed via SPSS. 

Items that got more than 50% of the participants’ acceptance were identified as the information needed for the system. The most influential items were education and motivational messages with 100% of experts’ agreement. Trauma history and medication therapy, however, got less than 50% and were removed. Other items were put into the study by gaining an average of more than 80% of the experts’ agreement.  

Emerging technologies in the field of heath can play a significant role in the optimization of stimulant abuse treatment by facilitating the treatment process, increasing the patient participation in the process of treatment, and reducing the costs of patients’ lapse and relapse.

Iron deficiency is one of the most common nutritional disorders in the world, and it may affect the metabolism and function of a number of proteins, including the level of thyroid hormones. As such, fluctuations in the level of thyroid hormones may also affect the body's iron status. The present study aimed to evaluate the relationship between thyroid hormones and the status of iron stores. The study populations included referral patients to laboratory of Shourideh clinic in Mashhad, Iran. Fe, Ferritin, TIBC (total iron-binding capacity), TSH, T4, T3, and CRP tests were performed with a physician's request. The target sample size was a total of 420 patients including 287 women and 133 men with an average age of 41.5 years. TSH and Ferritin test were measured by Elisa method, Fe and TIBC were measured by automated method. The results showed no significant relationship between the body's iron status and thyroid hormones level (P˃0.05). Interestingly, in subjects with lower iron level, TSH was at the highest level and T4 was at the lowest level. However, no positive relationship was found between iron status and T3 level. Although, there was no significant relationship between iron status and thyroid hormones level in the present study, it seems that the fluctuations of each of them may affect somehow the other.

Today, small businesses can be considered as a good strategy for different parts of hospitals in the country. Therefore, the use of any new mechanism in the health system needs to be examined and adapted to local conditions. This study aims to investigate factors affecting the implementation of outsourcing from the viewpoint of managers of Tehran University of Medical Sciences (TUMS) hospitals. The present research is a descriptive-correlational and applied study. Due to the size of the population (TUMS managers of financial and hospital affairs), sampling was done by census method. The research tool was a researcher-made questionnaire with two sections -- demographic information and factors affecting outsourcing in hospitals -- and was distributed among the subjects. Then, to run descriptive statistics for data analysis, SPSS version 18 was used. Fifty-eight percent of the participants had a long service record and 80% had postgraduate degrees. For successful outsourcing in hospitals, the following should be considered: formation of a strategic outsourcing team, checking out the quality of outsourced services, and managers’ close monitoring and mastery over outsourced principles. Since outsourcing of services can achieve positive results in terms of improving the quality of services, satisfying stakeholders, reducing costs, generating income, and so on, using the perspectives of queue managers who have a long service record can be effective in the implementation of successful decisions.

Aging process is associated with increased free radicals and cellular damage. However, resistance training may cause balance of the oxidative and antioxidant system in the elderly. Therefore, the aim of this study was to investigate the effect of eight weeks of progressive resistance training (PRT) on malondialdehyde (MDA) concentration and superoxide dismutase (SOD) enzyme activity in inactive elderly women. 26 inactive elderly women voluntarily participated in present study and divided into progressive resistance training (PRT; n=13) and control group (Con; n=13). The PRT performed resistance training for eight weeks (three sessions per week). Blood samples were collected before and after 8 week of progressive resistance training and analyzed for MDA concentration and SOD activities.  Results showed that after eight weeks of progressive resistance training, MDA concentration significantly decreased in the PRT compared to the control group (p=0.001). Also, SOD activity in the PRT was significantly increased compared to the control group (p=0.002). The present study showed progressive resistance training cause reduction in malondialdehyde concentration and increase activity of superoxide dismutase that is an important factor in reducing aging process. Therefore, it seems that the regular resistance training causes to balance the oxidant system and reinforcement the antioxidant system in the body and can play a role in preventing serious damage that caused by oxidative stress, especially in aging.

Due to the high level of out-of-pocket payments for health expenditures and the importance of household health expenditure management, this study aimed to investigate socioeconomic factors affecting Iranian urban households’ health expenditures. This descriptive-analytic and applied study was conducted cross-sectionally at national level with microeconomic approach. The sample included 18809 urban households living in Iran's provinces in 2016; they were selected by three-stage sampling method. Data were collected by the household income-expenditure questionnaire of Statistical Center of Iran (SCI). The results were evaluated in Stata 14 software using Heckman two-step method. The results showed that socioeconomic factors such as increasing of income and insurance expenditures, having insurance, number of employed people, head's literacy, increasing of per capita expenditures of tobacco and education led to an increase in household health expenditures. Mother-headed households had lower health expenditures than others; and head of household’s age, household size, and the presence of elderly persons led to an increase in household health expenditures. Household socio-economic factors not only affected the decision to enter health market but also influenced the purchase of goods and health services and inequality in health sector. Therefore, certain policies are essential to improve the socio-economic status towards reducing inequality in health sector; such a thing can be achieved through employment creation, growth of income, investment in education, and increase of insurance coverage.