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Background and purpose: Autonomy in making decision is one of the most fundamental principles of medical ethics. Respect for patient autonomy is a moral duty, therefore, many doctors agree to perform unnecessary cesarean. This study was designed to determine the incidence of maternal demands for cesarean sections and influential factors on making decision among pregnant women in Tehran, 2010-2011. Material and Methods: This cross-sectional study was carried out in women attending some hospitals in Tehran for delivery. There were 850 pregnant women who delivered their babies through cesarean section. Data was analyzed using univariate logistic regression in SPSS. Results: The prevalence of cesarean delivery on maternal request was 11.2%. The cause of cesarean among 82.3% was fear of vaginal childbirth. Pregnant women aged < 21 years old were 3.2 times more interested in having a cesarean section (OR=3.200, CI 95%=1.15-8.89), and those who had higher education were 18.5 times more likely to deliver their babies through cesarean (OR=18.5, CI95%=2.45-139.35). Performing cesarean on maternal request was found two times more in working women compared to housewives (OR=2.39, CI95%=1/45-3.93). Moreover, the employment status of husband (OR=6.037, CI95%=2.33-15.99), delivery in private hospital (OR=7.13, CI95%=4.08-12.44), and the idea of medical team (OR=45.89, CI95%=25.39-82.93) increased the probability of cesarean delivery. Conclusion:The findings indicated several factors that influenced cesarean birth on maternal request. Social norms were found as the most influential factor, therefore, providing the society with more training and education is necessary in enhancing the public idea about unnecessary cesarean section.

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Background and purpose: Cesarean delivery on maternal request is so common in Tehran, Iran. Behavioral beliefs have an important role in the intention of selective cesarean and could influence the choices for educational training. The aim of this study was to determine the behavioral beliefs about cesarean section based on Theory of Planned Behavior (TPB) in pregnant women. Materials and methods: A qualitative study with purposive sampling was designed in which data was collected through in-depth interviews. The interviews were recorded and then transcribed. Content analysis was performed in which exploratory interviews were performed according to the principles of TPB. Afterwards, the information was coded and each interview was analyzed. Results: A total of 36 women (mean age 27.8 ± 4.5) was interviewed. Two main themes were extracted from the interviews: positive and negative beliefs about cesarean section. Then four sub themes were explored including long term and short term complications, and long term and short term advantages of cesarean section. Conclusion: In this study women had both true and false beliefs about caesarean section. Thus, health care providers should be aware of misunderstandings about caesarean section among pregnant women.

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Background and purpose: Aquatic ecosystems are important sources of food for human which are sometimes highlycontaminated. It is important to determine their levels of contaminations, so, in this study, theconcentrations of lead, cadmium and nickel was investigated in the gills and musclesof Barbusxanthopterus captured from Dez River, Iran. Materials and methods: Thirty samples of Barbusxanthopterus were captured from the central basin of Dez River using gillnet. The tissues were isolated, and the samples were digested. The concentrations of lead, cadmium and nickel were measured using a PE-4100 graphite furnace atomic absorption spectrometer. Results: The levels of lead, cadmium and nickel in gills were 0.322 ± 0.006, 0.182 ±0.006, and 0.004 ± 0.219, respectively. The concentration of these metals in muscle were 0.277 ± 0.014, 0.005 ± 0.0146, and 0.013 ± 0.165, respectively. Higher concentrations of heavy metals were found in gills. T-test revealed significant differences in the levels of nickel, lead, and cadmium between the gills and muscle. Conclusion: According to thisresearchthe concentrations of studied metals were lower than the WHO standards.

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Background and purpose: Amputation is one of the oldest surgical procedures. The aim of this study was to investigate the level of anxiety and quality of life in patients with lower limb amputation. Materials and methods: In a descriptive study a list of all patients with lower limb amputation (between 2003-2009) was provided from the records in Sari Imam Khomeini Hospital. They were called and asked about their willingness to participate in the study. Data was then collected using the 12-Item Short Form Health Survey (SF-12) and Hospital Anxiety and Depression Scale (HADS). T-test and Chi-square test were applied in SPSS for data analysis. Results: There were 41 patients and 41 individuals (control group) who were matched to patients based on demographic characteristics and underlying diseases. The mean HADS depression and anxiety scores in patients were 9.98±4.8 and 9.8±4.6 and in control group were 9.49±4.22 and 10.34±4.58, respectively. There were significant differences in mean quality of life subscales including physical functioning, physical role, and pain between patient and control group (P<0.05). But no significant differences were seen between the two groups in general health, emotional role, vitality, mental health and social activity (P>0.05). Conclusion: In this study, no significant association was found in prevalence of depression and anxiety after amputation among patients and the control group. The two groups showed similar results in mental components but different outcomes in physical dimensions. Therefore, it is important to focus on physical rehabilitation programs and using prostheses in such patients.

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Abstract Background and purpose: Diabetic foot ulcers are one of the major causes of morbidity and mortality in diabetic patients. For centuries Aleo vera has been used in treatment of diabetic foot ulcers. In this study, a mixture of honey and Aloe vera was used for diabetic foot ulcer healing. Materials and methods: In a double-blind clinical trial, patients with nonischemic, noninfected diabetic foot ulcers (attending Imam Khomeini Hospital Diabetes Center, Sari, Iran) were divided into two groups, a treatment group (n= 24) and a placebo group (n=15). To compare the effect of the mixture t-test and qui square were applied. Results: A total of 39 patients (19 males and 20 females) with diabetic foot ulcers were enrolled. Mean age of the patients, mean body mass index, and mean duration of diabetes were 56.3 ±10.2, 31.2 ± 4.2, 16.2 ± 6.6, respectively which were not significantly different between the two groups. Wound size was determined using a ruler that showed no significant difference between the two groups (P=0.36). Debridement, offloading and washing were done for all participants. Combined gel of Aleo vera and honey was used for treatment group. Wound healing was seen in 21 (95.5%) patients in treatment group and in 11 (78.6%) patients in placebo group. Conclusion: In small, non-infected, non-ischemic ulcers the effect of honey and Aloe vera gel was the same as that of the placebo. Offloading, debridement and washing with normal saline have similar effect to the mixture in healing diabetic foot ulcers.

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Background and purpose: Cardiovascular diseases are the leading cause of death worldwide, accounting for 17 million deaths annually. Poor lifestyle is one of the factors influencing the incidence of some cardiovascular diseases such as coronary artery stenosis. The purpose of this study was to investigate the relationship between health promoting behaviors and severity of coronary artery stenosis among patients in angiography department in Mazandaran Heart Center, Iran.

Materials and methods: A descriptive analytical study was performed in 184 patients candidate for angiography. According to angiography, patients were divided into two groups: the arterial stenosis above 50% (n=92) and arterial stenosis less than 50% (n=92). Patients’ lifestyle was investigated using Health-Promoting Lifestyle Profile (HPLP II). Demographic characteristics and risk factors for cardiovascular disease were also extracted from the patients’ medical records. Data was analyzed applying Chi-square test, Mann-Whitney test, and multiple linear regression test in SPSS V.21.

Results: According to the results, the mean score for health responsibility, physical activity, stress management and total score for health promoting behaviors were significantly higher in patients with arterial stenosis less than 50% (P<0.05). Also, in this group of patients significant positive relationships were found between age and stress management (P=0.03), and history of hypertension and spiritual growth (P=0.001). In the group of patients with arterial stenosis above 50%, there were significant relationships between history of diabetes and interpersonal relationships (P=0.007) and smoking and spiritual growth (P=0.03).

Conclusion: According to this study, educational interventions that promote stress management skills and physical activity among people at risk for cardiovascular diseases may reduce the severity of coronary artery stenosis.

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Background and purpose: Aggressive behavior is one of the most common disorders in children that leads to consultation referral. The aim of this study was to predict aggression in children according to mental health and dimensions of violence against mothers.

Materials and methods: The research population included 250 mothers of preschool children who were selected by multistage sampling in Dezful, Iran. Data was collected by General Health Questioner, Violence toward Women Inventory, and Child Behavior Checklist.

Results: The results showed a significant negative correlation between mothers’ general health and children aggression (r= -0.517). But significant positive correlation was found between children aggression and mental, physical, sexual, and economic violence (0.647, 0.618, 0.360, and 0.344, respectively) against mothers (P= 0.001). Maternal mental health, and sexual and mental violence against mothers could predict aggression in children.

Conclusion: To control aggression in children, great attention should be paid to other systems such as family and the relationships within a family.

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Background and purpose: This study aimed to investigate the relationship between job stress, social support, and job satisfaction in the personnel of Mazandaran University of Medical Sciences, Iran.

Materials and methods: In this study, 302 individuals were selected from 1400 staff in Mazandaran University of Medical Sciences using stratified random sampling. Data was collected using Berry Field and Ruth questionnaire of job satisfaction, Occupational Stress Inventory (OSI), and Social Support Appraisals (SS-A). 

Results: There were inverse relationships between job satisfaction and job stress (r=-0.15), gender (r=-0.106), and marital status (r=-0.10). Positive relationships were observed between type of employment (r=0.07) and social support (r=0.80) and job satisfaction among employees. Job stress and social support were found to be responsible for 0.75% and 64% of the changes in job satisfaction.

Conclusion: According to the findings, incentives and social supports could increase job satisfaction and reduce job stress in the personnel of Mazandaran University of Medical Sciences.

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Background and purpose: Gastroesophageal reflux disease (GERD) is one of the most common chronic disorders of the digestive system. This survey was performed to determine the effect of Temperament–based dietary intervention on the symptoms of GERD.    

Materials and methods: In a randomized clinical trial, 60 patients with GERD attending the Qaem Hospital in Mashhad, Iran were randomly divided into nutrition education group (n= 30) and control group (n= 30). In case group, patients were referred to the Traditional Medicine Clinic and their temperament and dystemperament were verified by a traditional medicine physician. Temperament–based dietary education was held in intervention group for 1.5 hours according to the determined dystemperament. The participants were asked to follow the diet for two weeks. In control group, the same process was carried out along with the accustomed dietary education without taking notice to their temperament. The GERD questionnaire, food frequency questionnaire (FFQ), and 24-hour diet recalls (24-HDR) were administered to collect the data. SPSS V.11.5 was used to analyze the data applying Chi-square, Mann-Whitney, Independent T test, and Paired T test.

Results: After the intervention, significant decrease were seen in the symptoms among the intervention group including heartburn (25.5%), frequency of acid regurgitation (14%), heartburn severity (11.3%), acid regurgitation severity (23.6%) and duration of heartburn (5.2%), duration of acid regurgitation (34%), and heartburn dissemination (8.8%) (P<0.05).

Conclusion: Considering temperament in diet can play an important role in improving the symptoms in patients with Gastroesophageal Reflux Disease.

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Background and purpose: Multiple line of evidence suggested that diabetes has adverse effects on male sexual and reproductive functions. The aim of present study was to investigate the protective effect of colostrum (COL) on sperm parameters, sex hormones, testes histopathological changes, and oxidative stress in diabetic rats.

Materials and methods: In this experimental study, 30 diabetic male Wistar rats were randomly divided into three groups (n=10) and were treated either by saline (model) or COL (100-200 mg/kg). Also, 10 healthy age matched rats were allocated as normal control group which received only saline. The rats in the COL treated groups were given colostrum at 100-200mg/kg once a day orally for 8 weeks. At the end of the study, epididymal sperms were counted, and testis tissues and blood samples were collected for histopathologic and biochemical analysis. Data were analyzed using ANOVA, Kruskal-Wallis and Mann-Whitney tests in SPSS V.18.

Results: COL treatment (at both doses) significantly decreased the elevated glucose (P<0.01) and tissue malonaldehyde (MDA) (P<0.05) levels in plasma and testis tissues samples, respectively. The COL treated rats showed an improved histologic appearance (germinal layer thickness, spermatogonia number, seminiferous tubule diameters) and serum testosterone levels.

Conclusion: The results clearly provide evidence that CLO treatment can inhibit the progression of reproductive system complication in diabetic rats.

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Background and purpose: Restless legs syndrome (RLS) is a neurological disorder in hemodialysis patients. These symptoms cause distress and disability during rest, discomfort, stress and weakness, with secondary effects on performance, disruption of work and family life. This study investigated the effect of heat wrap on the severity of restless legs syndrome in hemodialysis patients.

Materials and methods: A quasi-experiment (before-after design) was conducted in 40 RLS patients who were randomly selected from hemodialysis departments in three hospitals in Yazd, Iran. The restless leg syndrome International questionnaire was completed by patients before and after using hot water bags. Data analysis was done in SPSS V. 17 applying descriptive statistics and Chi-square. P> 0.05 was considered significant.

Results: Most of the patients were ≥ 60 years of age (64%). 61.5% had been on dialysis for one to five years. The severity of symptoms were in moderate level before and after the intervention (69.5% and 61%, respectively). The mean score for RLS was found to be significantly different before and after the intervention (P= 0.000).

Conclusion: Application of hot water bag is suggested as an effective, safe, and low cost method that could be easily used by patients and their caregivers to reduce the severity of RLS in hemodialysis patients.

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Background and purpose: Sexual dysfunction (SD) is an important subject and unfortunately an overlooked symptom of multiple sclerosis (MS) especially in women. The aim of this study was to investigate the impact of affected functional systems on primary sexual dysfunction.

Materials and methods: A cross-sectional study was carried out in Tehran, Iran in which a sample of female patients with MS was recruited consecutively from an outpatient clinic. Sexual function was evaluated by the Multiple Sclerosis Intimacy and Sexuality Questionnaire. A neurologist evaluated the clinical characteristics including disease progress, duration, and affected functional systems. The neurological impairment was assessed by the Kurtzke Expanded Disability Status Scale (EDSS).

Results: There were 226 women in whom brainstem and/or cerebellum (OR for suffering from Brainstem and/or cerebellum=2.54, 95% CI=1.40-4.60, P=0.002), pyramidal dysfunction (OR for suffering from pyramidal dysfunction = 3.14, 95% CI= 1.363-7.26, P=0.002), and sensory dysfunction (OR for suffering from sensory dysfunction = 3.13, 95% CI= 1.56-6.25, P<0.028) were significant contributing factors to primary sexual dysfunction.

Conclusion: This study emphasized that sexual dysfunctions are associated with affected functional systems.  Therefore, more consultations and sensitive approaches are suggested in treatment of these systems.

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Background and purpose: Multiple lines of evidence demonstrated that Crocus sativus petals (saffron) have beneficial effects on some diseases such as diabetes. This study was carried out to elucidate the effects of ethanolic extract of SP on renal function in diabetic rats.

Materials and methods: In this experimental study, streptozotocin (STZ)-induced diabetic male Wistar rats (180-200 g) were orally treated with normal saline or 100 or 200 mg/kg of SP extract once a day for 28 days. Finally, fasting blood sugar (FBS), urine volume, 24 h urine total protein (UTP), blood nitrogen urea (BUN), and plasma creatinine (Cr) were assessed biochemically, and qualitative renal histomorphological alterations were evaluated pathologically. Data was analyzed using ANOVA and Kruskal-Wallis tests in SPSS, version 22.

Results: The FBS, urine volume, UTP, BUN, and Cr levels significantly increased in diabetic rats compared to those of the normal control group (P<0.05). SP treatment significantly lowered the FBS level at 200 mg/kg (P=0.011) and decreased urine volume and BUN at both doses (100 and 200 mg/kg) in diabetic rats. However, neither of the doses could modify UTP and Cr. There were several histological alterations such as thickening of the basement membrane of the Bowman’s capsule, sclerosis, mesangial matrix expansion, and hyaline deposit in glomeruli of the diabetic rats. These alterations were found to be ameliorated when SP extract was administrated.

Conclusion: SP may have beneficial effects against diabetic nephropathy through reducing extracellular matrix accumulation and its antioxidant properties.

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Background and purpose: Urban family physician was implemented as a pilot project in Fars and Mazandaran provinces in Iran since 2012. This study aimed at SWOT analysis of urban family physician from the perspective of beneficiaries.
Materials and methods: This qualitative research was conducted through in-depth and semi-structured interviews in 2016. Nine people including faculty members, family physicians, senior managers and health professionals who were fully informed about the family physician project. They were selected via purposive sampling. Verbatim transcription of interview data was done and analyzed using framework method.
Results: The main strengths included health services provision, easy accessibility to health services, classification of services, and decrease in unnecessary costs. The weak points according to SWOT analysis included management and planning, human resources, physical resources, referral system, electronic health records, payment mechanism, health services purchasing organizations, intersectoral coordination, and assessment and control systems. Authorities’ support, legal backing, educated human resources, and capacity of private section along public section were identified as the opportunities of the project. Furthermore, failure in public-private sector cooperation, health market and, society needs were considered as the threats.
Conclusion: This study showed the strengths and weaknesses of family physician plan, and the opportunities and threats it is faced with. Hence, it is necessary to find solutions and perform necessary interventions in order to eliminate the weaknesses and threats and maintain and improve the strengths and opportunities before its implementation throughout the country.
 
 

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Background and purpose: Imidacloprid (IM) is a systemic insecticide that is widely used to control a large number of pests in agriculture. It has toxic effects, therefore, it should be removed using appropriate methods. The aim of this study was to evaluate the efficiency of electrochemical degradation process to remove IM from aqueous solutions.
Materials and methods: In this experiment, a glass reactor and different combinations of electrodes were used to assess process efficiency in batch mode. The effects of various parameters were studied to determine the optimum conditions. We used the combinations of lead and stainless steel electrodes as the anode and the cathode, respectively. Then, under optimum conditions, the efficiencies of other electrodes including copper, iron, aluminum, steel and graphite in removal of IM were simply compared.
Results: The analysis showed that in the optimal conditions, the maximum removal efficiency of IM and COD were 97.2% and 88.57%, respectively. The data followed the pseudo first order reaction kinetics model. Among the electrodes investigated, lead followed by copper, iron, stainless steel, graphite, and aluminum showed the highest efficiency. Fourier transform infrared spectroscopy (FTIR) analysis showed that due to IM degradation, the functional groups have been changed, and the results of GC/MS analysis confirmed the degradation of the compound to the final products.
Conclusion: The results indicated that electrochemical process is an effective process in Imidacloprid removal which could remove ≈ 97% of IM.

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Background and purpose: A long non-coding transcript Lnc-Ang362 plays critical role on the expression of miR-221 and miR-222. Knockdown of Lnc-Ang362 reduces the expression of these miRNAs as well as vessel smooth muscle cell proliferation in response to vascular injury. This study, for the first time, considered the possible association between Lnc-Ang362 rs7887062A/G polymorphism with the risk of atherosclerotic coronary artery disease (CAD) in low risk patients.
Materials and methods: In this case-control study, 299 subjects, including 150 patients with atherosclerotic CAD and 149 healthy individuals (control group) enrolled. Genotyping of the rs7887062 was done using PCR-RFLP method. Data were analyzed using SPSS v.19.
Results: The frequency of heterozygote AG and G-allele carriage (GG+AG) genotypes were greater in controls compared to the patients, supporting the protective role against CAD. The G allele reduced the risk of disease (OR: 0.32, 95%CI: 0.15- 0.7, P=0.004). In cross tabulation of the study population based on gender, reduced risk of CAD in the presence of AG and G-carriage genotypes was seen in both males and females.
Conclusion: Lnc-Ang362 variant could be considered as a molecular screening marker for low risk susceptible subjects to atherosclerotic CAD.
 

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Background and purpose: Leveling of health services and resources is implemented in Iran to promote the health situation and preventing unnecessary visits and waste of human and financial resources. The relationship between these levels is built through referral system. The aim of this study was to analyze the patient referral system at all levels of the health system using Strengths, Weaknesses, Opportunities and Threats (SWOT) approach.
Materials and methods: This qualitative study was done by semi-structured and in-depth interviews in 2016. The sample size consisted of 20 people including administrative officers, family physicians, executive managers, and individuals working in insurance sector and 10 people receiving insurance services who were selected purposefully. Data was analyzed using content and structural analysis.
Results: The strengths included: reducing the costs, providing equitable access to health services, promoting the health level, and providing services in an evolutionary level. The weaknesses included not informing the people, physician issues, poor monitoring and evaluation, management issues, payment mechanisms, electronic health records, insurance organizations, and inadequate facilities and equipment of health centers. Opportunities included: the importance of health and health care for the leadership and the parliament, job creation, active participation of the private sector, the high level of literacy of the target group (people), and the cooperation of insurance organizations. The threats included lack of coordination and alignment between policy makers and planners, the therapeutic focus of health system, lack of attention of people to health care, and the influences of private sector.
Conclusion: The appropriate implementation of referral system promotes the health of society and increases the healthcare burden. But today, it does not follow its own rules which is caused by different factors. Therefore, health authorities should address these by appropriate planning and timely actions.
 

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Background and purpose: Multidrug resistance (MDR) phenotype is a major complication in cancer chemotherapy. Gankyrin is a key point molecule in cell cycle regulation and may contribute to drug-resistance phenotype of tumor cells. The aim of this study was to compare the basal Gankyrin expression level in ovarian and gastric drug-resistant cells with their parental drug-sensitive cells.
Materials and methods: In this experimental study, the Gankyrin expression at mRNA and protein levels in drug resistance cell lines was compared with their parental drug sensitive cell lines by real time RT-PCR and Western blotting.
Results: Gankyrin mRNA expression in A2780/RCIS cells was statistically lower than A2780 cells (p= 0.00) but their difference was not statistically significant at protein level (p= 0.240). In addition, Gankyrin expression in EPG85-257/RDB was lower than its parental drug sensitive cell line at mRNA and protein level.
Conclusion: This study found an opposite relationship between Gankyrin expression and MDR phenotype related to the overexpression of MDR transportes. This suggestes for the first time that the incidence of MDR phenotype could inhibit tumorgenisity.

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Background and purpose: Pregnancy is one of the factors that affect the mental and physical health of women. The aim of this study was to determine mental health in pregnant women and its related factors.
Materials and methods: A descriptive cross-sectional study was conducted in 834 pregnant women in health centers in Sari, Iran, 2017. The Persian version of Symptoms checklist-90-R was used. Data analysis was done in SPSS V22 using independent T test, One-way ANOVA, and Chi-square. Kruskal–Wallis test was applied in absence of normality assumption.
Results: The mean age of participants was 25.5±507 years and the mean gestational age was 23 weeks. Among the subjects 689 (82.6%) were healthy, 141 (16.9%) were found with moderate disorders and 4 (0.5%) had moderate to severe disorders. Somatization (28.6%) and hostility (17%) were the highest and lowest prevalent disorders, respectively. Comparing the mean scores of the nine aspect of the Symptoms checklist-SCL-90-R showed significant differences between different age groups, educational level, occupation, gestational age, and problems in previous pregnancies (P<0.05).
Conclusion: Current findings indicated a mild to moderate prevalence of psychiatric disorders in pregnant women. The severity of each mental health disorder was linked to demographic characteristics, gestational age, problems in previous pregnancies, and unwanted pregnancies.
 

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Correction to: Analysis of the Patient Referral System in Urban Family Physician Program, from Stakeholders` Perspective Using SWOT Approach: A Qualitative Study
 
 
Ghasem Abedi¹,
Khadije Safizadehe Chamokhtari²,
Aboalfazl Marvi²
 
1 Associate Professor, Department of Healthcare Management, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
2 MSc Student in Health Care Management, Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
 
 
   
 

In the article published in volum 28, issue 161, 2018, the order of authors’ names and affiliations have been published incorrectly, which are now corrected.