IRANIAN JOURNAL OF PUBLIC HEALTH
Year:2018 | Volume:47 | Issue:3

Background: Iran in recent years had the rapid development of industrialization and modernity, and changes in the people's lifestyles and environment, these changes may affect epidemiological patterns of various types of cancers. In this review, incidence and mortality of various cancers (skin, gastric, esophageal, breast, and prostate) in Iran have been reported. Methods: The related data about Iran and other countries were collected from databases such as Google Scholar, Scopus, PubMed, EMBASE, and Web of Science. All included studies were published before Jun 2017. Results: There is an increment trend of incidence and mortality rate for most cancers in Iran. Conclusion: The plan for control and prevention of cancers must be a high priority for health policy in Iran as well as it is suggested that earlier screening is need for high-risk population.

Background: The infections caused by drug resistant strains of Klebsiella pneumoniae are becoming an important health problem worldwide. There are several reports on antimicrobial resistant status of K. pneumoniae in Iran. However, a comprehensive analysis on drug-resistant K. pneumoniae from different parts of Iran has not yet been performed. Methods: The searches were done according to several English and Persian databases including PubMed, Sco-pus, Iranmedex, and SID to identify studies addressing antibiotic resistant K. pneumoniae in Iran from Jan 1998 to Nov 2014. Comprehensive Meta-Analysis (V2. 2, Biostat) software was used to analyze the data. Results: The incidence rate of imipenem and ceftazidime resistance in K. pneumoniae isolates was 3. 2% (95% confidence interval [CI], 1. 5-6. 5) and 55. 7% (95% CI, 46. 9-64. 1), respectively. The highest rate of resistance in isolates of K. pneumoniae was seen against ampicillin (82. 2%), aztreonam (55. 4%) and nitrofurantoin (54. 5%). Conclusion: There is a relatively high prevalence of drug resistant K. pneumoniae isolates in Iran. Thus, a high degree of awareness among physicians and microbiologists, active infection control committee, appropriate an-timicrobial therapy, improvement of hygiene condition and monitoring of drug resistant isolates are urgently needed in order to better control the emergence and spread of drug-resistant K. pneumoniae isolates in hospital settings.

Background: Sarcopenia has been implicated in the increased risk for cognitive impairment and depression associated with aging. In this cross-sectional study, we investigated the relationship of sarcopenia with cogni-tive impairment (MCI) and depression in a sample of 201 community-dwelling Korean women (mean age of 74. 0± 6. 8 yr) between 2014 and 2015. Methods: The Korean version of mini-mental state examination and the center for epidemiologic studies de-pression scale was used to assess cognitive performance and depression, respectively. Grp strength was meas-ured with a dynamometer. Demographics, body composition, education, alcohol consumption, and history of cardiovascular diseases were assessed as covariates. Results: Odds ratio (OR) and 95% confidence interval (95% CI) of MCI and depression were calculated ac-cording to sarcopenia status. Compared to non-sarcopenic, pre-sarcopenic and sarcopenic women had the ORs of 2. 160 (95% CI of 0. 840-5. 554, P=0. 030) and of 5. 493 (95% CI of 1. 854-16. 270, P=0. 002) for MCI. The OR of pre-sarcopenia for MCI remained significant (P=0. 030) even after adjustments for age, body mass index (BMI), lean body mass, and education, while the OR of sarcopenia for MCI was no longer significant (P=0. 084) when adjusted for the covariates. Compared to non-sarcopenic, pre-sarcopenic and sarcopenic women had the ORs of 3. 750 (95% CI of 1. 137-12. 370, P=0. 030) and of 4. 687 (95% CI of 1. 127-19. 505, P=0. 034) for depression. The ORs of pre-sarcopenia and sarcopenia for depression remained statistically sig-nificant (P=0. 020 and P=0. 042, respectively) even after adjusted for the covariatesConclusion: Sarcopenia was significantly associated with MCI and depression in otherwise healthy community dwelling elderly Korean women.

Background: This study aimed to investigate the effects of antibiotic application on the intestinal flora in el-derly hypertension patients with infectious diseases. Methods: A total of 2350 infected patients treated in Ordos Central Hospital (Inner Mongolia, China) from January 2010 to August 2016 were retrospectively analyzed and 790 healthy hypertension patients were selected as the control group. The 2350 patients were assigned into group A and B based on the administration with narrow-spectrum antibiotic or broad-spectrum antibiotic. The feces specimens of patients at the 1st, 5th, 9th and 14th day after antibiotic treatment were collected to analyze the bacteriological data and the cases of intes-tinal flora imbalance after applying the narrow-spectrum and broad-spectrum antibiotic were compared and the differences in the bacterial colony compositions of intestinal floras from those of the healthy hypertension pa-tients at the same period were analyzed. Results: The ratio of intestinal flora imbalance was 50. 4% after applying antibiotic in patients from group A and 78. 3% in group B. grade I and II imbalance were predominant in group A and grade III imbalance was the most severe one in group B (P<0. 05). Compared with the intestinal flora in healthy elderly hypertension pa-tients, the ratio of the primary composition flora of patients with imbalanced intestinal flora was changed obvi-ously. Conclusion: The application of narrow-spectrum antibiotic and shortening the application time of antibiotic can more effectively protect the normal intestinal flora of elderly hypertension patients.

Background: Interpersonal competence is an important capacity for nurses. Recently, the advent of smartphones has instigated considerable changes in daily life. Because smartphone has multiple functions, peo-ple tend to use them for numerous activities, often leading to addictive behavior. Methods: This cross-sectional study performed a detailed analysis of smartphone addiction subscales and social support related to interpersonal competence of nursing students. Overall, 324 college students were recruited at Catholic University in Seoul, Korea from Feb 2013 to Mar 2013. Participants completed a self-reported ques-tionnaire, which included scales that measured smartphone addiction, social support, interpersonal competence, and general characteristics. Path analysis was used to evaluate structural relations between subscales of smartphone addictions, social support, and interpersonal competence. Results: The effect of cyberspace-oriented relationships and social support on interpersonal competence were 1. 360 (P=. 004) and 0. 555 (P<. 001), respectively. Conclusion: Cyberspace-oriented relationship, which is a smartphone addiction subscale, and social support were positively correlated with interpersonal competence of nursing students, while other smartphone addiction subscales were not related to nursing student interpersonal competence. Therefore, effective smartphone teach-ing methods be developed to enhance nursing student motivation

Background: The infection of human papillomavirus (HPV) has been considered as the common cause of cervical cancer, which is the leading cause of cancer death in women, in Vietnam. Recently, hypermethylation at tumor suppressor genes (TSGs) has been also demonstrated to be an early epigenetic event and cofactor in human cancer, including cancer of cervix. This study evaluated the frequency of DcR1 gene promoter hyper-methylation status as well as whether did or not an association between patterns of DNA hypermethylation and high-risk HPV infection, led to risk of cervical cancer. Methods: Methylation-Specific-PCR (MSP) was performed to analyze hypermethylation status from 109 liq-uid-based Papanicolaou test samples, archived and admitted from the Medic Medical Center and Au Lac Clin-ic Laboratory, Vietnam, from 2011– 2014, a kind of non-invasive samples identified whether HPV/or non-HPV, high-risk/low-risk HPV infection. Results: DcR1 promoter was differentially methylated in 50% cases of high-risk HPV genotype 16 and 18 infected samples. In contrast, a low frequency of hypermethylated DcR1 promoter was found in low risk HPV genotype infected sample (16. 0%), and non-HPV infected sample (14. 6%). A trend toward positive as-sociation was found between hypermethylation of DcR1 gene and HPV exposure was observed (P=0. 0005). Moreover, the odds ratio (OR) and relative risk (RR) were found in statistical significant value (OR=5. 63 (95%CI = 2. 25-14. 07, P<0. 01), RR=3. 31 (95%CI = 1. 75-6. 26, P<0. 01)). Conclusion: The hypermethylation of DcR1 gene promoter is a significant characteristic of high-risk HPV infected samples in Vietnamese cervical patients. The OR and RR values showed that the strong correlation between DcR1 hypermethylation and high-risk HPV infection, in which increased the risk of cervical cancer. The combination of DcR1 hypermethylation and HPV detection based biomarker could be used in non-invasive samples obtained from high-risk cancer patients, offer significant practical advantages.

Background: We examined the current prevalence of substance abuse and sexual behaviors among junior high school students and the relationships between substance abuse, sexual behaviors, and victimization using multiple mediations. Methods: Overall, 1703 junior high school students from the 2013 Cambodia Global School-based Health Survey were selected for the study. The descriptive statistics were performed in IBM SPSS to determine the prevalence of substance abuse, sexual behaviors, and victimization. The Process Macro was installed in Re-gression of the SPSS to test the hypotheses and mediations. Results: The majority of students who used alcohol (15. 4%), drugs (3. 05%), and had sexual intercourse (12. 45%), were male aged 14-15, and in grade 7. These students were very vulnerable to many risky behaviors, including bullying (22. 20%), physical attacks (20. 96%) and fights (14. 50%), unintentional accidents (21. 32%), and suicidal attempts (5. 05%). All three hypotheses were significantly supported. Of the potential mediators examined, drug use is the most important mediator. Conclusion: The substance abuse and reproductive health are national problems, but abusive behaviors among students are of particular concern. Explicit policies and awareness programs of such problems at the high school level need to be made and called for public participation, particularly the school authorities and parents.

Background: We aimed to explore the diagnostic value of urinary microalbumin (mALB) level in postpartum acute kidney injury. Methods: A total of 127 maternity patients were selected from December 2013 to January in 2016 in Binzhou Central Hospital, Binzhou, Shandong, China and divided into two groups: the kidney injury and normal kidney group. The dynamic changes and diagnostic value of urine microprotein in postpartum acute kidney injury were analyzed. Results: The postpartum mean arterial pressure of maternity patients in the kidney injury group was 104. 3 ± 11. 6 mmHg, which was significantly higher than that of the normal kidney group (P<0. 05). The mean age of the kidney injury group was 32. 3 ± 11. 6 years, which was significantly higher than that of the normal kidney group (P=0. 006). In the kidney injury group, the postpartum glomerular filtration rate (GFR) was 78. 4 ± 11. 5 mL/min, which was significantly lower than the normal group (P=0. 001), and urinary microalbumin was 2. 87 ± 1. 24 mg/mmol· Cr. The difference was statistically significant (P=0. 002). mALB/GFR, Cr, urinary mALB, and GFR were the independent risk factors of postpartum acute kidney injury. The area under the ROC curve for mALB/GFR was 0. 759, whereas the area under the ROC curve for Cr was 0. 681, which was smaller (P = 0. 042). The area under the ROC curve of mALB was 0. 785 (P=0. 027), which was close to the area under the ROC curve of mALB/GFR. Conclusion: Urinary mALB test is noninvasive and has high diagnostic value for postpartum kidney injury.

Background: The increasing worldwide incidence of depression causes massive economic losses to the coun-try and society. Insufficient sun exposure aggravates depressive symptoms in patients with depression. Preven-tive light replenishment is provided to patients with depression and the potential population. In addition, we studied the applicable spectrum, which is crucial in the prevention of depression. Methods: Forty depressed male rats were randomly divided into five groups of 8 rats each: depressive model, microwave sulfur lamp, halogen lamp, fluorescent lamp, and LED lamp groups. Rats in the illuminated groups were exposed to light for 45 days for 2 h daily. Eight healthy rats were selected for the control group. The body weight and general behaviors of rats were recorded. After the experiment, peripheral blood was collected from the tail vein, and the concentrations of MT, 5-HT, NA, and BDNF in serum were detected by ELISA. Results: After the model was established, the body weight of rats in the depressive model group increased slowly. Compared with those of the control group, the results of the three behavioral tests were significantly different (P<0. 05); the contents of MT, 5-HT, NA, and BDNF were relatively low (P<0. 05). In addition, de-pression characteristics were significant. Rats regained their pleasant sensation after microwave sulfur lamp intervention. Compared with the rats in the depressive model group, the levels of MT, 5-HT, NA, and BDNF increased sharply. Conclusion: The spectral energy distribution of microwave sulfur lamp is similar to the solar spectrum, which can alleviate depressive symptoms in depressed rats.

Background: Phytoestrogens treatment to relieve hot flushes in menopausal women was considered recently. However, the actual effectiveness and safety are not clear. Methods: Randomized clinical trial (IRCT#20100706004329N5) was performed in 204 patients who com-plained of hot flushes in Arash Women's Hospital, Tehran, Iran from 2013-2015. The first group received 50 mg isoflavone (group A) once daily and the second group received placebo (group B) in the same regimen. Pa-tients were evaluated for breast examination (BE) and breast sonography (BS) as well as vaginal sonography at initial presentation and at 6th and 12th week follow-ups. Patients were educated to record frequency and se-verity of hot flushes. Results: Group A experienced less hot flushes attack (6 vs 9 patients with 5< attacks in 6 wk (P= 0. 05), 7 Vs 13 patients with 5< in 12 wk (P=0. 01)) which was also less severe (8 vs 12 patients with severe symptoms in 6 wk (0. 04) and 3 Vs 10 patients with severe symptoms in 12 wk (0. 001). Isoflavone had no effect on neither breast density nor nodularity (in 6 wk, P=0. 50 and 0. 80, respectively and in 12 wk, P=0. 32 and 0. 43) and nei-ther breast tenderness nor nipple discharge (in 6 wk, P=0. 40 and 0. 34 respectively and in 12 wk, P= 0. 31 and 0. 26). There were no significant differences in endometrial thickness in 6 and 12wk. Conclusion: Effects of isoflavone on frequency and severity of hot flushes in perimenopausal women is ob-served. Some clinical and ultrasonographic benign non-significant changes of the breast and endometrium are noted after isoflavone intake.

Background: Two years after the implementation of the Health Sector Evolution Plan (HSEP), this study evaluated the effects of the plan on health equity indices. Methods: The main indices assessed by the study were the Out-of-Pocket (OOP) health expenditures, the Fairness in Financial Contribution (FFC) to the health system index, the index of households’ Catastrophic Health Expenditure (CHE) and the headcount ratio of Impoverishing Health Expenditure (IHE). Results: The per capita share of costs for total health services has been decreased. The lowered costs have been more felt in rural areas, generally due to sharp decrease in inpatient costs. Per capita pay for outpatient services is almost constant or has slightly increased. The reform plan has managed to improve households’ Cat-astrophic Health Expenditure (CHE) index from an average of 2. 9% before the implementation of the plan to 2. 3% after the plan. The Fairness in Financial Contribution (FFC) to the health system index has worsened from 0. 79 to 0. 76, and the headcount ratio of Impoverishing Health Expenditure (IHE) index deteriorated after the implementation of plan from 0. 34 to 0. 50. Conclusion: Considerable improvement, in decreasing the burden of catastrophic hospital costs in low income strata which is about 26% relative to the time before the implementation of the plan can be regarded as the main achievement of the plan, whereas the worsening in the headcount ratio of IHE and FFC are the equity bottlenecks of the plan.

Background: In the human evolutionary history, Single Nucleotide Polymorphism (SNP) frequencies are valu-able in terms of finding connections between different populations. Due to the pronounced role of the im-mune system in combating pathogens and environmental stressors, polymorphisms in the immune genes are subject to selection pressure of the diseases as well. The functional polymorphisms in NF- B1 promoter (-94 ins/del) are associated with different diseases; therefore, we aimed to establish the frequencies of NF- B1 rs28362491 alleles in a population of Southwestern Iranians in comparison with the world populations. Methods: We assessed the polymorphism of-94 ATTG ins/del (rs28362491) in 201 Iranian healthy blood donors from Fars Province, central Iran in a one year period between 2015 and 2016 by PCR-RFLP method using DNA extracted from peripheral blood mononuclear cells. Results: The frequency of ins/ins homozygote genotype was found to be 46. 97%. The frequency of heterozy-gote individuals was 42. 42% and the percentage of del/del homozygote genotype was 10. 61%. We observed a genetic similarity based on the genotype frequencies of NF- B1-94 ins/del ATTG polymorphism between our sample of Iranians with American Jewish, Turkish, American non-Jewish, Chinese-Uyghurs and Germans. Conclusion: The results confirmed genetic interrelation of Iranians with some ancient neighbors and their admixture with countries along the Silk Road. We suggest that mapping the distribution of NF- B1-94 ATTG ins/del along with HLA genes may help to better define the relations between human populations and design population-specific vaccines for pathogens with a high rate of variation.

Background: There is a requirement to assess the effectiveness and resources used in two protocols United Kingdom (UK-ALL) and Berlin-Frankfurt-Munster (BFM-ALL) that are most commonly used to treatment of ALL patients by oncologists in Iran. Accordingly, we analyzed the cost of treatment and utility of children treated with two protocols in Iran. Methods: The entire medical direct costs of patients in "BFM ALL" protocol and "UK ALL" protocol in mul-ti-centers calculated from Apr 2010 to Jun 2015. For calculating utility and Quality Adjusted Life Year (QALY) of the patients, we used standard questionnaire Health Utilities Index 3 (HUI3). The patients and their parents were interviewed. Data were analyzed using software SPSS18 and EXCEL. Results: The average direct medical cost for each patient for BFM-ALL was 15026 USD and UK-ALL was 8282 USD which showed a significant difference in the total cost of the treatment in the two protocols (P≤ 0. 02). Finally, there was a significant difference in the utility score of the maintenance phase of these two methods (P≤ 0. 003). Conclusion: UK-ALL is dominant and BFM protocol is dominated by both sides total costs and utility and QALY. Mainly, more hospital stay in "BFM ALL" protocol is the cause of raised costs in this protocol. Conse-quently, by considering different QALYs in the methods and low costs in "UK ALL" protocol, "UK ALL" protocol is more preferred.

Background: Congenital anomalies are important medical and public health conditions. The pattern and preva-lence of birth defects may vary over time or with geographical location. We investigated the live birth preva-lence and occurrence pattern of birth defects in Golestan Province, northern Iran. Methods: This cross-sectional descriptive study was carried out on 144920 live newborns in 13 hospitals in Golestan Province, northern Iran, from 21 Jan 2008 to 19 Mar 2013. The newborns were examined for the presence of birth defects and mothers were interviewed for variables such as maternal age and ethnicity. In ad-dition, data for each newborn was filed in a questionnaire and the coding of birth defects was translated to the International Classification of Diseases 10th revision– clinical modification (ICD-10-CM). Results: Overall, 1690 infants were diagnosed as having birth defects among 144920 live newborns. The preva-lence rate of birth defects was 11. 66 per 1000 live births, the prevalence of birth defects per 1000 was11. 62 in males and 11. 42 in females. The prevalence of congenital anomalies among native Fars, Turkmen and Sistani were 13. 03, 11. 16 and 13. 07, respectively, per 1000 live births. Anomalies of the cardiovascular system were the most common defects; the prevalence rate of cardiovascular system was 8. 34 per 1000 live birth. Conclusion: The prevalence rate of birth defects in this area was lower than in the other regions in Iran (20. 3 per 1000 live births) but higher than in some parts of Asia (7. 33 per 1000 live births).

Background: Growth failure, constituting one the health problems in children below 2 yr of age, can lead to major complications such as death or mental, emotional and physical disabilities. The present study aimed to investigate ef-fective factors on growth failure in the height and weight of less than 2 yr old children of Khorramabad, Iran in 2013. Methods: This present longitudinal retrospective study used stratified and clustered sampling. Based on growth curves in family records, the incidence times of growth failure in height and weight of each child were recorded. In the next stage, using recurrent events model (proportional rate model), along with SAS software (version 9. 2), the data were modeled. Results: According to proportional rate model, the effect of mothers’ educational level on the rate of growth failure in the height and weight of children was significant (P=0. 046, P=0. 049) and the effect of fathers’ job was significant only on growth failure in children’ s weight (P<0. 001). However, the effect of other variables, including gender, birth order and exclusive breastfeeding status on children’ s growth failure rate was not significant. Conclusion: Enhancing mother’ s awareness in low-income families, in tandem with changing educated mothers’ atti-tude towards the required skills and guiding principles for feeding children below 2 yr of age, can be conceived of as the most important approach in dealing with growth failure of children.

Background: This study measured socioeconomic inequalities in different types of disabilities in Iran. We also examined the prevalence of disabilities across different socio-demographic groups in Iran in 2011. Methods: This was cross-sectional study using secondary data analysis on all Iranian. Data related to disability prevalence and socioeconomic status (SES) of each province was extracted from the 2011 National Census of Population and Housing (NCPH) and the 2011 Households Income and Expenditure Survey (HIES), con-ducted by Statistical Center of Iran (SCI). The concentration index and concentration curve were used to measure and illustrate socioeconomic inequalities in different types of disabilities. Chi-squared test was also used to examine the relationship between the socio-demographic variables (age-groups, sex, education level, employment status) and disability. Results: The results suggested the existence of socioeconomic inequalities in blindness, deafness, vocal disor-ders and hand disorders in Iran. The concentration index for these four disabilities were-0. 0527 (95% confi-dence interval [CI]:-0. 0881,-0. 0173),-0. 0451 (CI:-0. 0747,-0. 0156),-0. 0663 (CI:-0. 1043,-0. 0282) and-0. 0545 (CI:-0. 0940,-0. 0151), respectively. There were also significant associations between the demographic variables such as age-groups, sex, education level, employment status and disability (P<0. 05). Conclusion: There were significant socioeconomic inequalities in different types of disabilities in Iran with poorer provinces having higher prevalence of disabilities in blindness, deafness, vocal disorders and hand dis-orders. Strategies to address the higher prevalence of different types of disabilities among poorer provinces should be considered a priority in Iran.

Background: We analyzed the Y-chromosome haplogroups of six documented Arab subpopulations that accommodated separately in different counties of Chaharmahal and Bakhtiari Province but nowadays speak Indo-European language (Luri and Farsi). Methods: This was an outcome study conducted in 2015 to test whether there was any genetic relatedness among some Indo-European-speaking Arab subpopulation accommodated in a geographically similar region, Chaharmahal and Bakhtiari Province, Iran. Seven main Y-chromosome bi-allelic markers were genotyped in six documented Arab subpopulations. Therefore, after DNA extraction from blood samples, PCR reaction carried out by designed primers for J1-M267, J2-M172, and J-M304, I-M170, IJ-M429, F-M89 and K-M9 markers. Then PCR products after quality control on agarose gel were sequenced. Results: Most subjects (83. 3%) belonged to F-M89 haplogroup. These subjects belonged to K-M9 (40%), J2-M172 (40%) and I-M170 (20%). Generally, there were at least three genetically distinct ancestors with a divergence date of about 22200 yr for I, 429000 for J and 47400 before present for K haplogroup and may show separate historical migrations of studied populations. As the most recent common ancestor (MRCA) of most of these populations, haplogroup F, lived about 40000-50000 yr ago, the data do not support a nearly close genetic relationship among all of these populations. However, there were populations with same haplogroups J2 (n=2), K (n=2), or with a closer MRCA, IJ haplogroups, among I and J2 haplogroups. Finding haplogroup I, a specific European haplogroup, among Arab populations was not expected. Conclusion: Identification of various haplogroups in Arab subpopulations despite its small area and geographically conserved region of this part of Iranian plateau was unexpected.

Background: Following community health assessment Project (CHAP) in suburbs of Bandar Abbas city, health problems in women and children such as pregnancy complications and infant/child impaired growth are highly prevalent. Therefore, the present population-based prospective cohort study investigated the effects of a wide range of modifiable exposures during pregnancy and postpartum on mother and child health. Methods: The sample comprised of 1000 pregnant women in their first gestational trimester, who live in the three most socially and economically vulnerable neighborhoods of Bandar Abbas, are under recruitment during Feb 2016-18. Four structured questionnaires are being carried out from pregnancy to 30 d, 6 months, and 12 months postpartum. Biologic and ultrasound results are also gathered through hospital and health center records. The study is currently close to the end of the recruitment phase. Conclusion: The results of the interim and final analyses are being translated into applicable preventive action plans aiming to reduce and control modifiable risk factors for ill-health in mothers and children in suburb com-munities in South of Iran.

Dear Editor-in-ChiefIn football training, small-sided games (SSG) re-gimes are generally used as a means to improve players' technical skills and tactical knowledge. They are more effective and motivating for play-ers than other regimes. Players' participation in a training exercise corresponds to intrinsic motiva-tion, pleasure, satisfaction, and enjoyment (1). Thus, SSG was produced high physical enjoy-ment (PE) than high-intensity interval training among youth elite soccer players (1).

Dear Editor-in-ChiefElectromechanical delay (EMD) means a lag time between the onset of electrical activity and force output (1). In case of the EMD phenomenon, the time when force starts to be produced is called “ development EMD (d-EMD)” , while the time when force ends is called “ relaxation EMD (r-EMD). This phenomenon indicates that electrical activation occurs before force is produced in case of muscle contraction.....

Dear Editor-in-ChiefHealth is known as one of the main precondi-tions for the social welfare system, people to achieve the level of health in the incidence of sickness, in addition, to keep appropriate lifestyle, use health services and on the other way, they try to buy those services. Taking advantage of these services impose different financial pressures on people in different societies, these fees paid di-rectly out of pocket sometimes may cause finan-cial problems for patients and their families (1).....

Dear Editor-in-Chief: Keratoconus (KC) is disorder of the eye charac-terized by progressive thinning of the cornea. Several genes have been associated with KC dis-ease. Both genetic and environmental factors are associated with KC (1, 2).....

Dear Editor-in-Chief: Services in healthcare environment are carried out with knowledge-intensive agents or compo-nents as providers and consumers in order to at-tain one identical value. This complex integration of human-centered activities is increasingly de-pendent on information technology. Healthcare requires combination of many computerized sys-tems with different user environments to provide quality efficient services in less time because it is data-intensive and technology-driven environm-ent. The system complexities can only be dealt with methods in such environments to promote system integration and adaptation (1)......

Dear Editor-in-ChiefFamily-Cantered Care (FCC), which has become the cornerstone of pediatric nursing practice, supports trust between child and family health (1). Families are recognized as an essential part of specialized childcare during illness, and they are expected to be skilled in childcare (2(......

Dear Editor-in-ChiefIncreasing for inpatient utilization after Health Sector Evolution Plan in Iran was done in 2014. “ It seems that inpatient health coverage by gov-ernment increase the possibility of induced de-mand by service provider after Iranian health care reform are important reasons for this changes in utilization index” (1).....

Dear Editor-in-ChiefWomen’ s empowerment in reproductive deci-sion-making means empowering them in funda-mental issues of life (1). The empowerment of women is the foundation of population and de-velopment program of countries (2). Women's health challenges, including deaths due to preg-nancy and childbirth, unwanted pregnancy, abor-tion, and HIV occur in the reproductive period and indicate the inability of women in decision-making and control of fertility. Women's em-powerment leads to health promotion in the community (3)....