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BACKGROUND: The importance of data quality whether in collection, analysis or presenting stage is a tangible and undeniable scientific fact and the main objects of researches implementation. Objective: This paper aims at explaining the main problems of the Iranian scientific papers for providing better data in the field of national and sub-national prevalence, incidence estimates and trends of obesity and overweight. METHODS: To assess and evaluate papers, we systematically followed an approved standard protocol. Retrieval of studies was performed through Thomson Reuters Web of Science, PubMed, and Scopus, as well as Iranian databases including Irandoc, Scientific Information Database (SID), and IranMedex. Using GBD (Global Burden of Diseases) validated quality assessment forms to assess the quality and availability of data in papers, we considered the following four main domains: a) Quality of studies, b) Quality report of the results, c) Responsiveness of corresponding authors, and d) Diversity in study settings. RESULTS: We retrieved 3,253 records; of these 1,875 were from international and 1378 from national databases. After refining steps, 129 (3.97%) papers remained related to our study domain. More than 51% of relevant papers were excluded because of poor quality of studies. The number of reported total population and points of data were 22,972 and 29 for boys, and 38,985 and 47 for girls, respectively. For all measures, missing values and diversities in studies' setting limited our ability to compare and analyze the results. Moreover, we had some serious problems in contacting the corresponding authors for complementary information necessary (Receptiveness: 17.9%). CONCLUSION: As the present paper focused on the main problems of Iranian scientific papers and proposed suggestions, the results will have implications for better policy making. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Critical Assessment of Progress of Medical Sciences in Iran and Turkey: The Way Developing Countries with Limited Resources Should Make Effective Contributions to the Production of Science" by Massrat and Kolahdoozan in the November 2011 issue.

Background: Long-term complications of stroke, persisting for more than 6 months after the initial event, substantially reduce the quality of life (QoL) in a significant percentage of stroke survivors. In this paper, we studied the prevalence of long-term urinary incontinence (UI) in post-stroke patients. In addition, we attempted to identify patient characteristics which were associated with higher UI prevalence, higher UI severity, and less UI-associated QoL. Methods: Medical records in a tertiary referral hospital were used to contact patients who had experienced a stroke between 6 to 32 months before the study date. The patients were given the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) questionnaire for determining the presence of UI and its severity. UI-positive patients were then given the I-QOL questionnaire to determine their QoL. Results: The prevalence of UI in our study population (n = 189) was 31%. Older age at the time of stroke was associated with higher UI severity (r = 0.290) and lower QoL (r = -0.265). Furthermore, the presence of movement limitation was associated with higher UI prevalence (P < 0.001, OR = 3.89) and severity (P = 0.002, d = 1.05). Movement limitation also significantly impacted the psychological and social aspects of UI-associated QoL (P = 0.035, d = -0.74). Conversely, higher body mass indices (BMIs) were associated with lower UI severity (r = -0.346) and higher QoL (r = 0.281). Conclusion: In conclusion, UI continues to be prevalent in stroke survivors long after the cerebrovascular accident (CVA). As a result, these patients require continuous monitoring and UI prevention. [ABSTRACT FROM AUTHOR]

Iran is a great country with a long history of civilization and medicine. Following the increase in the prevalence of multiple sclerosis (MS), Iranian scientists and physicians started considering this disease and its outcomes in Iran. The first MS paper published by Iranian scientists dates back to 1963, when a case of hereditary spastic ataxia mimicking MS was reported. With the cooperation of his colleagues, Prof. Jamshid Lotfi conducted the first MS-related paper. The Iranian MS Society was established in 1998 in Iran, and is currently a member of the MS International Federation (MSIF). Progressively, after the scientific development of Iranian universities and recognizing the importance of the disease, the first specialized MS ward was established in Sina hospital by Prof. Mohammad Ali Sahraian and was followed by the establishment of the first MS research center. MS Society is presently quite active and the Iranian MS congress is annually held in one of the Iranian universities to review the most recent achievements in the field of the disease. The present study aims to illustrate the history of the efforts made on the way, and attempts to introduce the people who took significant steps in this regard. [ABSTRACT FROM AUTHOR]

Background: Accomplishments in stem cell science and tissue engineering have resulted in a remarkable revolution in the context of future medicine. However, a general insight over the progress of stem cell research in Iran is still lacking. A better understanding of current needs in this field is required to design a better national roadmap. Methods: In this study, we defined the geographical regions based on the significance of their contribution to stem cell research; then, using the Scopus database, we retrieved reports from Iran and other countries concerning stem cell science and regenerative medicine published from 1994 until the end of 2016. Results: A significant number of citations belong to North America (6 554 029 citations equal to 49% of the total citations) and Europe (4 425 465 citations equal to 33% of the total citations) and the rest of citations were related to Asia (2 423 352 citations equal to 18% of the total citations). East Asian (2 168 472 citations equal to 76% of the total citations related to Asia) documents were cited more than those from the Middle East (ME) (494 141 citations equal to 17% of the total citations related to Asia) and North and Central Asia (196 382 citations equal to 7% of the total citations related to Asia). Iran as a country in the ME attracted 17% of the total citations related to the Asian countries winning the second position in this regard. The overview of total number of citations showed a sharp increase and upward trend in citation numbers for all the Iranian institutes from 2007 that resulted in the expansion of stem cell science in all major cities of Iran such as Shiraz (8%), Mashhad (5%), Isfahan (5%) and Ahvaz (5%). H-index of Tehran University of Medical Science, which has the highest total citations and document numbers, is the highest among all Iranian research institutes. Citation per paper of Royan Institute (RI) is the highest among the top 10 Iranian institutes, by 13 citations per paper. Conclusion: Stem cell research in Iran is rapidly developing. Since 2007, the number of published documents in major research institutes increased; thus, there is necessity for analysis of the status of publications in this field and choosing a better direction based on needs. Furthermore, it is necessary to expand and organize international collaborations to enrich our research and benefit from different team experiences. [ABSTRACT FROM AUTHOR]

Background: Leukemia and multiple myeloma (MM) are the most common hematologic malignancies in Iran. This paper describes the geographic and temporal changes in their incidence in Golestan, northern Iran. Methods: Data on cases of leukemia and MM during 2004--2017 were obtained from the Golestan Population-based Cancer Registry (GPCR). The GPCR is a dynamic database of Golestan residents diagnosed with primary cancers. Age-standardized incidence rates (ASRs) (per 100 000) of leukemia and MM were calculated using direct standardization method considering the world standard population. We used Joinpoint regression to assess incidence trends using the average annual percent change (AAPC). Results: In total, 2119 new cases of leukemia and MM were registered by the GPCR during 2004--2017. The ASRs of leukemia were 9.71 and 6.70 in males and females, respectively, while the rates were lower for MM: 2.66 and 1.97 in males and females, respectively. The incidence rates of leukemia suggested an increasing trend in urban population (AAPC = 2.73; P value = 0.154), while in rural area, the incidence rates were slightly decreasing (AAPC = - 0.73; P value = 0.658). There were high incidence areas of leukemia in the central and western regions of Golestan. Conclusion: Our results suggested high incidence rates of leukemia and MM in the Golestan province. We also found geographical diversities and increasing trends in the incidence of leukemia in the urban population. Exposure to occupational and environmental carcinogens including pesticides may partly explain high rates and the observed trends. Further investigations should be considered to clarify these points in our population. [ABSTRACT FROM AUTHOR]

One in eight adults in Iran is estimated to have major depressive disorder (MDD) - a leading cause of disability in the country. Many remain undiagnosed, and some receive only partial treatment. An estimated 60% of those with MDD were reported to have received no treatment during the past year. In this paper, we have critically reviewed the current health-care structure in the country along with prevailing patterns of health-care service utilization. We have addressed the role of psychiatrists, general practitioners (GPs), psychologists, and other health-care personnel in the treatment and care of patients with MDD, with an emphasis on the quality of service provision. In addition, the strengths and weaknesses of primary healthcare (PHC), the health insurance system, and inpatient care have been discussed. We have paid attention to the contextual issues such as mental health literacy, stigma, and healthcare inequity where relevant. Finally, practical recommendations have been provided to improve the quality of care for patients with MDD in Iran. [ABSTRACT FROM AUTHOR]

Background: In recent years, international ranking systems have been used by diverse users for various purposes. In most of these rankings, different aspects of performance of universities and research institutes, especially scientific performance, have been evaluated and ranked. In this article, we aimed to report the results of research ranking of Iranian universities of medical sciences (UMSs) based on some international indicators in 2015. Methods: In this study, after reviewing the research indicators of the majority of international ranking systems, with the participation of key stakeholders, we selected eight research indicators, namely research output, high-quality publications, leadership, total citations, citations per paper in 2015, papers per faculty member and h-index. The main sources for data gathering were Scopus, PubMed, and ISI, Web of Science. Data were extracted and normalized for Iranian governmental UMSs for 2015. Results: A total of 18023 articles were indexed in 2015 in Scopus with affiliations of UMSs affiliation. Almost 17% of all articles were published in top journals and 15% were published with international collaborations. The maximum h-index (h-index = 110) belonged to Tehran University of Medical Sciences. The average paper per faculty member was 1.14 (Max = 2.5, Min = 0.13). The mean citation per published articles in Scopus was 0.33. Conclusion: Research ranking of Iranian UMSs can create favorable competition among them towards knowledge production. [ABSTRACT FROM AUTHOR]

Abdulkarim Vessal, a distinguished professor of the Shiraz School of Medicine, was the founder of the "Archives of Iranian Medicine Journal" and a permanent member of the "Iranian Academy of Medical Sciences", who finally, after five decades of efforts to promote radiology and medical journalism in Iran, passed away on February 18, 2022 in Shiraz. His demise is a great loss for the Iranian medical community, especially in Shiraz. In the present paper, his life and career are briefly reviewed. [ABSTRACT FROM AUTHOR]

Background: The need for mental health care among children and adolescents in Iran, as in other low and middle income countries (LAMIC) remains mostly unmet. In this paper, we sought to provide an overview of the extent of unmet need and mental health services in Iran. We also aimed to propose approaches to address this gap. Method: We reviewed the published epidemiologic studies of child and adolescent mental and behavioral health problems in Iran. We also examined the current status of child mental health services and the gaps between current needs and available services based on published literature that included papers published in scientific journals, as well as governmental and other administrative reports. The contextual issues relevant to child mental health care were also explored, as well as the possibilities to introduce new or scale up promising services. Results: Child and adolescent mental and behavioral health problems are highly prevalent in Iran. Different studies have estimated that 16.7% to 36.4% of children and adolescents suffer from one or more mental health problems. However, there is a serious scarcity of resources to meet this need. Available services are delivered by independent public organizations (e.g., Ministry of Health, Welfare Organization, and Ministry of Education) or private sector with inefficient communication and collaboration among them and no mandatory national mental health policy. Available specialized child and adolescent services are mostly confined to small inpatient units and university outpatient facilities in larger cities, and there is a scarce evidence for the effectiveness of the available services. Conclusions: Expansion of primary care's role in timely detection and management of child and adolescent mental health problems, implementation of task-shifting and -sharing initiatives, as well as improved collaboration among responsible governmental and nongovernmental sectors are some of the most promising future venues to improve mental health care for the Iranian youth. [ABSTRACT FROM AUTHOR]

This paper presents a systematic literature review of studies that shed light on the health of migrants in Iran from the perspective of social justice. A systematic search was conducted in PubMed and Iranian databases, including IranMedex, Magiran, and SID, in June 2012. All studies that were published until June 2012 describing the health status of migrants-including refugees-in Iran were included. The search results were categorized according to an adapted version of the six dimensions of well-being in Madison Powers'and Ruth Faden's theory of social justice in health. They consisted of access to health care, health, respect, self-determination and attachment, personal security, and social determinants of health. The majority of papers mentioned issues related to infectious diseases (100 papers, 60.2%). Only a few papers mentioned socioeconomic status and access to health services, education, and work. Infectious diseases and high population growth among migrants and the problematic image of migrants as "threat" to the Iranian population's health appear to be the most prominent results in our search. It is imperative to combat the high numbers of infectious diseases among migrants in Iran while simultaneously making efforts to change the public image of migrants as a health and social service threat to Iran. Data concerning social and ethical issues of migrants' health in Iran is scarce, and thus, future research is necessary using other methods and sources. [ABSTRACT FROM AUTHOR]

Parasites and parasitic diseases have been prevalent in Iran according to Iranian ancient scholars and physicians' inscriptions dating back to 865-1496. Some protozoan diseases such as malaria and cutaneous leishmaniasis have been introduced by clinical manifestations and helminthic infections by size and morphology of the worms. Scientific studies of Parasitology started in Iran from 1833, first by foreign physicians and continued from 1909 by Iranian researchers. The pioneer medical parasitologists of Iran were DrN.Ansariand Dr. Sh. Mofidi who established the Department of Medical Parasitology in the School of Medicine, University of Tehran, 1939. Afterward, a considerable number of researchers and professors of parasitology have been active in training and research works in the fields of medical parasitology throughout the entire nation. At present, some significant parasitic diseases such as bilharsiasis and dracunculiasis are more or less eradicated and malaria is in the elimination phase. The prevalence of most helminthic infections has considerably decreased. Most of the departments of medical Parasitology in Iran are active in training MD, MSPH and PhD students. The Iranian Society of Parasitology established in 1994 is active with many eligible members and its creditable publication, the Iranian Journal of Parasitology, published seasonally since 2006. From 1833, when the scientific studies of Parasitology have started in Iran up to 2013, many researchers have been done on various fields of medical Parasitology and parasitic diseases in Iran and 2517 papers in English and 1890 papers in Persian have been published in national and international scientific journals. In addition, more than 420 books related in the field of medical parasitology field have been published in Persian language. [ABSTRACT FROM AUTHOR]

Background: Oral diseases, as a group of chronic diseases, are among the major public health problems that lead to disability throughout the world. The major part of burden of oral diseases is caused by dental caries, periodontal diseases, edentulism, mouth cancer, cleft lip, and cleft palate. The aim of the present paper is to report the global results for the burden of oral disease in Iran from 1990 to 2010, derived from the Global Burden of Disease study 2010 (the GBD study 2010) by sex and age. Methods: The Global Burden of Disease Study 2010 was a systematic effort with a common framework to estimate disability adjusted life years (DALYs) for diseases in different parts of the world. Years of life lost due to premature mortality (YLLs) were assessed based on cause-of-death estimates and by means of a cause of death ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplying the prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was conducted to estimate disease distribution using a Bayesian meta-regression method (DisMod-MR). Disability weights were measured by collecting data from population-based surveys. Uncertainty interval (Ul) from all inputs into the calculations of DALYs was disseminated using Monte Carlo simulation techniques. In this paper, we describe the results of the GBD study 2010 regarding oral diseases in Iran, critique the results, and provide some recommendations. Results: Between 1990 and 2010 in Iran, an increase occurred in DALYs at all ages, attributed to dental caries (from 37,230 to 56,521) as well as periodontal diseases (from 21,482 to 43,308), and a decrease was found for edentulism (from 53,134 to 47,960). DALYs at all ages attributed to mouth cancer increased (from 5,597 to 7,771), while a decline was noted for cleft lip and cleft palate (from 6,157 to 5,034). The age-standardized DALY rates per 100,000 population did not considerably change for dental caries and periodontal diseases, while edentulism showed a reduction. The corresponding DALY rate due to mouth cancer decreased, while it remained almost unchanged for cleft lip and cleft palate over this period. DALY rates per 100,000 population due to dental caries and edentulism were higher among Iranian women than for Iranian men at all ages, while Iranian men suffered from a higher burden of periodontal disease, mouth cancer, cleft lip, and cleft palate. The most significant burden due to dental caries and periodontal diseases was found in Iranians aged 15-49 and 50-69 years, respectively and edentulism and mouth cancer led to the highest burden in Iranians older than 70 years of age. The highest burden caused by cleft lip and cleft palate occurred in children younger than 5 years old. Conclusion: The findings address the challenging changes in oral diseases and difficulties in responding to the urgent oral health needs in Iran. The burden of oral diseases should be considered as a priority in Iran. A need also exists to pay more attention to the oral health policies and principles of preventive oral care. Global analyses of disease burdens provide a useful framework to guide a suitable policy in response to disease changes. In fact, strong national and sub-national analyses will be required to provide more effective public health strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Estimating the burden of diseases, injuries and major risk factors is necessary for adopting appropriate health policies in every country, and this paper aims to explain the study protocol of national and sub-national burden of breast cancer in Iran from 1990 to 2013. METHODS: We will perform a systematic review of the confirmed databases and literature to gather data on breast cancer epidemiology in Iran. The definitions, data sources, organizing the team, methods of data gathering and data generating will be explained in this paper. The methodology of estimating the trend of prevalence, years of life lost due to premature death (YLLs), years of life lost due to disability (YLDs) and disability-adjusted life years lost (DALYs) of breast cancer by age groups, provinces and probable inequalities will be explained. We will tackle possible data problems due to the lack of data points on provinces and years and also geographical misalignment by using two advanced statistical methods, namely Bayesian autoregressive multilevel and Spatio-temporal models. Trend estimation will be reported using these two models together with uncertainty intervals. CONCLUSION: This study provides a comprehensive assessment of breast cancer and its specific pattern in Iran. The results will help policy makers to know the trend of prevalence, the distribution, and the inequalities of breast cancer in Iran to allocate resources in a better way. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is to present a synthesis of solutions for post-graduate medical education (PGME) and the health-care system in addressing challenges in relation to women's health. Methods: A critical review was conducted within three themes: women's health status, women's preferences for female physicians, and women in surgery. The study was conducted in two phases that consisted of an analysis of the trends of Iranian women's health and women's participation in PGME since 1979 followed by a thematic analysis to assess the current challenges and their implications on medical education. Results: Our analysis revealed important trends and challenges. Since 1979, life expectancy has increased by 29% in Iranian women, while female adult mortality rate has decreased by 78%, and maternal mortality rate has decreased by 80%. The number of female medical specialists has increased by 933%, while the number of female subspecialists has increased by 1700%. According to our review, ten major challenges regarding women's health were identified: 1) Increase in chronic disease; 2) Increase in cancer cases; 3) Preference for same-gender physicians in sensitive procedures; 4) Delayed care-seeking due to lack of female surgeons; 5) Lack of gender-concordance in clinical settings; 6) Underestimating female surgeons' capabilities; 7) Female physicians' work-family conflicts; 8) Male-dominancy in surgical departments; 9) Women's under-representation in higher rank positions; and 10) Lack of women in academic leadership. Conclusion: We identified different solutions to bridge these gaps. Community-based education, Gender- concordant considerations, and empowering women in surgical departments could help medical education policy makers to address the challenges. [ABSTRACT FROM AUTHOR]

Background: There is currently little known about the epidemiology of lymphomas in Iran. The aim of this paper is to describe the geographic and time variations in incidence rates of lymphomas in the Golestan province between 2004 and 2013. Methods: The Golestan Population-based Cancer Registry (GPCR) routinely registers primary cancer patients from all sources (e.g. pathology centers, hospitals, etc.) throughout the Golestan province. We obtained data on newly-diagnosed lymphomas in Golestan during 2004-2013 from the GPCR dataset. Crude rates and age standardized incidence (ASR) rates (per 100 000) of lymphomas were estimated, joinpoint regression was used to quantify incidence trends and average annual percent changes (AAPCs) were calculated. Results: In total, 898 new cases of lymphoma were registered in the GPCR during 2004-2013. The ASR of Hodgkin lymphoma (HL) was 1.5 and 1.1 in males and females, respectively, while corresponding non-Hodgkin lymphoma (NHL) rates were greater, at 6.5 and 3.4 in males and females, respectively. Our results indicated a significant difference in the trends of HL between males (AAPC = -3.2) and females (AAPC = 3.6, P value = 0.001). The incidence rates of lymphoma were considerably higher in the urban population (ASR = 7.3) compared to those residing in rural areas (ASR = 5.3, P value = 0.054). We also found higher incidence rates for both HL and NHL in the western parts of the Golestan province. Conclusion: The incidence rates of lymphoma in the Golestan province are relatively high and vary geographically, with a higher incidence observed in the western area. Such differences may reflect unknown lifestyle and environmental determinants linked to ethnic susceptibility differing between the two areas. [ABSTRACT FROM AUTHOR]

Background: Human albumin is an expensive therapy with inappropriate use in many clinical conditions. Inappropriate use of albumin imposes a substantial economic burden on the healthcare system and society. Drug use evaluation (DUE) is one method of assessing the appropriateness of drug use which has been powered by increasing concern about the cost-effectiveness of drugs. The objective of this study is to systematically review the appropriateness of albumin utilization in Iranian hospitals. Methods: We searched the PubMed, MEDLINE, EMBASE, SCOPUS, and Google Scholar for articles in English and SID, Magiran, Medlib, and Irandoc for articles in Persian from 1997 to 2018. Studies on the DUE of albumin in Iranian hospitals were included in this study. Articles conducted outside Iran, editorials, letters and review articles were excluded. Results: In total, eight studies were selected for the final review. The majority of the papers were conducted in Tehran. In most studies, the highest albumin consumption was related to the intensive care unit. The most frequent reasons for prescribing albumin were edema, hypoalbuminemia, volume expansion after heart surgery, ascites, cardiac surgery and cirrhosis. Of the studies included, five studies evaluated the costs of drug use. Conclusion: Our findings show that inappropriate use of albumin imposes a relatively high additional cost on the society. The included studies show that the percentage of inappropriate use of albumin is relatively high in Iran and this abuse is an essential problem in Iranian hospitals. Prescription based on standard guidelines could improve rational use of albumin and lead to savings in treatment costs. [ABSTRACT FROM AUTHOR]

Background: Lifestyle and dietary pattern in adolescence and young adulthood not only affect the general state of health in these years, but also leave long-term effects. Due to the importance of diet in youth, this systematic review summarized observational studies representing dietary intakes among Iranian adolescents and young adults. Methods: PubMed, Scopus and Web of Science databases were searched up to September 2013 using keywords related to diet, youth and Iran. Relevant papers were identified through applying a series of exclusion criteria in screening steps. Data were tabulated in 4 tables according to the level of assessed dietary exposure including energy or nutrients, foods or food groups, diet quality indices or dietary patterns, and dietary habits. Results: Out of 1348 retrieved papers, 17 papers were eligible to enter this systematic review. Most studies were conducted in Tehran and Isfahan. Totally, 13113 individual were studied including 7327 girls and 5785 boys aged 10 to 28 years. Receiving lower or higher energy than required resulted in two burdens of malnutrition. Fiber intake was nearly half of the recommended amounts. Among micronutrients, calcium, phosphorus, folate and iron had the most common insufficient intakes. The youth consumed low whole grain, fruits, vegetables, dairy and unsaturated fatty acids and low diverse diet. Skipping breakfast was rife. Eating fast foods and unhealthy snacks was another prevalent inappropriate dietary habit. Conclusion: Dietary intakes and habits of young people are not favorable. Implementing informative programs and developing practical policies should be noted to improve the diet quality of adolescents and young adults. [ABSTRACT FROM AUTHOR]

The oldest literature that mentioned the immunity was related to the plague of Athens in 430 BC. The germ theory had more influence on the description of the discrimination between self and non-self which is the core concept of immunology. Allergic diseases were known from 2,000 years ago while Rhazes wrote the first medical monograph about seasonal allergic rhinitis. In Iran, Dr. Mohammad Kermanshahi introduced the basic concepts of serology in 1900. The first Department of Serology was established at Tehran University, Faculty of Medicine in 1951 by Prof. Dr. Hassan Mirdamadi. After that, immunology entered into the cellular and molecular period. Prof. Mohammad Ali Maleki established the first Iranian Society of Allergy and then Prof. Abolhassan Farhoodi found the first Department of Clinical Immunology and Allergy at Tehran University. In this paper, we review the role of famous Iranian scientists and physicians in the progress of modern immunology and allergy from a historical perspective. [ABSTRACT FROM AUTHOR]

The recent efforts for revitalizing traditional Iranian medicine (TIM) have shaped two main streams: The quackery traditional iranian medicine (QTIM) and the academic traditional iranian medicine (ATIM). The QTIM encompasses a wide range of practitioners with various backgrounds who work outside the academic arena and mostly address the public. These practitioners have no solid bases or limited boundaries for their claims. Instead, they rely on making misleading references to the Holy Islamic Scriptures, inducing false hope, claiming miraculous results, appealing to the conspiracy theories, and taking advantage of the public resentment toward some groups of unprofessional healthcare providers. The theories and practices of ATIM, however, can be categorized into two major categories: First, valid and scientific TIM that is aimed to conduct well-designed clinical trials and thereby, supply the evidence-based medicine with new treatments originated in or inspired by TIM. Second, a pseudoscientific part of the current TIM that is based on some obsolete medical theories, especially the medieval humoral medicine, and erroneous accounts of human anatomy, physiology, and physiopathology, mostly adopted from the ancient and medieval medical scripts. TIM has recently established some clinical centers for practicing humoral medicine that is partly pseudoscientific and involves significant risks. This paper suggests that the public health sector has a duty to act against the promulgation of medical superstitions by QTIM and the pseudoscientific medical practices of ATIM, and at the same time, support and promote the valid and potentially beneficial research pursued by ATIM aimed to explore the rich recourses of TIM and thereby enrich the evidence-based medicine. [ABSTRACT FROM AUTHOR]

Background: The probability of HIV transmission through contaminated blood and blood products is eye catching. 5%-10% of blood products are contaminated with HIV. Therefore, it is essential to provide safe blood supply to prevent transmission of infectious diseases. Current systematic review and meta-analysis was conducted to evaluate the weighted prevalence of HIV in Iranian blood donors. Methods: This study was reported according to PRISMA checklist for systematic reviews and meta- analysis. Required data were collected by using key words such as "HIV", "blood donation" OR "blood donors", "epidemiology" OR "prevalence", "blood transfusion" and "Iran", in international databases including PubMed, Scopus, Web of Science, Cochrane, Embase and national databases including Magiran, IranMedex and Scientific Information Databank. Papers were searched until December 2017. Cochran's Q test and I² index were used to assess the heterogeneity among studies. Results: A total of 49 studies including 5 403 170 donors entered this meta-analysis. According to analysis, the prevalence of HIV- positive patients among Iran blood donors was estimated 7.9/100 000 (95% CI: 0.000052-0.000121%). The highest prevalence was related to the central region of Iran (11.3/100,000 [95% CI:0.000063-0.0002%]) and Kermanshah province (49.2/100 000 [95% CI:0.000273-0.000888%]) and the lowest prevalence was related to the eastern region (1/100 000 [95% CI:0.000001- 0.000072%]) and Khorasan Razavi province (0.9/100 000 [95% CI:0.000001-0.000139%]. Conclusion: The overall HIV prevalence in Iranian blood donors is low and satisfying. However, the high prevalence in some regions and provinces should be reviewed more meticulously. [ABSTRACT FROM AUTHOR]

Background: Health systems have a set of limited resources for meeting the needs of communities. Health priority setting based on criteria and values is inevitable in such situation. This paper aims to identify the social values that are considered in Iranian health system. Methods: This qualitative study was conducted in 3 steps including collecting national documents and literature review, interviewing key informants, and a 2 round Delphi. Interviews and documents were analyzed through thematic framework analysis. Statistical guidance was applied for determining consensus cut-off in Delphi technique. Results: Five social values including freedom of choice, equity, solidarity, severity of disease(s), and burden of disease(s) were considered more important than other values in the health priority setting decisions. Moreover, 2 non-value based factors including conflict of interest and lobbying had a high effect on decision making. Conclusion: Most health policy makers decide based on Egalitarian school, but restriction of resources in the country decreases the outcome. Moreover, personal judgments and preferences sometimes affect their decisions. It seems that developing a valuebased framework and making it as a national guidance could have affirmative effect on health administers decisions. [ABSTRACT FROM AUTHOR]

Background: The main objective of the Second National Integrated Micronutrient Survey (NIMS-II) was to assess the nutritional status of four micronutrients, namely iron, zinc, and vitamins A and D, and also to conduct an anthropometric assessment of selected groups of children, adolescents, pregnant women, and adults, disaggregated by sex and residential area in nationally representative samples. This paper reports the design of the study along with preliminary findings. Methods: In this study, 32 770 individuals were selected by using single-stage cluster sampling. Venous blood samples were collected on site for laboratory analysis; interviews were conducted, and anthropometric measurements were performed. Results: The prevalence of anemia was highest (17.1%) among 15- to 23-month-old children; vitamin A deficiency was 18.3% in this age group. As regards iron deficiency anemia, the prevalence in all age/sex groups was less than 5%, ranging from 0.5% in 6-year-old children to 4.2% in 15- to 23-month-old children. Zinc and vitamin D deficiencies were highest among pregnant women (8% and 85.3%, respectively). Finally, the prevalence of overweight and obesity among adults was 40.3% and 29.2%, respectively. Conclusion: Results of this study can help in designing nutritional intervention programs for nationwide implementation. Of all micronutrient deficiencies, vitamin D deficiency was the most prevalent in all study groups. Thus, appropriate actions should be taken in our community. [ABSTRACT FROM AUTHOR]

Registration systems for diseases and other health outcomes provide important resource for biomedical research, as well as tools for public health surveillance and improvement of quality of care. The Ministry of Health and Medical Education (MOHME) of Iran launched a national program to establish registration systems for different diseases and health outcomes. Based on the national program, we organized several workshops and training programs and disseminated the concepts and knowledge of the registration systems. Following a call for proposals, we received 100 applications and after thorough evaluation and corrections by the principal investigators, we approved and granted about 80 registries for three years. Having strong steering committee, committed executive and scientific group, establishing national and international collaboration, stating clear objectives, applying feasible software, and considering stable financing were key components for a successful registry and were considered in the evaluation processes. We paid particulate attention to non-communicable diseases, which constitute an emerging public health problem. We prioritized establishment of regional population-based cancer registries (PBCRs) in 10 provinces in collaboration with the International Agency for Research on Cancer. This initiative was successful and registry programs became popular among researchers and research centers and created several national and international collaborations in different areas to answer important public health and clinical questions. In this paper, we report the details of the program and list of registries that were granted in the first round. [ABSTRACT FROM AUTHOR]

Background: In 1990, one of the most important strategies of supporting and managing reproductive research focused on development of research structures. This targeted vision, at the first step, mainly followed through creating research units. The present paper aims to explore the policies and strategies of medical research centers (MRCs)development, and its achievements and challenges over the last 25 years. Methods: Based on expected outcomes of better directions of research activities aligned with the priorities and policies of research, the Deputy of Research and Technology of Ministry of Health and Medical Education (MOHME), initiated the set up and development of research units. Results: During the last 24 years, the number of MRCs has increased from 1 in 1992 to 736 in 2016. The progressive trends of expansion of the research centers are affected by a complex set of influencing factors. At first steps of program, the process of establishment and development of research structures followed slow trends in few unstructured primary centers. From 2008 to 2012, a rapid investment in development of research structures in biomedicine fields led to numerous complex challenges in supervision and management of MRCs (MRCs). Conclusion: Participatory approach in research centers management, benefiting from all available capacities of research stakeholders, could be considered as a practical strategy for better management of limitations and achieving targeted goals. [ABSTRACT FROM AUTHOR]

Background: During the last 3 decades, Iran has experienced a rapid population growth and at the same time the health of Iranian people has improved greatly. This achievement was mainly due to training and availability of health manpower, well organized public health network and medical science and research improvement. In this article, we aimed to report the relevant data about the medical science and research situation in Iran and compare them with other countries. Methods: In this study, after reviewing science development and research indicators in medical sciences with participation of key stakeholders, we selected 3 main hybrid indexes consisting of "Research and Development (R&D) expenditures," "Personnel in Science and Technology sector" and "knowledge generation" for evaluation of medical science and research situation. Data was extracted from reliable databases. Results: Over the past decade, Iran has achieved significant success in medical sciences and for the first time in 2015 based on Scopus index, Iran ranked first in the number of published scientific papers and number of citations in the region and among all Islamic countries. Also, 2% of the world's publications belong to Iran. Regarding innovation, the number of Iranian patents submitted to the United States Patent and Trademark Office (USPTO) was 3 and 43 in 2008 and 2013, respectively. In these years, the number of personnel in science and technology sectors including post graduate students, researchers and academic members in universities of medical sciences (UMSs) have increased. The female students in medical sciences field account for about twothirds of all students. Also, women comprise about one-third of faculty members. Since 5 years ago, Iran has had growth in science and technology parks. These achievements were attained in spite of the fact that research spending in Iran was still very low (0.5% of gross domestic product [GDP]) due to economic hardships and sanctions. Conclusion: Medical science and research development has been at least partially due to health technological development, training and availability of health manpower and improvement of overall health status in Iran compared to other Islamic countries. [ABSTRACT FROM AUTHOR]

Dr. Marcel Baltazard (1908-1971), French scientist and former director of Pasteur Institute of Iran, is known in the international arena due to his research on the control of infectious diseases such as plague, rabies, relapsing fever, leprosy, smallpox and tuberculosis. Dr. Baltazard also played a significant role in the launch of vaccination against tuberculosis, cholera and smallpox. Dr. Baltazard's spent the first 13 years of academic life at Pasteur Institute of Casablanca, Morocco, and then 20 years at Pasteur Institute of Iran and over the last five years at Pasteur Institute of Paris. In this paper, the activities of this important and influential researcher in the field of health and medicine are addressed. [ABSTRACT FROM AUTHOR]

The pivotal role of plaster of Paris (POP) cast as an immobilization tool to promote healing in complex and/or other types of fractures is irrefutable. We dearly know that Antonius Mathysen extensively applied plaster cast during Crimea and/or other wars and reportedly saved thousands of lives. However, the exact origin of using POP in orthopedic cast is yet to be clear. In his famous report from Bandar-e Rig, a city in Iran, William Eton paved the way for the conclusion that POP cast might have originated from the Persian Empire. In this paper, we provide more supporting evidences which make the aforementioned claim more probable. [ABSTRACT FROM AUTHOR]

Objective: The aim of the paper is to investigate the association between physicians' adherence to a pharmacotherapy guideline and continuity of care for patients with depressive and/or anxiety disorders in a collaborative care program. Methods: This retrospective observational study was conducted using medical records of subjects suffering from depression and/or anxiety disorder visited by 26 general practitioners (GP) working with Community Mental Health Center (CMHC), who run a collaborative care program in Tehran, Iran. All patients were visited by a general practitioner in private offices from November 2010 to May 2013. A scoring system was utilized to assess physicians' adherence to the pharmacotherapy guideline using medical records. Patients' continuity of care was calculated based on the number of days of being in the collaborative care program. To investigate the association between physicians' adherence to the guideline and the patients' continuity of care, univariate logistic regression analysis, multiple logistic regression analysis and parametric survival analysis were performed using Stata version 11. Result: A total of 3,338 patients were studied. Their mean age was 37 years and 81.6% were female. Being treated by a particular GP was an important factor in patients with depressive and/or anxiety diagnosis as well as having both diagnoses. Furthermore, higher score of adherence to the guideline was associated with less continuity of care in depressive patients. Conclusion: Being treated by certain GPs is an effective way of retention of patients in the treatment. The results demonstrate that patients with guideline-based pharmacotherapy need to be told about continuity of care in community mental health program. [ABSTRACT FROM AUTHOR]

Introduction: Professional behavior is first learned at the university. One of the necessary considerations in maintaining the professional environment of the university is establishing a set of codes for the behavior of physicians and medical students. This paper describes the process of developing the professional code of conduct in Tehran University of Medical Sciences, Tehran, Iran. Methods: A review of Iranian and international literature was performed to develop the first draft of the guideline. In sessions of group discussion by the authors, the articles of the draft were evaluated for relevancy, clarity, and lack of repetition. The draft was sent for evaluation to all participants, including the medical faculty members, residents, and medical students, four times and necessary corrections were made according to the comments received. Results: The final guideline included 76 behavior codes in 6 categories, including altruism, honor and integrity, responsibility, respect, justice, and excellence. The codes of the guideline cover the physicians' commitments in the physician-patient, physician-colleague, and instructor-student relationships in order to improve the quality of the services. Conclusion: The Islamic and Iranian culture were taken into consideration in developing the guideline. Accordance with the administrative and educational conditions of the universities was ensured in developing the guideline and its acceptance was ensured through extensive surveys. Thus, it is expected that this guideline will be very effective in enhancing professional commitment in medical universities. [ABSTRACT FROM AUTHOR]

Traditional standardization methods have been used in medical research for a long time to standardize the effect of interest for one confounder such as age. Model-based standardization extension of these methods is used when we have more than one variable produces an effect which is the population average and has marginal causal interpretation. In this paper, we discuss the most traditional model-based standardization methods that are used to estimate the marginal causal effect of exposure. We applied these methods to data from Tehran Thyroid Study and estimated the standardized effect of exposure on outcome. Based on the simulation studies, covariate standardization is preferred except when 1) we have enough information about the mechanism of exposure or 2) the outcome is rare and exposure is frequent, so propensity score standardization is suggested. [ABSTRACT FROM AUTHOR]

Background and objectives: This paper aimed to study the epidemiology of suicide and causes related to fatal suicide in Ilam province, west of Iran. Methods: All data related to attempted suicide and fatal suicide during 2011-2012 were extracted from the suicide registry of authorized directorates in Ilam Province, Iran. Risk factors for fatal suicide were evaluated using logistic regression modeling and discrimination of model assessed using ROC curve. Results: A total of 1537 registered cases were analyzed, among which 130 were recorded as fatal suicides (1227 attempted suicides). Overall, 805 (52.4%) cases were female, 9.2% had a history of suicide, 59.3% were married and 63.3% of cases were aged under 24 years. The most common suicide method was overdose of medications (75.5%). In multivariable analysis, male gender (OR: 0.50; CI 95% 0.25 to 0.99) and higher education (OR: 0.36; CI 95% 0.20 to 0.65) were protective factors and application of physical methods (OR: 11.61; 95% CI 5.40 to 24.95) was a risk factor for fatal suicide. Conclusions: Female gender, low education level and use of physical methods of suicide were revealed as risk factors of fatal suicide. We suggest population based case-control studies based on the suicide registry data for further assessing the risk factors of suicide in Ilam. [ABSTRACT FROM AUTHOR]

Background: Cancer is one of the most common non-communicable diseases in both sexes and a major cause of disability and death around the world, as well as in Iran. The aim of the present manuscript is to report the results of the Global Burden of Disease study 2010 (the GBD 2010) to compare them with other similar findings. The paper also discusses the current deficiencies in the GBD study. Our aim was to describe and criticize the attributed burden of cancers according to the GBD results by sex and age. Methods: The GBD 2010 has profited from 100 collaborators worldwide and provides a vast network of data on health outcomes, vital registries, and population surveys. The GBD has used various scientific-approved methods to estimate important health statuses like death rates, life expectancy, and healthy adjusted life expectancy, disability-adjusted life years, years of living lost due to premature death and years of life with disabilities. In the present study, we extracted and graphed the GBD results for Iran in order to present a better scheme for readers. Results: The mortality rate of cancers in Iranians has increased by about 8.5%, while the disability-adjusted life year rates have declined by about 9%, and years lost due to premature death have also decreased by about 10% from 1990 to 2010 compared to an 85% increase in years of life with disabilities in the same time period. Conclusion: The burden of all non-communicable diseases (NCDs) including cancers shows a decrease during the past two decades. However, these diseases still remain a global health challenge. Prevention should be considered as an important priority and responsibility. The health authorities also need to determine the burden of cancers at national and sub-national levels for implementation of effective preventive strategies. [ABSTRACT FROM AUTHOR]

Background: Hemoglobinopathies are known as the most common genetic disorders in Iran. The paper aims to provide global estimates of deaths and disability adjusted life years (DALYs) due to hemoglobinopathies in Iran by sex and age during 1990 to 2010 and describe the challenges due to limitations of the Global Burden of Diseas study 2010 (the GBD study 2010). Methods: The GBD study 2010 estimates of the numbers of deaths and years of life lost (YLLs) due to premature mortality were calculated using the Cause of Death Ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplication of prevalence, the disability weight for occurrence of sequelae, and the duration of symptoms. Prevalence was estimated through a systematic search of published and available unpublished data sources, with a Bayesian meta-regression model developed for GBD study 2010. Disability weights were produced using collected data from population-based surveys. Uncertainty from all inputs was incorporated into the computations of DALYs using simulation methods. We aim to prepare and criticize the results of the GBD study 2010 and provide some recommendations for reaching better conclusions about the burden of hemoglobinopathies in Iran. Results: Between 1990 and 2010, the overall deaths attributed to hemoglobinopathies decreased from 0.51% to 0.36% of total deaths, with the corresponding burden declining from 1 % to 0.82% of total DALYs. There was a reduction in deaths and DALYs rates for all ages and the rates attributed to all ages followed the same pattern in Iranian men and women. The highest DALYs for hemoglobinopathies, thalassemia, sickle cell disorder, and glucose-6-phosphate dehydrogenase deficiency (G6PD-D) were found in those aged less than 5 years. The collective burden of all of these hemoglobin disorder was lower in 2010 than in 1990. Conclusion: Although the screening programs in Iran have been very successful in reducing the number of thalassemia patients between 1990 to 2010, in order to provide a better estimation of the burden of hemoglobin disorders, it is necessary to perform a national and sub-national study of hemoglobinopathies using multiple national and sub-national surveys. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from the Global Burden of Disease study 2010, by sex and age in Iran from 1990 to 2010. Methods: The Global Burden of Disease Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. In this study, our aim was to reformulate the GBD 2010 data, produce new graphs, and explain the results for Iran in greater detail. Results: Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1 % in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory diseases. In 2010, three leading burden of diseases attributed to tobacco smoking belonged to ischemic heart disease, chronic respiratory disease, and cerebrovascular diseases, respectively. Conclusion: Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for death and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the and disease burden attributed to tobacco smoking. [ABSTRACT FROM AUTHOR]

Introduction: Policy formulation and adoption often happen in a black box. Implementation challenges affect and modify the nature of a policy. We analyzed hospitals' autonomy policy in Iran that was intended to reduce hospitals' financial burden on government and improve their efficiency. Methods: We followed a retrospective case-study methodology, involving inductive and deductive analyses of parliamentary proceedings, policy documents, gray literature, published papers and interview transcripts. We analyzed data to develop a policy map that included important dates and events leading to the policy process milestones. Results: We identified four time-periods with distinctive features: 'moving toward the policy' (1989 - 1994), 'disorganized implementation' (1995 - 1997), 'continuing challenges and indecisiveness in hospitals financing' (1998 - 2003), and 'other structural and financial policies in public hospitals' (2004 to date). We found that stakeholders required different and conflicting objectives, which certainly resulted in an unsatisfactory implementation process. The policy led to long-lasting and often negative changes in the hospital sector and the entire Iranian health system. Conclusion: Hospital autonomy appeared to be an ill-advised policy to remedy the inefficiency problems in low socioeconomic areas of the country. The assumption that hospital autonomy reforms would necessarily result in a better health system, may be a false assumption as their success relies on many contextual, structural and policy implementation factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma is a chronic inflammatory airway disease caused or worsened by environmental factors in genetically vulnerable people. The study of national and sub-national burden of asthma aims to provide a quantitative method and valid estimates for the prevalence, incidence, and economic burden of asthma disease in Iran from 1990 to 2013 and this papers explains measures, data sources, methods, and challenges that we will use in the study. METHODS: In order to conduct this study, we will use all available unpublished data sources, including claim databases and data collected by the food and drug organization (FDO). Moreover, we will devise and run a systematic review of all studies and literature published about asthma epidemiology in Iran, which includes all cross-sectional, cohort and case-control studies with asthma epidemiology focus that are population based. In this study, we will use two statistical models, including spatio-temporal and multilevel autoregressive models to estimate mean and uncertainty intervals for the parameters under study by gender, age, year, and province. All programs will be written in R statistical packages (version 3.0.1). CONCLUSION: This study helps to obtain information concerning the variation among regions and provinces, and in general among sub-national divisions. Our study can be contribute to better allocation of resources, since it helps policymakers to recognize inequalities between regions and provinces and consequently help them to allocate resources more efficiently. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dementia is a disabling syndrome, which generally affects aged population more than any other age group. This syndrome has a growing prevalence and incidence worldwide. The prevalence and burden of this group of diseases in Iran have not been estimated in a community-based study yet. This paper aims to explain the systematic approach, data sources, research methodology, and statistical analysis that will be used to quantify the prevalence and burden of dementia at national and sub-national levels. METHODS: This is the protocol of a secondary data study that explains the design and method of conducting the study. We will use several sources of data that will include a systematic review of articles and gray literature which have reported the prevalence or incidence of dementia and its uncertainty at national and sub-national levels in Iran, in addition to data about dementia-specific drug sales per each year at provincial levels, as well as data extracted from 23 million health insurance prescriptions over 8 years and some data from medical documents of Iranian Alzheimer's Association members. The technical groups of National and Sub-national Burden of Disease will collect some covariate data, such as age and sex structure of population, urbanization status, mean years of schooling, plasma cholesterol, fasting plasma glucose, and systolic and diastolic blood pressure at provincial levels which will be used in our models. Two statistical models, namely spatio-temporal and hierarchical autoregressive models, will be used for interpolation and extrapolation of missing data. CONCLUSION: It seems that the study of national and sub-national burden of dementia could provide more accurate estimation of prevalence and burden of dementia in Iran with an acceptable level of uncertainty than the previous studies. [ABSTRACT FROM AUTHOR]

Over the past 35 years Iran had significant quantitative progress in postgraduate medical education; and growth in specialist's physician workforce supply. Health and medical education policy makers have struggled with many issues related to physician supply, such as determining the sufficient number of physicians workforce and the appropriate number to train; establishing new medical schools; the diversity of specialty programs; efforts to increase the supply of physicians in specialty level in remote and rural areas; and the growing number of female physicians and its impact on health services. After establishment of MoHME in Iran, expansion of medical specialty education was a priority. Since then, great advances have been made in training of new specialty programs. Despite of these brilliant advances during the last decades in Iran, there has been no integrated and comprehensive documentation of previous and current growth trend, yet. To understand where Iranian physician supply and specialty training is headed, we examined the Iranian medical specialist's trends from 1979 to 2013 in a national study by support of Iranian academy of medicine. This paper documents the growth trend of medical specialist's workforce over the past 35 years. Examining the health manpower growth trends allow health and medical education policy makers to plan innovative strategies for the purposeful expansion of postgraduate medical education to ensure that in future there would be sufficient physicians supply, with the right skills, in the right places in response to population demands. [ABSTRACT FROM AUTHOR]

Introduction: Hospitalized patients constitute the main fraction of users in any health system. Financial burden of reimbursement for received services and cares by these users is sometimes unbearable and may lead to catastrophic medical payments. So, designing and implementing effective health prepayments schemes appear to be an effective governmental intervention to reduce catastrophic medical payments and protect households against it. We aimed to calculate the proportion of hospitalized patients exposed to catastrophic medical payments, its determinant factors and its distribution. Matherials and Methods: We conducted a cross sectional study with 400 samples in five hospitals affiliated with Tehran University of Medical Sciences (TUMS). A self-administered questionnaire was distributed among respondents. Data were analyzed by logistic regression and χ2 statistics. Also, we drew the Lorenz curve and calculated the Gini coefficient in order to present the distribution of catastrophic medical payments burden on different income levels. Results: About 15.05% of patients were exposed to catastrophic medical payments. Also, we found that the educational level of the patient's family head, the sex of the patient's family head, hospitalization day numbers, having made any out of hospital payments linked with the same admission and households annual income levels; were linked with a higher likelihood of exposure to catastrophic medical payments. Also, the Gini coefficient is about 0.8 for catastrophic medical payments distribution. Conclusion: There is a high level of catastrophic medical payments in hospitalized patients. The weakness of economic status of households and the not well designed prepayments schemes on the other hand may lead to this. This paper illustrated a clear picture for catastrophic medical payments at hospital level and suggests applicable notes to Iranian health policymakers and planners. [ABSTRACT FROM AUTHOR]

Multiple endocrine neoplasia (MEN) type 2A, a dominant inherited syndrome caused by germline activating mutations in the RET protooncogene, is characterized by association of medullary thyroid carcinoma, pheochromocytoma and primary hyperparathyroidism. There is limited data on this disease in the Middle East region. In this paper, we present clinical and genetic studies of an Iranian patient and her family members. The patient was a 49-year old Iranian woman who presented with hypertension due to bilateral pheochromocytoma. She had history of a medullary carcinoma of thyroid which had been operated 28 years ago. Analysis of the RET gene in the family revealed a C634R mutation in codon 11 and 3 polymorphisms, G691S, S836S and S904S in codons 11, 14 and 15, respectively, that might have been important in modifying the clinical picture. Due to paucity of information on MEN type 2 in the area, this study can be helpful in portraying the clinical and cytogenetic characteristics of the disease in the region. [ABSTRACT FROM AUTHOR]

Background: Drawing on the results of the country-level Global Burden of Diseases, Injuries, and Risk Factors 2010 Study, we attempted to investigate the drivers of change in the healthcare system in terms of mortality and morbidity due to diseases, injuries, and risk factors for the two decades from 1990 to 2010. Methods: We decomposed trends in mortality, cause of death, years of life lost due to disability, disability-adjusted life years (DALYs), life expectancy, health-adjusted life expectancy, and risk factors into the contribution of total increase in population size, aging of the population, and changes in age-specific and sex-specific rates. Results: We observed a decrease in age-specific mortality rate for both sexes, with a higher rate for women. The ranking of causes of death and their corresponding number of years of life lost remained unchanged between 1990 and 2010. However, the percentages of change indicate patterns of reduction for most causes, such as ischemic and hemorrhagic stroke, hypertensive heart disease, stomach cancer, lower respiratory infections, and congenital anomalies. The number of years lost due to disability caused by diabetes and drug use disorders has significantly increased in the last two decades. Major causes of DALYs, such as injuries, interpersonal violence, and suicide, showed increasing trends, while rates of communicable diseases, neonatal disorders, and nutritional deficiencies have declined significantly. Life expectancy and health-adjusted life expectancy increased for both sexes by approximately 7 years, with the highest rate of increase pertaining to females over the age 30. Conclusions: Time trend information presented in this paper can be used to evaluate problems and policies specific to medical conditions or risk factors. Despite recent improvements, implementing policies to reduce the number of deaths and years of life lost due to road traffic injury remains the highest priority for Iranian policymakers. Immediate action by Iranian researchers is required to match Iran's decreasing mortality rate due to liver and stomach cancers to a rate comparable to the global level. Prevention and treatment plans for mental disorders, such as major depressive disorder, anxiety disorder, and particularly drug use disorders, should be considered in reforms of the health, education, and judiciary systems in Iran. [ABSTRACT FROM AUTHOR]

BACKGROUND: Worldwide, injuries are a major public health concern and make a considerable contribution to the disease burden. The present study is a component of the National and Subnational Burden of Diseases, Injuries, and Risk Factors from 1990 to 2013 (NASBOD) study in Iran, which was designed to investigate the burden of most important injuries (road traffic injuries, falls, burns, poisonings and drownings) at the national and sub-national levels in Iran. In this paper we explain definitions, organization, injuries selection process, data sources, data gathering methods, and data analyses of the national and sub-national burden of injuries study in Iran. METHODS: The burden of most important injuries in current metric of DALYs at the national and sub-national levels in Iran over 1990-2013 will be estimated through comprehensive reviews of either published or national data sources. Statistical modeling will be used to impute the missing data on the burden of selected important injuries for each district-year. CONCLUSION: The results of present study can help health policy makers to plan more comprehensive and cost-effective strategies at national and sub-national level for prevention and control of burden caused by injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Iran has witnessed a substantial demographic and health transition, especially during the past 2 decades, which necessitates updated evidence-based policies at national and indeed at subnational scale. The National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD) Study aims to provide the required evidence based on updated data sources available in Iran and novel methods partly adopted from Global Burden of Disease 2010. OBJECTIVE: This paper aims at explaining the motives behind the study, the design, the definitions, the metrics, and the challenges due to limitations in data availability.METHODS: All available published and unpublished data sources will be used for estimating the burden of 291 diseases and 67 risk factors from 1990 to 2013 at national and subnational scale. Published data will be extracted through systematic review. Existing population-based data sources include: registries (death and cancer), Demographic and Health Surveys, National Health Surveys, and other population-based surveys such as Non_Communicable Diseases Surveillance Surveys. Covariates will be extracted from censuses and household expenditure surveys. Hospital records and outpatient data will be actively collected as two distinct projects. Due to lack of data points by year and province, statistical methods will be used to impute the lacking data points based on determined covariates. Two main models will be used for data imputation: Bayesian Autoregressive Multi-level models and Spatio-Temporal regression models. The results from all available models will be used in an Ensemble Model to obtain the final estimates. Five metrics will be used for estimating the burden: prevalence, death, Years of Life Lost due to premature death (YLL), Years of Life Lost due to Disability (YLD), and Disability-Adjusted Life Years Lost (DALY). Burden attributable to risk factors will be estimated through comparative risk assessment based on Population Attributable Fraction (PAF). Uncertainty Intervals (UIs) will be calculated and reported for all aforementioned metrics. RESULTS: We will estimate trends in terms of prevalence, deaths, YLLs, YLDs, and DALYs for Diseases, Injuries, and Risk Factors province from 1990 to 2013. CONCLUSION: Results of the present study will have implications for policy making as they address health gaps in Iranian population and their inequality between provinces. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) and their risk factors are a major health threat at the global level, notably for developing countries. The tracking of cardiometabolic risk factors from childhood to adulthood is well documented. Therefore, more attention needs to be directed at primordial and primary prevention of NCDs. Given the high prevalence of NCDs and their risk factors in Iranian population, a study was designed to determine the attributable burden of cardiometabolic risk factors in Iranian pediatric population during past decades. Methods: This paper explains the definitions, organization, data sources, methods of data gathering or generating, data analyses, and the trend analysis of the study. A national expert working group addressed unmet needs and offered consultations on the selection of risk factors and the practical definition of disease. In the later stages, during the course of the study, they will supervise the statistical modeling methods, the interpretation of results, and the publication strategy. Also an international expert advisory group will collaborate with the project team. Conclusion: The findings of this study should provide basic information regarding NCD related risk factors, and their burden and trends in children, which is necessary for health policy decisions to reduce the burden of disease and to plan cost-effective preventive strategies. [ABSTRACT FROM AUTHOR]

The history of human and animal cancers date back to antiquity. The earliest written document on cancer appeared on Egyptian papyrus. For centuries, the theory of "four humors" was the primary hypothesis that explained the cause for cancer. Finally, in the 19th century a new era began with the detection of the cellular origin of cancer; in due course, the nature of this lethal disease was better recognized and led to further achievements in cancer treatment. During the 20th century researchers investigated several risk factors for cancer such as tobacco smoking and environmental chemicals, in addition to the carcinogenic role of certain viruses, occupational association of cancer, its relationship with certain hormones and dietary habits, and the genetic basis of cancer. These investigations resulted in more efficient cancer management. After the advent of radiotherapy and chemotherapy as two complementary therapeutic modalities to surgery, the campaign against cancer has improved. However, cancer remains a major health challenge that accounts for substantial morbidity and mortality worldwide. The present paper briefly reviews the history of cancer in Iran, particularly during the last decades of the 20th century. [ABSTRACT FROM AUTHOR]

Almost four decades ago, an eminent physician, outstanding mentor and scholar, Professor Faramarz Ismail-Beigi (b. 1941) was appointed Chair of the Department of Internal Medicine at Shiraz Medical School. Soon, this proved to be the beginning of a golden era in medical education at that center. Professor Ismail-Beigi invited outstanding teachers and physicians to collaborate with him. Their efforts during the next decade laid a strong and unique foundation for medical education based on quality mentorship and role-modeling. In this paper, we briefly highlight the importance of mentorship in medicine and medical education, followed by a glance at the academic life and career of Professor Ismail-Beigi and his role as a prominent mentor at the Shiraz School of Medicine. [ABSTRACT FROM AUTHOR]

On March 9th, 2011, the eminent scholar of Iranian studies, historian, bibliographer, Persian manuscript expert, journalist, biographer and writer, Iraj Afshar passed away at the age of 85 in Tehran. His demise was a great loss to Iranian culture. He edited or wrote around 300 books in various fields of Iranian studies, including the history of medicine in Iran and published more than 2000 papers in local and international journals. The late Afshar was considered as a world-class Iranologist who promoted Persian culture for over five decades and had profitable mutual worldwide connection with famed scholars in the field of Iranian studies and pertinent international societies. Herein is a brief look at his life and career, with special focus on his works in the field of the history of medicine in Iran. [ABSTRACT FROM AUTHOR]

Approximately ninety two years ago, the worst influenza pandemic or "Spanish flu" occurred in 1918, at the end of the First World War (WWI, 1914 - 1918) which resulted in the deaths of millions of people worldwide. The death toll exceeded the total number of victims of WWI. The 1918 Spanish flu was a deadly, major global event that affected many countries, including Iran. In Iran, it was accompanied by a high mortality rate estimated to be more than one million. However, detailed information on the impact of this outbreak in Iran is scarce. The present paper describes a brief history of the influenza pandemics in the world as well as the spread of the 1918 Spanish flu to Iran. [ABSTRACT FROM AUTHOR]

This report describes an experience of the first international health for peace conference held in November 2018 in Shiraz University of Medical Sciences. This paper discusses the panel on peace education in medical and paramedical schools and the way for the future. [ABSTRACT FROM AUTHOR]