Social Values in Health Prioritizing: the analysis of national documents of Iran

Background: Health system, as a part of the wider social system, should consider social values in decisions for health prioritizing. This study was aimed at identifying social values considered in the health-related national documents. Methods: This qualitative study was conducted based on the Clark-Weale framework to identify the social values in health related national documents. Identification of health-related basic documents (11 documents) was performed purposefully. Documents included Iran's Constitution Law, the 5-year development plan, national health insurance law, urban family physician program, health sector development map, Health Ministry foundation law and Health Ministry structure and organizational law. Each value was analyzed based on qualitative content analysis. Results: Different approaches toward considering social values were observed. While some documents had explicitly considered social values, some others had implicitly considered them. The health Road Map was the most comprehensive document in terms of considering social values. Equity was the most repeated value in documents and clinical effectiveness was not mentioned in any of the documents. Conclusion: Although, the importance of social values has been increased in national documents during the recent years, it dose not have the same trend in different documents and each of them have emphasized on different social values. It seems that using national documents, as a practical guide, can be effective in achieving health system goals

Effect of Fluoride Gel on Microhardness of Flowable Composites: An In Vitro Study

Objective: Adequate knowledge about restorative materials particularly flowable composite resins with favorable physical properties like optimal microhardness and resistance to environmental factors is a big concern for many dentists. Flowable composites have several applications for fissure sealant therapy and preventive resin restorations (PRR); which are common treatments in pediatric dentistry.  Acidulated Phosphor Fluoride (APF) topical gels can cause surface degradation and  weight loss in composite resins and decrease their wear resistance. This study aimed to assess the effect of APF gel on the microhardness of flowable composites.Methods: This experimental in vitro study was conducted on 60 specimens measuring 2mm in thickness and 6mm in diameter fabricated of Tetric N-Flow (Ivoclar-Vivadent), PermaFlo  (Ultradent) and Denfil (Vericom) flowable composites (n=20 for each group). Specimens were stored in artificial saliva at room temperature for one week. The 20 specimens in each group were randomly divided into 2 subgroups of test and control (n=10). Microhardness was measured using Vickers microhardness tester. In the control groups, 3 indentations were made on each disc on the periphery of a circle with at least 1mm distance from one another and from the specimen margin.  The mean microhardness value was then calculated. The mean of all measurements was calculated  as well. Test specimens were subjected to (Sultan) 1.23% APF gel for 4min and then rinsed and air- dried. Their microhardness was measured again as described above. Two-way ANOVA was used to compare the effect of APF gel and type of composite on the microhardness of different flowable composites.Results: Based on the results, the microhardness of Denfil, PermaFlo and Tetric N-Flow was 16.5 (1.32), 37.36 (2.13) and 20.39 (0.52) before and 16.46 (2.20), 35.04 (2.43) and 19.13 (2.20) after theapplication of APF gel, respectively. The difference between the before and after values for each composite was significant (p=0.193) while the difference between different composites was statistically significant in this regard (p<0.001).Conclusion: Exposure of Denfil, PermaFlo and Tetric N-Flow flowable composites to APF gel for 4min had no effect on their microhardness

An assessment of recent Iranian fertility trends using parity progression ratios

Background In 2013 a draft population bill was introduced in the Iranian Parliament. Based on the presumption that fertility in Iran had fallen to a very low level, the bill proposed a wide range of pronatalist policies with the aim of increasing fertility to 2.5 births per woman. The draft law called for restrictions on the employment of women and young single people and inducements for women to marry in their late teens. New estimates of fertility, such as those provided in this paper, cast doubt upon the view that fertility had fallen to a very low level. In May 2014 a statement issued by the Supreme Leader provided guidelines for a more moderate approach to sustaining fertility at around the replacement level. Objective To measure the trend in fertility in Iran, especially from 2000 onwards. Methods Using the 2010 IDHS, the synthetic cohort parity progression ratio method is used to measure the fertility trend in Iran. Synthetic parity progressions are compared with real cohort parity progressions to examine the presence of tempo effects. Comparison is made with age-based measures from surveys, censuses, and the birth registration system. Results This paper demonstrates that fertility in Iran was constant for the decade 2000-2009, at a level of around 1.8-2.0 births per woman. Conclusions Our findings provide evidence supporting a more moderate approach to sustaining fertility in Iran at around the replacement level. Comments The paper demonstrates the advantages of parity-based measurement over age-based measurement when tempo effects may be involved

Inequality in household catastrophic health care expenditure in a low-income society of Iran

Background We assessed change in household catastrophic health care expenditures (CHE) and inequality in facing such expenditures in south-west Tehran. Methods A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the ‘household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors. Results Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups. Conclusions We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payment

Inequality in household catastrophic health care expenditure in a low-income society of Iran

Background We assessed change in household catastrophic health care expenditures (CHE) and inequality in facing such expenditures in south-west Tehran. Methods A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the ‘household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors. Results Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups. Conclusions We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payment

Isolation, cloning and molecular analysis of ag85a and tb10.4 genes from Mycobacterium tuberculosis

Background: Novel tuberculosis (TB) vaccines that aim to boost and/or replace Bacillus Calmette-Guerin (BCG) are currently in development. DNA vaccines can stimulate both humoral and cell-mediated immunity in different animal models of TB and is thought to be a promising strategy in the development of new vaccines against TB. The aim of this study was to design and construct a DNA vaccine encoding ag85a and tb10.4 fusion genes of Mycobacterium tuberculosis.Materials and Methods: tb10.4 fragment was amplified by PCR and the product was digested with restrictionenzymes. Next, it was cloned into the pcDNA3.1+ plasmid. The ag85a gene and pcDNA3.1+/tb10.4 plasmid were digested by EcoRI and BamHI restriction enzymes. Constructed vector was sequenced. The molecular analysis was done using bioinformatics software. New chimeric vector containing ag85a-tb10.4 genes were purified. Expression of pcDNA3.1+/tb10.4-ag85a plasmid was confirmed in eukaryotic cells.Results: Fragments of 297 bp for tb10.4 and 1017 bp for ag85a were observed in agarose gel electrophoresis.Alignment of ag85a-tb10.4 genome sequence with reference genes in GenBank showed exact identities that indicate correction of all cloning procedures. Transfection of eukaryotic cells with pcDNA3.1+/tb10.4-ag85a vector and existence of tb10.4-ag85a fusion gene were both confirmed with RT-PCR.Conclusion: In this study, tb10.4 and ag85a genes were isolated from Mycobacterium tuberculosis H37Rv strain and cloned into pcDNA3.1+. Also, the capability of constructed vector in producing fusion ag85a-tb10.4 protein was confirmed with RT-PCR. pcDNA3.1+/tb10.4-ag85a vector can be used for further studies in future

Epithelial-to-Mesenchymal Transition Contributes to Immunosuppression in Breast Carcinomas

The epithelial-to-mesenchymal transition (EMT) is a cell biological program that confers mesenchymal traits on carcinoma cells and drives their metastatic dissemination. It is unclear, however, whether the activation of EMT in carcinoma cells can change their susceptibility to immune attack. We demonstrate here that mammary tumor cells arising from more epithelial carcinoma cell lines expressed high levels of MHC-I, low levels of PD-L1, and contained within their stroma CD8þT cells and M1 (antitumor) macrophages. In contrast, tumors arising from more mesenchymal carcinoma cell lines exhibiting EMT markers expressed low levels of MHC-I, high levels of PD-L1, and contained within their stroma regulatory T cells, M2 (protumor) macrophages, and exhausted CD8þT cells. Moreover, the more mesenchymal carcinoma cells within a tumor retained the ability to protect their more epithelial counterparts from immune attack. Finally, epithelial tumors were more susceptible to elimination by immunotherapy than corresponding mesenchymal tumors. Our results identify immune cells and immunomodulatory markers that can be potentially targeted to enhance the susceptibility of immunosuppressive tumors to various therapeutic regimens.National Institutes of Health (U.S.) (Grant P01-CA080111

Enzymatic Construction of DARPin-Based Targeted Delivery Systems Using Protein Farnesyltransferase and a Capture and Release Strategy

Protein-based conjugates have been extensively utilized in various biotechnological and therapeutic applications. In order to prepare homogeneous conjugates, site-specific modification methods and efficient purification strategies are both critical factors to be considered. The development of general and facile conjugation and purification strategies is therefore highly desirable. Here, we apply a capture and release strategy to create protein conjugates based on Designed Ankyrin Repeat Proteins (DARPins), which are engineered antigen-binding proteins with prominent affinity and selectivity. In this case, DARPins that target the epithelial cell adhesion molecule (EpCAM), a diagnostic cell surface marker for many types of cancer, were employed. The DARPins were first genetically modified with a C-terminal CVIA sequence to install an enzyme recognition site and then labeled with an aldehyde functional group employing protein farnesyltransferase. Using a capture and release strategy, conjugation of the labeled DARPins to a TAMRA fluorophore was achieved with either purified proteins or directly from crude E. coli lysate and used in subsequent flow cytometry and confocal imaging analysis. DARPin-MMAE conjugates were also prepared yielding a construct manifesting an IC$_{50}$ of 1.3 nM for cell killing of EpCAM positive MCF-7 cells. The method described here is broadly applicable to enable the streamlined one-step preparation of protein-based conjugates

Predictors of Transition in Different Stages of Smoking: A Longitudinal Study

Abstract We investigated longitudinally the prevalence of smoking according to three stages of smoking (never smoking, experimenting the smoking, and regular smoking), the rates of transition from one stage to another one, and determinant predictors of transition through these stages of smoking. Of all 10th grade students in Tabriz, 1785 students were randomly selected and assessed twice, with a 12-month interval, with respect to the changes of stage. The predictor variables were measured when the students were in the 10th grade. Logistic regression and principal component analysis were used to analysis data at grade 11. Of 1785 students, 14.3% (CI 95%: 12.3-16.4) and 2.8% (CI 95%: 2.0-4.0) of the never smokers became experimenters and regular smokers, respectively and 16.5% (CI 95%: 12.4-21.7) of the experimenters became regular smokers. Among never smokers, participating in smoker groups (OR = 1.24), having smoker friends (OR = 1.85) and a positive attitude towards smoking (OR = 1.22) predicted experimentation; and participating in smokers groups (OR = 1.35) and a lower socioeconomic class (OR = 0.36) predicted regular smoking. Among experimenters, students having general high risk behaviors (OR = 2.56) and participating in smoker groups (OR = 2.58) were distinguished as those who progressed to regular smoking in follow-up. Programs aimed at smoking prevention and intervention should incorporate plans which focus on predictors of transition through smoking stages, and targeting participation in smoker groups