Journal of School of Public Health and

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Background and Aim: Infectious complications after renal transplantation are associated with significant morbidity and mortality. We evaluated post-transplant complications due to infections and their relationship with graft function, immunosuppressive drugs and mortality.
Materials and Methods: Over a 2-year period (2002-2004), 179 renal transplantations were performed in our center. Of these, 142 cases were followed for a period of one year. The immunosuppressive regimen included cyclosporin A, mycophenolate mofetil and prednisolone. Each patient was assessed through regular visits and according to the ward protocol. Results of the investigations (infections and their relationship with age, sex, donor type, creatinine level, acute rejection, immunosuppressive drugs, graft and patient survival) were recorded and analyzed.
Results: The overall incidence of infection was 54%. The most common sites were lower urinary tract (42%) and respiratory tract (6%). The most frequent causes were Klebsiella (24%) and Cytomegalovirus (18%). Wound infection occurred in 5% of the patients. The overall mortality was 7.7%, and almost half of the death cases (3.5%) involved sepsis development. Graft loss occurred in 16 (11%) of the cases: 2 developed Cytomegalovirus infection, 2 experienced urinary tract infection (UTI) and 5 developed sepsis (and expired). Mycobacterial and hepatitis C infections were noticeably low compared to other studies. The hazard rate in occurrence of UTI, CMV, acute rejection and mortality were higher in cadaveric transplant recipients than in others.
Conclusion: This study identifies infections as a major cause of morbidity and mortality in the post-transplant period. Patients having higher creatinine levels and those receiving high doses of drugs at discharge are considered to be at high risk and should be evaluated thoroughly.

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Background and Aim: Domestic violence against women is a major health problem, as well as a violation of human rights. It adversely affects the physical, mental, and social well being of women, families and communities. This phenomenon exists in all countries around the world. Although its prevalence, strength, types, effects, and risk factors are different, it is not limited to any geographical zone or distinct social class. This article presents the views of Tehrani couples and experts on underlying factors causing domestic violence against women in Iran and action to be taken for prevention.
Materials and Methods: This qualitative study was carried out through eight FGD meetings, in 2 days, with the participation of 50 couples. The couples were divided into 8 groups based on sex, education, and history of violence. Results of the FDGs were categorized and analyzed. Data were discussed in group meetings of 50 experts in different fields, such as health, medicine, law, education, and Islamic studies, from academic, policy making, governmental executive, and women's affairs organizations, divided into three groups of community general education and information dissemination, health system, and judiciary system. Results were discussed and finalized in a general meeting.
Results: The couples and experts identified underlying factors in 4 categories socio-cultural, economic, legal, and medical. Actions to be taken for prevention and control were believed to be educational, legal, and supporting services.
Conclusion: On the basis of the findings of this study, it was suggested that strategies/actions/services to solve the problem and reduce harm should include providing appropriate information and education for couples and the community emphasizing the health system responsibility empowering physicians and other health personnel to help women who are victims or susceptible to domestic violence legal transparency and reforms meeting legal needs law reinforcement and implementation providing safe shelters for victims and establishment of a national center for research and planning on violence.

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Background and Aim: Thalassemia is one of the most common worldwide single-gene diseases. On the molecular level, it is a heterogeneous disease. So far, beside large deletions, more than fifty point mutations have been identified for this disease around the world. Four to ten percent of Iranians are carriers of thalassemia-affected genes. In this study we determined the relationship between the value of MCV/MCH and the type and severity of mutations in alpha thalassemia carriers.

Methods and Materials: The major abnormality in alpha thalassemia carriers is decreased values of MCV and MCH. A total of 104 adult alpha thalassemia heterozygotes, 20-40 years old, including 33 persons from Khoozestan Province and 71 from Khorasan Province, were included in the study. Two hundred and eight chromosomes were isolated from peripheral blood leukocytes using standard procedures. DNA samples were amplified by Gap-PCR.

Results: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

Conclusion: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

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Background and Aim: Many studies show that the only way to control diabetes and prevent its debilitating complications is continuous self-care. This study aimed to determine factors affecting self-care behavior of diabetic women in Khoy City, Iran based the extended theory of reasoned action (ETRA).

Materials and Methods: A sample of 352 women with type 2 diabetes referring to a Diabetes Clinic in Khoy City in West Azarbaijan Province, Iran participated in the study. Appropriate instruments were designed to measure the relevant variables (diabetes knowledge, personal beliefs, subjective norm, self-efficacy and behavioral intention, and self-care behavior) based on ETRA. Reliability and validity of the instruments were determined prior to the study. Statistical analysis of the data was done using the SPSS-version 16 software.

Results: Based on the data obtained, the proposed model could predict and explain 41% and 26.2% of the variance of behavioral intention and self-care, respectively, in women with type-2 diabetes. The data also indicated that among the constructs of the model perceived self-efficacy was the strongest predictor for intention for self-care behavior. This construct affected both directly and indirectly self-care behavior. The next strongest predictors were attitudes, social pressures, social norms, and intervals between visiting patients by the treating team.

Conclusion: The proposed model can predict self-care behavior very well. Thus, it may form the basis for educational interventions aiming at promoting self-care and, ultimately, controlling diabetes.

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Background and Aim: There is evidence showing that increased inflammatory mediators and reduced serum levels of polyunsaturated fatty acids may be present in patients with neurodevelopment and psychiatric disorders, e.g.  attention-deficit/ hyperactivity disorder. (ADHD). The objective of this study was to determine the effects of dietary omega-3 fatty acid supplementation on hyperactivity, attention deficit, and serum inflammatory mediators in children with ADHD

Materials and Methods: This was an 8-week randomized double-blind clinical trial. The participants were 103 6 to12-year old children with ADHD receiving effective maintenance therapy, who were assigned randomly to receive either a daily omega-3 supplement (635 mg eicosapentaenoic acid and 195 mg docosahexaenoic acid (intervention group) or a placebo visually similar to the omega-3 capsules (placebo group). The serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were determined at baseline and at the end of the period. In addition, the abbreviated 10-item Conners parent rating scale (CPRS) was completed for each child before and after the intervention. 

Results: The intervention brought about statistically significant reductions in the levels of CRP and IL-6 and a significant improvement in the CPRS score in the omega-3 group.

Conclusion: The findings indicate that dietary omega-3 fatty acid supplementation can have desirable effects on hyperactivity, attention deficit and inflammatory mediators in children with ADHD.

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Background and Aim: Bioaerosols are one of the most important agents that cause post operating infections in hospitals. Surgical masks are recommended for prevention of bioaerosols transmition in operating rooms. This study aimed at evaluation of submicron particle filtration efficiency of domestic and imported surgical masks.
Materials and Methods: In this cross sectional study, 5 types of surgical masks that have the most utilization in operating rooms of country’s hospitals including domestic and imported surgical masks were tested. To evaluate all samples, the submicron particle filtration measurements were carried out based on ISIRI 6138 and American DOP standards. Filtration efficiency calculations and pressure drop measurements were performed and the results were analyzed using statistical tests.
Results: Results showed that particle filtration efficiency of domestic and imported masks were 56.130% (±10.7) and 31.906% (±7.062) respectively. Also, filtration efficiency in domestic masks were more than imported masks (P> 0.001). Among all samples, Arman mask had the most filtration efficiency (66.5475 % ±6.14951), where the least (27.8275 % ±4.44152) filtration efficiency (P> 0.001) belongs to Blosom. The maximum mean of pressure drop in Arman mask (35 ±2. 58 Pa) and the least mean of pressure drop in Zist filter mask (11 ±1.82 Pa) were observed. According to the effect of filtration efficiency and pressure drop on general quality of mask, the quality factor of masks were also evaluated. Results showed that Zist filter mask had the most quality factor (0.068) while Blosom had the least quality factor (0.016).
Conclusion: This research showed that domestic surgical masks have a better quality toward imported surgical masks but can not obtained quality confirmed by standards, yet. To reduce respective infections and prevalence of diseases, it is recommended using filters with suitable physical characteristics and also carrying out test of surgical masks before supplying.

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Background and aim: Oral and dental diseases limit an individual&aposs activities at the school, work place and home, leading to a loss of millions of work and school hours all over the world. The period of adolescence is critical as regards shaping of healthy behaviors related to oral and dental diseases. The purpose of this study was to explore and describe school pupils&apos viewpoints on factors influencing development of dental caries.  

Materials and Methods: A qualitative study with a content analysis approach was conducted to collect the perspectives of 18 Iranian students in 8 guidance schools selected by purposive sampling. Structured and semi-structured interviews were held to collect data. An informed consent was obtained and the interviews were recorded and transcribed. The data was analyzed through an inductive approach of content analysis. In order to support the validity and rigor of the data, different criteria such as acceptability, confirmability and transferability were utilized.

Results: Data analysis could identify four major factors influencing dental caries development: "family interactions in dental health", "role of school in caring for teeth", "role of dentists in caring for teeth" and "effect of education in caring for teeth". The factors influencing caring for teeth and mouth had a greater significance.

Conclusion: The students&apos experiences, as observed in this study, can help in developing mutual trust between students and dentists, delivering better services in schools by relevant organizations, and designing more effective oral health interventions, with due consideration of vital role of the parents.

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  Background and Aim: probably after pestilence, HIV/AIDS is most important and severe health threat for public health. Prisons could facilitate the spread of HIV/AIDS and Hepatitis and transmit it to societies. The main strategy to control HIV/AIDS and hepatitis among Injecting Drug Users is Harm Reduction Programs. These programs are conducted in Iran Prisons. The goal of this study is to evaluate Harm reduction Programs including Methadone Maintenance Therapy (MMT) and Needle exchange from the viewpoint of prison staff in Iran including principals, managers, physicians and counselors.

  Materials and Methods : It was a cross sectional study in which 370 prison staff working in prisons all around the country were evaluated to assess their viewpoint and insight about Harm reduction Programs including Methadone Maintenance therapy and Needle exchange.

  Results: A percentage of 95.23 of prison managers and experts had a positive view toward Methadone Maintenance therapy. 70.25 percent had a positive insight toward needle exchange program. The employment type and work experience was significantly (p<0.05) related to the viewpoint of managers and experts towards Methadone Maintenance therapy program. Age was the only factor that had a significant relationship (p<0.05) with Needle exchange program.

  Conclusion: MMT has lots of supporters in prisons. The positive insights of managers and experts towards methadone maintenance therapy program demonstrate the high level of staff’s approval for conducting this program it could be interpreted as a sign of success of program in the country. However there is not a comprehensive approval and collaboration with needle exchange program in prisons. Nevertheless, it is alarming that 42.5% of staff believe that conducting methadone maintenance therapy may increase and intensify addiction in prisons.

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  Objectives: The role of mammography in early detection of b reast cancer is evident and persuasion to do that is very important in health sector. Majority of the interventions are based on education and informing and there has been less attention to making mammography cost beneficent. This study aimed at assessing the effect of a social marketing-based intervention to persuade to do mammography in Bojnord.

  Methods: In this quasi-experimental study, two villages around Bojnurd with similar demographic characteristics, considered as intervention and comparison groups randomly. All 35- years and older women consist of 343 women (151 in intervention and 191 in comparison groups) were identified. To obtain the main idea for intervention, and exploring the viewpoints of target group about mammography, a formative research combined of a quantitative survey (through completing the questionnaire for assessing the women’s attitudes based on health belief model) and a qualitative study (through establishing four focus group discussions) was done. According to the gathered and analyzed data, an intervention focused on the main barriers designed and implemented through four weeks. One week after the intervention, the number of mammograms in two villages was determined and compared.

  Results: Quantitative survey showed that the mean of the scores related to expending time and high economical costs (perceived barriers) not remember to do mammography and fear of exposure to x- ray is less than other constructs. In qualitative study, time expending and high economical cost considered as two main factors related to not doing mammography. After the intervention, 48.1 percent of the women in intervention group went to do mammography and there are no change similar results in comparison group.

  Conclusions: Educational interventions are not enough to persuade women to do mammography and we have to consider their perceived barriers and concerns. One of the most effective approach to promote an idea, behavior or service, is identifying the viewpoints of target group and design them as consumer- oriented programs. So, acceptance of the idea and behavior will be cost-beneficent.

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  Backgrond and Aim: Demodicosis is a common skin disease. Great number of admissions to the clinics is occurring in the country. Regarding the high prevalence of this parasitic arthropod, investigating on pathogenesis, route of transmission and the complications they may produce, is considered of great importance. Generally, demodex parasites often exist in the skin tissue and tend to live in the face specifically in cheeks, forehead and nose, where sebum excretion is active and may provide a favorable habitat for living and breading the parasite. Diagnosis is carried out during an exploratory skin test for a cne, pityriasis rosacea and ophthalmic infectious diseases such as blepharitis. Determination of their biological role in chronicity of general skin disorders is an interesting topic in research.

  Materials and Methods: Patients were admitted to the Razi hospital, Research Center for skin diseases and leprosy, and three other clinical laboratories considered for assays. The questionnaire was filled for each patient and the sample was taken from the affected area. Ecto parasites were transferred to the potassium chloride solution 10% and studied under a light microscope.

  Results: A total of 100 patients were studied, from which 78 patients were diagnosed as infected with the Demodex folliculorum. Of these, (%92) were female and (%7.6) male (p <0.05). The highest frequency was observed in the age group 41 to 50 years (P <0.05).

  Conclusion: In this study, the relative frequency of demodicosis was more common in women and in the middle-aged group. Generally this high level of frequency will intensify the necessity of the identification of parasites and its pathological effects in chronic infectious diseases.

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  Background and Aim: Economic factors, including life insurance in financial sector may have a significant effect on health sector and consequently on the life expectancy of the society. The life insurance effects on health index indirectly through economic growth and directly through bringing mental relaxation and social welfare for the person applying for life insurance. The main purpose of this study was to investigate how life insurance demand and other economic factors effect on life expectancy index of the society.

  Materials and Methods: In this study, the relevant data with respect to life expectancy as dependant variable and economic factors including life insurance demand have been collected from Organization of Islamic Conference ( OIC) countries for the years 2011 to 1998 using panel data analysis .

  Results: The results of the study indicate a significant and statistically positive effect of life insurance demand on life expectancy index of the selected OIC countries. On the other hand, the variables such as financial development and per capita income also have significant positive effect, while the variables such as unemployment and inflation have significant negative effect on life expectancy index of health.

  Conclusion: The results suggest that economic conditions improvement through lowering rate of unemployment, lowering rate of inflation, increase in per capita income and the financial market development could probably improve the condition of life expectancy in a society. Therefore, that is recommended for the planners to take into account the fundamental economic indicators specially life insurance consumption while planning for health and welfare betterment of the society.

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  Background and Aim: Exposure to heavy metals always causes serious health problems in people working in the industry. Heavy metals may interfere with enzyme functioning or accumulate in specific body organs, leading to various health problems. Cadmium is a toxic heavy metal widely used in various industries and, therefore, workers in metal industries are at risk of exposure to it.

  Materials and Methods: A solid-phase sorbent was synthesized and factors influencing its sorption and elution steps were optimized (R>95%). The validated sorbent (chemically, physically and as regards reproducibility) was used to determine the cadmium content of the worker`s urines.

  Results: Optimized conditions for sorption and elution step were found to be as follows: pH= 7 sorption and elution time (both)= 5 min elution volume= 6 mL, and elution concentration= 2 mol L^-1. The great selectivity and the nano-particle size of the sorbent resulted in its highly precise performance (0.6ppb) and high validity and accuracy (CV<3%).

  Conclusion: Using the nano-magnetic sorbent technique and some such laboratory methods as flame atomic absorption spectroscopy, one can easily measure trace amounts of heavy metals in urine. This technique is relatively less expensive and rapid since, when using it, one can omit the filtration and centrifugation steps.

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Background and Aim: A New Health Reform Plan consisting of seven programs was initiated in Iran in mid-May 2015 aiming to reduce the out-of-pocket payments, improve the public’s health, and promote the public health indicators. This study was conducted to determine the effect of the Plan on the performance indicators of Hamedan university hospitals.

Materials and Methods: In this longitudinal descriptive-analytical study, based on the interrupted time series design, data related to hospital performance indicators were collected from all (15) Hamedan University hospitals for a period of 15 months (7 months before, and 7 months after, the implementation of the Plan, with a one-month interval in between). The SPSS software was used for data analysis.

Results: The data indicated changes in all the performance indicators after the implementation of the Plan. The largest changes were in the number of emergency and selective surgeries and the smallest in the ratio of active to total beds. Further analysis of the data showed that, as compared to the same months in the previous year, only a small number of these changes (number of emergency surgical operations and the ratio of active to total beds) were statistically significant.

Conclusion: Based on the findings it can be concluded that changes have occurred in all the selected indicators as a result of implementation of the New Reform Plan, indicating that the Plan has affected favorably performance of the hospitals. However, the effects observed should be judged cautiously, considering the possible negative consequences such as induced demand and hospital workload increase in the long run.

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Background and Aim: Economic evaluation of health interventions is critical for efficient allocation of resources. The aim of this study was to critically review empirical studies on the cost-benefit of health interventions published over the last 40 years.

Materials and Methods: This study was carried out by searching seven  databases (PubMed, Cochrane Database of Systematic Reviews, Web of science, Science Direct, Scopus, Springer Link, and SID) using appropriate keywords to find articles on the cost-benefit of health interventions published during 1975-2015. All the relatedretrieved articles were analyzed after quality assessment using a valid check list.

Results: A total of 33studies on the cost-benefit of health interventions during the last 40 years were included in the review; 39%, 37%, 21% and 3%of the studies had been conducted in Asia, America, Europe and Africa, respectively. The subjects dealt with in most ofthe studies (79%) were related to immunization, education, healthy nutrition and use of health technologies. Further analysis of the data showed mental health education, healthy nutrition, use of safety equipment while driving, vaccination, diagnostic and screening tests, and oral and dental healthto have considerable clinical and economic benefits.

Conclusion: The number of studies on the cost-benefit analysis of health interventions is increasing. Preventive and promotive interventions can help planners and policy-makers to better utilize the limited resources in the health sector aiming at promoting health of the people.

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Background and Aim: Human resources in any organization are its main capital. They are the only unique asset that are not liable to depreciation over time, but they even create more added value. The Social Security Organization (SCO) as a social insurer organization needs urgent assessment of its human resource management. In this regard, it appears that such an essential assessment can be done using the European Foundation for Quality Management (EFQM) model.

Materials and Methods: This project was an applied descriptive study conducted at the Social Security General Department in Tehran, Iran. The data collection tool was a standard questionnaire for performance assessment based on the EFQM model, the reliability of which (0.989) was determined by using the Cronbach's alpha coefficient. A total of 388 questionnaires were distributed, of which 311 were completed and returned to the researcher; the response rate was 81%. Analysis of the data was done using the SPSS-16 software.

Results: The human resource managers in the SCO achieved a score of 495.72. The empowerment and results dimensions rated 261.34 and 198.38, respectively. In the empowerment dimension, policy and strategy criteria had the highest score (56.12) and process the lowest (51.28), while in the results dimension, community criteria had the highest (50.27) and the customers criteria the lowest (51.18) score.

Conclusion: Based on the findings it can be concluded that the European Foundation for Quality Management (EFQM) model is suitable for assessing both the performance, strengths and weaknesses of the Tehran Security General Department human resources and improving its performance. Certainly better implementation of programs and achieving excellence will be possible through sustainable collaboration.

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Background and Aim: Following the deployment of the Health Transformation Plan (HTP) in most of the public hospitals, various changes occurred in the relationships between insurance organizations and hospitals. The purpose of this study was to find the obstacles and challenges facing the two types of organizations and suggest solutions.
Materials and Methods: This was an exploratory study. The research population was a total of 74 participants from Tehran public, private and military hospitals (managers, senior nursing officers, financial officers, and chiefs of accounting) and basic and complementary insuring organizations (insurance agents in hospitals, insurance officers from insuring organizations, and insurance managers). Data were gathered through semi-structured interviews and analyzed using thematic analysis.
Results: The most important challenges were as follows: acting on one’s own preferences,  deductions, delays in the payments of hospital expenditures, an insufficient number of insurance agents in some hospitals, insufficient accountability of hospital personnel in expenditure management, lack of sufficient interaction between the two organizations, and lack of contracts between complementary insurance companies and public hospitals and between private hospitals and basic insurance organizations.
Conclusion: Given the importance and sensitivity of the relations between the health service providers and receivers and considering further the complexity and challenges that appeared after HTP and hospital accreditations, a knowledge of the challenges identified in this research can help policy-makers and managers to find suitable, effective strategies for enhancing relations and communication between insurance companies and hospitals.
 

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Background and Aim: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. This study aimed to examine the relationship between accreditation and hospital performance. In addition, the most important accreditation constructs affecting hospital performance were identified and ranked.
Materials and Methods: This descriptive, correlational and cross-sectional study was conducted using the data related to accreditation scores and nine performance indicators of 121 hospitals in 2014 and 123 hospitals in 2015 in Tehran province, Iran. Shannon entropy method was used for calculating the weights of the hospital indicators. Then, Feature Selection method in data mining was used to explore the relationship between accreditation scores and hospital indicators. Data were analyzed using IBM SPSS Modeler software. Analyses were carried out at the 0.05 significance level
Results: The mean of hospitals’ accreditation scores were 61.98% and 69.56% in 2014 and 2015 respectively. All performance indicators except the number of outpatients were increased in 2015 compared to 2014. There was no significant difference in the scores between 2014 and 2015 data. Hospitals’ accreditation scores were not associated with their performances. However, accreditation scores of leadership and management; accident and emergency; and procurement departments had the most effect on hospitals’ performance.
Conclusion: Accreditation was not correlated with hospital performance. Thus, improving accreditation system including standards, methods and surveyors and using quality management strategies in hospitals are necessary for improving hospital’ performance.
 

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Background and Aim: The Internet is a strong and multimedia technology that meets the most basic needs of human beings; however, this new technology can have great negative effects on people's lives. This study aimed to determine the prevalence of Internet addiction and its relationship with quality of sleep and quality of life among students of Zahedan University of Medical Sciences.          
Materials and Methods: This descriptive-analytical cross-sectional study was conducted in Zahedan in 2017.The study population included all the students of Zahedan University of Medical Sciences. A sample of 340 students were selected through stratified random sampling. Data were collected using three World Health Organization questionnaires, namely, quality of sleep, Internet addiction and quality of life questionnaires, and analyzed using SPSS (v22), the statistical tests being ANOVA and linear regression test and T-test.
Results:  Data analysis showed that Internet addiction and the quality of life among the students were mild (43 ± 15) and desirable (78.4± 1.6), respectively. However, the sleep Quality Index for 282 students (82.9%) was not desirable. There were statistically significant associations (p<0.05) between the place of residence on the one hand and Internet addiction, quality of sleep and quality of life on the other.
Conclusion: Based on the findings it can be concluded that Internet addiction has a negative effect on the quality of sleep and quality of life of the students. The students need to pay more attention to the use of the Internet. It is also recommended that behavioral and cognitive intervention be designed and implemented aiming at teaching the students proper use of the computer and the Internet.

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Background and Aims: Nocardia asteroides complex is the most common cause of infectious diseases due to nocardiosis. Interspecies differentiation of Nocardia genera is essential for prognosis and timely proper treatment, as well as for epidemiological studies. Since each genus has its own antibiotic resistance, precise careful diagnosis is of prime importance. As compared to biochemical and phenotypic methods, the efficacy of molecular methods for fast and accurate identification of Nocardia species has been proven. The aim of this study was to detect for the first time Nocardia asteroides complex in clinical isolates using real time polymerase chain reaction (Real-Time PCR).
Materials and Methods: Out of the 25 clinical isolates suspected to be Nocardia asteroides genus 10 were identified as Nocardia asteroids complex by biochemical and phenotypic methods, followed by genomic DNA extraction of the suspicious isolates. Nocardia asteroides complex positive controls were prepared using standard strains. Real-time PCR was conducted on all the 10 suspicious isolates. The final real-time PCR samples were sent for sequencing to verify the identified species.
Results: Based on sequencing results 3 of 10 clinical isolates suspected to be identified as Nocardia asteroides complex were confirmed as belonging to the Nocardia asteroids complex genera ─ Nocardia asteroids, Nocardia farcinica, and Nocardia nova.
Conclusion: This study shows that, as compared to biochemical and phenotypic methods, real-time polymerase chain reaction is faster and more specific, and is considered as an efficient method, for Nocardia interspecies identification and differentiation.

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Background and Aim: Economic evaluation of health interventions by comparing the relevant costs and benefits will result in optimum allocation of resources and increasing the effectiveness of the health system and, through improving equity and increasing accessibility to health services, will lead to increased effectiveness of the health system. The purpose of this study was to critically evaluate the Cost Effectiveness Analysis (CEA) studies on health interventions worldwide.
Materials and Methods: A critical review of the published CEA studies on health interventions was conducted. Seven databases including PubMed, Cochrane Database of Systematic Reviews, Web of science, Science Direct, Scopus, Springer Link, and SID were searched between 1975 and 2018, using appropriate keywords. The retrieved articles were evaluated using the Drummond (2005) quality assessment checklist. Overall, 173 articles met the entry criteria and were included in this study.
Results: CEA of health-related interventions were classified into six categories, namely, studies on immunization, education, nutrition, sexually transmitted diseases prevention, gynecological diseases prevention and vector-borne diseases and, eventually, cost-effective interventions were identified. Further analysis of the data showed that the methods used in health intervention CEA studies are very heterogeneous and lack sufficient scientific quality especially in developing countries. Researchers working in this area should pay more attention when designing studies and follow valid guidelines for CEA, particularly as regards research methods, sample size, CEA model, cost and benefit calculations, determining effectiveness, timeframe and, finally,  analysis of  the sensitivity and validity the research data.
Conclusion: The number of cost effectiveness analysis and cost utility studies has increased greatly during the last two decades. In order to improve the quality of these studies it is essential to revise the guidelines and procedures for economic evaluation of health interventions and train and update researchers in this area.