Knowledge production in Iranian social determinants of health research centers: Toward health equity.

Background: As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran's health research system (HRS). Methods: In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators. Results: Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers' indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers' high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences. Conclusion: Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.

Significance of multiple nodal basin drainage in patients with truncal melanoma.

BACKGROUND: Assessing whether an association exists between drainage to multiple basins and lymphatic metastasis in patients with truncal melanoma (TM). METHODS: The study included 260 patients with primary TM (163 men; median age 56.5 y/o) with a cN0 M0, who underwent a sentinel lymph node scintigraphy and biopsy. The median tumor thickness (TT) was 1.51 mm. RESULTS: One hundred and three patients showed more than one basin; of these, 95 patients had 2 basins, 6 had 3 basins, and 2 had 4 basins of drainage. Nodal histology was positive for metastatic disease in 65 patients, of whom, 40 had 1 basin, 24 had 2 basins and 1 had 3 basins of drainage. Of the 195 node-negative patients, 116 had 1 basin, 70 had 2 basins, 5 had 3 basins, and 2 had 4 basins of drainage (P=0.89). In a median follow-up of 36 months, 26 patients showed progressive disease, of whom 15 had 1 basin and 11 had 2 basins (P=0.76). Twenty patients died, of whom 11 had 1 basin and 9 had 2 basins (P=0.8). CONCLUSIONS: There is no significant association between the number of drainage basins and sentinel node positivity or further progress of the disease in patients with TM.

Knowledge production in Iranian cardiovascular research centers: A way to reduce the burden of disease.

BACKGROUND: According to the World Health Organization (WHO), non-communicable diseases (NCDs) including cardiovascular diseases (CVDs) will be responsible for almost 70% of all deaths in 2020. Therefore, knowledge production to find suitable ways to prevent, diagnosis, and effectively cover this disease in research centers is mandatory. Therefore, the present study is carried out with the aim to examine the results of studies performed in three years in Iranian cardiovascular centers. METHODS: Iranian cardiovascular research centers with more than three years of activity from 2015 to 2017 were evaluated. Research output, international collaboration, high quality publication, total citation, and average h-index (H) were evaluated and scored. RESULTS: 23 cardiovascular diseases research centers (CVDRCs) related to 15 universities of Medical Sciences (UMSs) were evaluated. The mean and standard deviation (SD) of age of the research activities in CVDRCs was 11.47 ± 8.60 years. Based on the research ranking, the first three centers were Isfahan Cardiovascular Research Center, Iran, Tehran Heart Center, and Shaheed Rajaei Cardiovascular Medical and Research Center, Iran, respectively, all of which have independent budget line. However, there is not any CVD research center in some provinces such as Zanjan, Kurdistan, Lorestan, and Arak, Iran. CONCLUSION: Mission oriented research activities in Iranian cardiovascular research centers may be effective in reducing the burden of CVDs. Moreover, establishment of CVD research centers in high risk areas may be useful.

Early storybook reading and childhood development: A cross-sectional study in Iran.

Background: Development is a process that continues from childhood to death, and most developmental changes occur during childhood. UNICEF introduced early storybook-reading (ESR) and storytelling as part of child care indicators. The aim of this study was to investigate the status of book-reading to children and its relationship with early childhood development in Iran. Methods: This is a descriptive-analytic study conducted in Tehran April-May 2017. In total, 272 mothers of children aged 3-30 months, who were referred to health centers, were selected using a convenience sampling method. Exclusion criteria was scoring below the cutoff point of any developmental domains of the Ages and Stages Questionnaire (ASQ). ESR was assessed by checklist and child development was assessed by the ASQ. Data were analyzed using SPSS. Results: The mean number of children's books owned was 10.23±8.642, and 84.75% had at least 3 books. The average book reading, storytelling and singing duration for children was 10±9.65, 11.48±11.756, and 23.88 ±17.880 min per day, respectively. Average book reading, storytelling, and singing duration was significantly greater in children 18-30 months than <17 months. There was a significant relationship between the number of books and a child's age, mother's age, family income, income satisfaction, father's employment, and parents' education. The score of communication domain in the ASQ questionnaire was significantly related to the number of books, duration of reading and storytelling, while problem-solving had a significant relationship only with the number of books (p˂0.05). Based on linear regression, child's age, income, and mother's and father's educational level were models for predicting the number of children's books (p=0.0001 for all). Conclusions: ESR was associated with some developmental domains of communication and problem-solving in the present study. Therefore, creation of ESR culture in Iranian families as an integral part of the life of children is necessary from birth.

False positive 18F-FDG-PET/CT in a patient after talc pleurodesis.

A 61-year-old man presented with spontaneous pneumothorax. After diagnosis of emphysemic bullae, the patient underwent talc pleurodesis and had no further complaints. Five years later a routine chest X-ray showed suspicious pleural lesions in addition to the emphysema, which was deemed compatible with the known history of talc pleurodesis. Subsequent chest CT, however, revealed one lesion in the right lung that appeared not typical for this condition in addition to multiple lesions in pleural proximity. FDG-PET/CT demonstrated high glucose uptake in all the lesions. Subsequent needle biopsy of the suspicious intrapulmonary and also of one mediastinal lesion yielded the histopathological diagnosis of talcum granuloma with long-standing calculous fibrotic changes and no evidence of malignancy. This report on PET/CT after talc pleurodesis addresses the potential pitfalls caused by this condition, as chronic granulomatous reactions, like other inflammatory lesions, may account for highly increased FDG uptake which should be interpreted with caution and not simply read as a sign of malignancy. PET/CT offers the opportunity to exactly localize the areas of increased FDG uptake within regions of pleural thickening caused by talc deposition, however, the dilemma of misleading FDG accumulation cannot be solved by this hybrid imaging modality.

Involving Mothers in Child Development Assessment in a Community-based Participatory Study Using Ages and Stages Questionnaires.

BACKGROUND: Child-friendly environment project (MAZDAK) is a community-based project for monitoring the development of children in Iran that was implemented as a pilot study in one of the neighborhoods of Tehran (Eyvanak-e Gharb). This study attempted to engage mothers in monitoring of their children's development and assesses the status of children's development by a community-based participatory approach using the ages and stages questionnaires (ASQ). METHODS: This study was a community-based participatory research. Two hundred households residing in Eyvanak-e Gharb with children under 5-year-old were selected as a convenient sample and completed the ASQ. Descriptive measures were used to describe the overall status of children, in each domain. Furthermore, we compared the current sample with other populations, using independent t-test. RESULTS: This study engaged mothers, trained volunteers from the community, and some local institutions in screening and monitoring children development and addressing any poor developmental growth. The mean scores of the different domains (communication, gross motor, fine motor, problem solving, and social-personal) in sampled children in MAZDAK project were higher than corresponding mean scores of the children in a project conducted in Tehran in 2006. CONCLUSIONS: Involving mothers and community in monitoring children development based on ASQ was an effective strategy to monitor and foster children development.

Early Childhood Development and Iranian Parents' Knowledge: A Qualitative Study.

BACKGROUND: Early childhood is the most important step throughout the lifespan and it is a critical period continuing to the end of 8-year-old. Mothers' knowledge is one of the important aspects of child development. The goals of this study were to determine the situation of knowledge in Iranian parents about the concept and the importance of early childhood development (ECD) and determining the sources of parental knowledge about ECD from the perspective of parents and grandparents. METHODS: This qualitative study was conducted based on the directional content analysis in 2016. The purposive sampling method is utilized to select 24 participants among parents and grandparents in Tehran. The inclusion criteria consisted of speaking in Persian and having a child or grandchild <3-year-old. Data were collected through four focus group discussions and four individual interviews. RESULTS: Iranian parental knowledge about integrative ECD is not enough, their knowledge about motor development and speech and language are relatively better, about cognitive development is little and socialemotional is very little. They said parents and other caregivers influence the process of children's development. Parents' knowledge resources about ECD included human resources, physical resources, virtual space, and the media. According to the majority of participants, "pediatricians are the most reliable source of parents' knowledge about ECD" even though the main focus of pediatricians is on treating diseases, physical health, and growth of children. CONCLUSIONS: According to the results, the knowledge of Iranian parent is not enough about ECD; therefore, actions must be taken to increase their knowledge in these domains. Parents look for reliable and valid sources to enhance their knowledge and they rely the most on pediatricians in this regard. Therefore, more studies on assessing parents' knowledge in community and the practical methods for knowledge promotion in this field is recommended.

Research Ranking of Iranian Universities of Medical Sciences Based on International Indicators: An Experience From I.R. of Iran.

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.

How to Assess Quality of Research in Iran, From Input to Impact? Introduction of Peer-Based Research Evaluation Model in Iran.

BACKGROUND: Research evaluation is a systematic and objective process to measure relevance, efficiency and effectiveness of research activities, and peer review is one of the most important tools for assessing quality of research. The aim of this study was introducing research evaluation indicators based on peer reviewing. METHODS: This study was implemented in 4 stages. A list of objective-oriented evaluation indicators were designed in 4 axes, including; governance and leadership, structure, knowledge production and research impact. RESULTS: The top 10% medical sciences research centers (RCs) were evaluated based on peer review. Adequate equipment and laboratory instruments, high quality research publication and national or international cooperation were the main strengths in medical sciences RCs and the most important weaknesses included failure to adhere to strategic plans, parallel actions in similar fields, problems in manpower recruitment, knowledge translation & exchange (KTE) in service providers and policy makers' levels. CONCLUSION: Peer review evaluation can improve the quality of research.

The Role of Medical Research Centers in Health Research System Promotion in I.R. of Iran: 2001-2014.

BACKGROUND: Research centers, defined as organized research units having research as their primary mission, are positioned as an organizational solution to tighten the knowledge to do gap in health research system (HRS). Therefore, this study aims to explore the roles of medical research centers (MRCs) in promoting HRS. METHODS: In this cross-sectional study, we reviewed the evaluation results of research performance of MRCs from 2001 to 2014. Data of evaluation indicators (in knowledge production and capacity building domains) were gathered and finally compared for these years. RESULTS: In the mentioned period, the number of medical research centers has grown by more than 11 folds. In the domain of knowledge production, the total number of published articles and published articles in ISI, Web of Science per researcher rose from 0.5 and 0.05 to about 3.5 and 1.2, respectively. The number of indexed articles in scientific international databases has increased more than 66 times and the total number of citations of MRCs' articles has increased to more than 80000. In the domain of capacity building, the trend of workshops and held congresses is ascending. CONCLUSION: MRCs are well empowered in knowledge production in national HRS.

Health Research Governance: Introduction of a New Web-based Research Evaluation Model in Iran: One-decade Experience.

BACKGROUND: Governance is one of the main functions of Health Research System (HRS) that consist of four essential elements such as setting up evaluation system. The goal of this study was to introduce a new web based research evaluation model in Iran. METHODS: Based on main elements of governance, research indicators have been clarified and with cooperation of technical team, appropriate software was designed. Three main steps in this study consist of developing of mission-oriented program, creating enabling environment and set up Iran Research Medical Portal as a center for research evaluation. RESULTS: Fifty-two universities of medical sciences in three types have been participated. After training the evaluation focal points in all of medical universities, access to data entry and uploading all of documents were provided. Regarding to mission - based program, the contribution of medical universities in knowledge production was 60% for type one, 31% for type two and 9% for type three. The research priorities based on Essential National Health Research (ENHR) approach and mosaic model were gathered from universities of medical sciences and aggregated to nine main areas as national health research priorities. Ethical committees were established in all of medical universities. CONCLUSION: Web based research evaluation model is a comprehensive and integrated system for data collection in research. This system is appropriate tool to national health research ranking.

Pasteur Institute of Iran--an evaluation model.

BACKGROUND: Pasteur Institute of Iran was established in 1919 with the aim to produce vaccines and prevent communicable diseases in Iran. Over time, their activities extended into areas of research, education and services. Naturally, such a vast development begs establishment of a comprehensive management and monitoring system. With this outlook, the present study was carried out with the aim to design a performance assessment model for Pasteur Institute of Iran that, in addition to determining evaluation indicators, it could prepare the necessary grounds for providing a unified assessment model for the global network of the Pasteur Institutes. METHOD: This study was designed and performed in 4 stages: first; design of indicators and determining their scores. Second; editing indicators according to the outcome of discussions and debates held with members of Research Council of Pasteur Institute of Iran. Third; implementation of a pilot model based on the Institute's activities in 2011. Fourth; providing the pilot model feedback to the stakeholders and finalizing the model according to an opinion survey. RESULTS: Based on the results obtained, the developed indicators for Pasteur Institute of Iran evaluation were designed in 10 axes and 18 sub-axes, which included 101 major and 58 minor indicators. The axes included governance and leadership, resources and facilities, capacity building, knowledge production and collaborations, reference services, economic value of products and services, participation in industrial exhibitions, status of the institute, satisfaction and institute's role in health promotion. CONCLUSION: The indicators presented in this article have been prepared based on the balance in the Institute's four missions, to provide the basis for assessment of the Institute's activities in consecutive years, and possibility of comparison with other institutes worldwide.

Appearance of extraosseous pelvic Ewing sarcoma on triphasic bone scan.

A 24-year-old man with extraosseous Ewing sarcoma in the pelvis underwent a triphasic bone scintigraphy to rule out bone metastases and local bone infiltration before chemotherapy. The bone scintigraphy showed tracer uptake in the tumor in all 3 phases.

Psychosocial needs assessment among Earthquake survivors in Lorestan province with an emphasis on the vulnerable groups.

INTRODUCTION: Iran is one of the ten most earthquake prone countries in the world. Earthquakes not only cause new psychological needs among the population but particularly so when one considers vulnerable groups. This in - depth study was conducted with the aim of assessing psychosocial needs six months after an earthquake happened in the west of the county in Lorestan province. METHODS: This is a qualitative study using focus group discussion that focuses mainly on the vulnerable groups (women, children, elderly and disabled people) after an earthquake in Bozazna; a village in Lorestan province in western part of Iran. FINDINGS: Results of the psychosocial assessment indicated feelings of anxiety and worries in four vulnerable groups. Horror, hyper-excitement, avoidance and disturbing thoughts were observed in all groups with the exception of the elderly. Educational failures, loneliness and isolation were highlighted in children. All groups encountered socio-economic needs that included loss of assets and sense of insecurity and also reproductive problems were reported in women's group. DISCUSSION AND CONCLUSION: Modification of a protocol on psychosocial support considering the context of the rural and urban areas with emphasis on the specific needs of the vulnerable groups is an appropriate strategy in crisis management. It seems that appropriate public awareness regarding assistance programs can be effective in reducing stress and needs of disaster survivors.

The importance of Tc-MAA SPECT/CT for therapy planning of radioembolization in a patient treated with bevacizumab.

A 76-year-old man with colorectal cancer and hepatic metastases was referred to us for radioembolization of the liver. Angiography with 99mTc-MAA SPECT/CT was performed 8 weeks after the discontinuation of bevacizumab. 99mTc-MAA SPECT/CT showed a diffused intrahepatic tracer distribution with no focally accentuated accumulation in the tumorous region. The test was repeated 6 weeks later and Tc-MAA SPECT/CT showed this time a tumor accentuated tracer accumulation in the liver. Subsequently, the patient was treated with resin microspheres. Tc-MAA SPECT/CT allows a better evaluation of intrahepatic tracer accumulation of Tc-MAA and facilitates the determination of the most appropriate treatment time.

Health research system evaluation in I.R. of Iran.

BACKGROUND: Several systems have been proposed to rank academic institutions worldwide. We aimed to introduce a new method of Health Research System (HRS) evaluation in Iran. METHODS: In this cross-sectional study, a specific questionnaire has been used to assess stewardship, capacity building, and knowledge production through annual evaluations of HRS in Iran. This article has explored the results of the 5-year evaluation (2003 - 2008) and aims to introduce this method to other developing countries. RESULTS: According to our study, in the stewardship axes, all medical science universities designed strategic plans by 2008 and 70% of the approved projects were based on priorities. In the domain of capacity building, the trend in the number of arranged workshops and held congresses is ascending. In the domain of knowledge production, the number of Iranian biomedical research articles increased from 2996 in 2003 to 8816 in 2008.The proportion of ISI Web of Science/Pub Med indexed articles per academic members also increased from 0.09 to 0.33. CONCLUSION: We conclude that HRS evaluation in Iran has supported knowledge production and has strengthened evidence-based policy making. The adapted ranking system for evaluation of medical research activities is an effective strategy for HRS promotion.