Iranian Journal of Public Health
Year:2016 | Volume:45 | Issue:1|Papers Count:25

In parallel with previous years, in this issue we are going to present a critical appraisal on sub-mitted article to Iranian Journal of Public Health in 2015 and report a short report on the destina-tion of these articles in terms of rejection, accep-tance, publication etc. In addition, this editorial will compare the trend of whole publication process during 2012-2015.

Background: Androgen insensitivity syndrome (AIS) or testicular feminization is a partial or complete inability of cell response to androgen. The cause is enzymatic defect in synthesis of testosterone, resulting sexually immature pheno-typically female, with primary amenorrhea. There are three categories of AIS, complete, partial and mild, depending on the degree of external genital masculinization. The aim of this study was to find out chromosomal abnormalities, and correlation between AIS and maternal/paternal age, parents' consanguineous marriage, family history and clinical ob-servation, in Iranian AIS patients.Method: This study includes a retrospective data analysis of 72, 000 families' medical records in the Genetic Clinic in Tehran, during a 30-yr period (1984-2014). The essential basis for the patients' referral to the clinic by gynecologists was primary amenorrhea. Cytogenetic abnormalities has been confirmed by chromosome G-banding and conventional staining methods.Results: Seventy AIS female patients with 46XY pattern were cytogenetically diagnosed and the frequency of AIS syndrome was estimated about 0.05% ( ~70.140000). The results showed no association between AIS and maternal or paternal age nor were the marital pattern of the parents. The clinical findings illustrated that primary amenorrhea had the highest indication for referral of AIS patients for genetic counseling and cytogenetic study.Conclusion: No correlation was observed between AIS and maternal or paternal age or consanguineous marriages. Amenorrhea is the most clinically observed sign of AIS patients.

Background: This study provides a national profile of major work safety accidents in China, which cause more than 10 fatalities per accident, intended to provide scientific basis for prevention measures and strategies to reduce major work safety accidents and deaths.Methods: Data from 2003-2012 Census of major work safety accidents were collected from State Administration of Work Safety System (SAWS). Published literature and statistical yearbook were also included to implement informa-tion. We analyzed the frequency of accidents and deaths, trend, geographic distribution and injury types. Additionally, we discussed the severity and urgency of emergency rescue by types of accidents.Results: A total of 877 major work safety accidents were reported, resulting in 16, 795 deaths and 9, 183 injuries. The numbers of accidents and deaths, mortality rate and incidence of major accidents have declined in recent years. The mortality rate and incidence was 0.71 and 1.20 per 106 populations in 2012, respectively. Transportation and mining contributed to the highest number of major accidents and deaths. Major aviation and railway accidents caused more casualties per incident, while collapse, machinery, electrical shock accidents and tailing dam accidents were the most severe situation that resulted in bigger proportion of death.Conclusion: Ten years’ major work safety accident data indicate that the frequency of accidents and number of deaths was declined and several safety concerns persist in some segments.

Background: The aim of the study was to evaluate the relationship between the serum levels of androgens and Coro-nary Artery Disease (CAD) in an Iranian population.Methods: Male individuals admitted to Tehran Heart Center and Sina Hospital, Tehran, Iran from 2011-2012 were categorized into CAD and control groups based on selective coronary angiography. Baseline demographic data, including age, BMI, diabetes, and a history of hypertension were recorded. Patients were also assessed for their serum levels of total testosterone, free testosterone, estradiol, dehydroepi and rosterone sulfate (DHEA-S), and Sex Hormone Binding Globu-lin (SHBG). Data analysis was carried out chi-square and ANOVA tests as well as logistic regression analysis.Results: Two hundred patients were in the CAD group and 135 individuals in control group. In the CAD group, 69 had single-vessel disease, 49 had two-vessel diseases, and 82 had three-vessel diseases. Statistically significant differ-ences were observed between the individuals in the two groups with respect to age (P<0.0001), diabetes (P<0.0001), and a history of hypertension (P=0.018). The serum levels of free testosterone (P=0.048) and DHEA-S (P<0.0001) were significantly higher in the control group than in the CAD group; however, the serum level of SHBG was higher in the CAD group than in the control group (P=0.007). Results of the logistic regression analysis indicated that only age (P=0.042) and diabetes (P=0.003) had significant relationships with CAD.Conclusion: Although the serum levels of some of the androgens were significantly different between the two groups, no association was found between androgenic hormone levels and the risk of CAD, due mainly to the effect of age and diabetes.

Background: During recent years, infection of Acinetobacter baumanii showed a rapid growth in hospitals and commu-nity. Toll-like receptors (TLRs) are the most important pattern recognition receptors, which play a critical role during recognizing invading pathogens by the natural immune system. Our objective was to determine the associations of TLRs polymorphisms with the susceptibility to A. baumanii infection in a Chinese population.Methods: We carried out a case-control study, genotyping 13 polymorphisms of TLR-2, TLR-4, TLR-5 and TLR-9 genes on 423 A. baumanii-infected patients and 385 exposed controls. Thirteen SNPs at the TLR-2 (rs3804099, rs7656411 and rs76112010), TLR-4 (rs1927914, rs10759932 and rs11536889), TLR-5 (rs1341987, rs1640827, rs1861172, rs2241097, rs5744174 and rs17163737) and TLR9 (rs187084) genes were analyzed. SNP genotyping was performed using an improved multiplex ligation detection reaction (iMLDR) technique.Results: The SNP of TLR-9, rs187084, was related to A. baumanii-infection significantly under recessive model (G/G, to A/A+G/A, P=0.0064, OR=0.59, 95% CI=0.40-0.86) after adjustment with age. Besides, the haplotype GCG of TLR-4 was significantly associated with A. baumanii infection (P=0.027).Conclusion: TLR-4 and TLR-9 may be related to the susceptibility to A. baumanii infection in a Chinese population.

Background: Kidney transplantation is the best alternative treatment for end-stage renal disease. Several studies have been devoted to investigate predisposing factors of graft rejection. However, there is inconsistency between the re-sults. The objective of the present study was to utilize an intuitive and robust approach for variable selection, random survival forests (RSF), and to identify important risk factors in kidney transplantation patients.Methods: The data set included 378 patients with kidney transplantation obtained through a historical cohort study in Hamadan, western Iran, from 1994 to 2011. The event of interest was chronic nonreversible graft rejection and the duration between kidney transplantation and rejection was considered as the survival time. RSF method was used to identify important risk factors for survival of the patients among the potential predictors of graft rejection.Results: The mean survival time was 7.35±4.62 yr. Thirty-seven episodes of rejection were occurred. The most im-portant predictors of survival were cold ischemic time, recipient's age, creatinine level at discharge, donors’ age and duration of hospitalization. RSF method predicted survival better than the conventional Cox-proportional hazards model (out-of-bag C-index of 0.965 for RSF vs.0.766 for Cox model and integrated Brier score of 0.081 for RSF vs.0.088 for Cox model).Conclusion: A RSF model in the kidney transplantation patients outperformed traditional Cox-proportional hazard model. RSF is a promising method that may serve as a more intuitive approach to identify important risk factors for graft rejection.

Background: We observed the clinical effects of comprehensive nursing intervention pattern in 23G minimally inva-sive vitreous surgery according to the comprehensive nursing intervention table developed by our hospital, which would supply a basis for its clinical application.Methods: In this prospective study, we followed 120 patients undergoing 23G minimally invasive vitreous surgery from Xuzhou First People's Hospital from February 2013 to February 2015 and divided them into control and obser-vation groups by a random number table (60 patients in each group). A regular nursing pattern was adopted for the control group, and a comprehensive nursing intervention pattern was adopted for the observation group. After that, a comparative analysis was made to identify the differences between the clinical effects of the two groups.Results: Scores of cognition ratio, patient compliance and comfort level of patients in the observation group were higher than those of the control group were, and there was significant difference between the groups (P<0.05). Com-plication incidence of the observation group is significantly lower than that of the control group (P<0.05).Conclusion: The comprehensive nursing intervention pattern developed by our hospital can improve clinical effects notably, which is of application value. We recommend it to be applied in eye diseases.

Background: Considering the lack of data available on changes of physical activity over time in Iran, this study was designed to evaluate changes in physical activity levels among Iranian adults over a median 6.5 yr period.Methods: In this population-based cohort study, 3515 participants, aged ³20 yr (2100 females and 1415 males) were followed from phase II (2002-2005) to phase IV (2008-2011) of the Tehran Lipid and Glucose Study. Information on physical activity, both leisure time (LTPA) and occupational (OCPA), was collected using the Modifiable Activity Questionnaire. Scores £600 METs-min/wk were considered as having low physical activity. Wilcoxon test was per-formed for comparing MET values between the two phases. McNemar test was used to evaluate differences between paired qualitative data.Results: In both phases, 59.8% of adults were women, with mean±SD age 44.3±14.6 and 50.9±14.6 yr, in phases II and IV respectively. The prevalence of low physical activity decreased significantly in the follow up period (from 45.9% in phase II to 42.6% in phase IV, P=0.004). In both genders, a non-significant decrease in OCPA was ob-served, However, there was a significant decrease in LTPA among women (P=0.031), but not in men.Conclusion: Despite the high levels of physical activity in Tehranian adults, a decreasing trend was observed. Significant decrease in LTPA among women indicates the urgent need to target women for prevention and implementation of pub-lic educational programs to promote physical activity levels and LTPA in particular, to compensate the reduction in OCPA.

Background: In this study, specific measures of extended nursing services and its values on patients with bladder cancer after endoscopic bladder electrosection were examined.Methods: Sixty-six patients diagnosed with bladder cancer in Laiwu People's Hospital (NO.001, Xueyehu Street, Changshao Road, Laiwu, Shandong, China) between February 2012 and February 2014, and underwent endoscopic bladder electrosection were enrolled in the study. Patients were randomly allocated into the control group (n=30 cas-es) or the observation group (n=36 cases) according to the order of hospitalization. Conventional nursing measures were given to the control group while extended nursing service measures were given to the observation group, and the differences of nursing effect were compared.Results: The occurrence rate of postoperative complications within the hospital for the observation group was signif-icantly lower than that of the control group, as was the length of hospital stay. The nursing service satisfaction was also significantly improved within the observation group. These differences were statistically significance (P<0.05). The anxiety and depression scores for the observation group were significantly lower than that of control group and these differences were also of statistical significance (P<0.05). The follow-up compliance after hospitalization for the observation group was significantly enhanced, quality of life scores were significantly improved, and both differences were of statistical significance (P<0.05).Conclusion: Extended nursing service improves the effect and long-term prognosis of patients with bladder cancer after undergoing endoscopic bladder electrosection.

Background: Hypomagnesaemia is one of the main side effects of cisplatin-based chemotherapy regimens in cancer patients. The aim of the current investigation was to evaluate the effect of oral magnesium oxide (MgO) supplementa-tion on cisplatin-induced hypomagnesemia.Methods: This parallel-randomized controlled, open label trial was conducted in a hospital of Iran University of Med-ical Sciences in Tehran between December 2009 and May 2011. Participants were 69 adult patients with newly diag-nosed non- leukemia neoplasms candidate for starting cisplatin-based chemotherapy. Oral MgO supplement according to cisplatin dose (500 mg MgO per 50 mg/m2 of cisplatin) as 2-3 divided daily doses was started after completion of each chemotherapy cycle and continued to the next cycle for the intervention group. Patients in the control group did not receive any supplementation. Serum magnesium (Mg) was measured before each chemotherapy cycle. The main outcome was measuring serum Mg change and hypomagnesaemia rate during chemotherapy treatment.Results: Sixty-two participants (31 intervention- 31 controls) enrolled into the study. Serum Mg levels showed signifi-cant difference between the two groups (P=0.01). There was a significant decrease in serum Mg of the control group (P=0.001). At the end of follow-up period prevalence of hypomagnesaemia in the intervention group was 10.7% ver-sus 23.1% in the control group.Conclusion: Continuously oral supplementation with MgO according to cisplatin dose (500 mg MgO per 50 mg/m2 cisplatin) as 2-3 divided daily doses at rest days between chemotherapy cycles reduces the decline in serum Mg levels and also the prevalence of hypomagnesaemia in cancer patients.

Background: Serum levels of lipocalin 2 (LCN 2) and retinol-binding protein-4 (RBP 4), increase in type 2 diabetes mellitus (T2DM). We sought to determine whether serum LCN 2 and RBP 4 change after an intervention with omega-3 fatty acids supplementation in diabetic patients.Methods: Forty-five type 2 diabetic patients from Iranian Diabetic Association in Tehran, Iran in 2013 were randomly recruited into two groups: one group received 4 g/d omega-3 for 10 wk; and the control group received placebo. Blood samples, food intake records, anthropometric measurements were obtained from all participants at the begin-ning and end of the study.Results: Fasting RBP 4 plasma levels significantly changed after 10 wk supplementation (P=0.01). The LCN 2 con-centrations decreased in omega-3 group, but the changes were not statistically significant. Omega-3 supplementation had no noticeable effect on anthropometric factors.Conclusions: These findings provide a rationale for omega-3 supplements aimed at lowering serum RBP 4 levels in T2DM.

Background: The term crystallized silica refers to the crystallized form of Sio2 and quartz, the most frequency com-position in the earth’s crust that can cause silicosis and lung cancer through occupational exposure and inhalation of its large quantities.Methods: Occupational exposure of workers in Pakdasht, Iran, in 2011 was investigated in four different casting pro-cesses in small foundries with less than 10 workers. Sampling respirable dust was collected on MCE filter, using HD cyclone at a flow rate of 2.2 lit/min. The filters were analyzed for dust using NIOSH Method 7601. Gravimetric and visible absorption spectrophotometer was used to determine amounts of inhalable dust and free silica, respectively. Risk assessment techniques were also used to predict silicosis and lung cancer.Results: Geometric means of occupational exposure to crystalline silica in 4 different casting processes were studied within the range of 0.009-0.04 mg/m3. Mortality rate due to silicosis was in the range of 1-13.7 per 1000 persons ex-posed. Risk of mortality due to lung cancer in exposed workers in small casting workshops in Pakdasht, Iran ranged 4-16 per 1000 persons exposed based on geometric mean and 45 years of exposure. According to risk assessment, mor-tality due to silicosis, cumulative exposure of 96% of population was at an acceptable level of 1/1000.Conclusion: Fifty percent of workers were exposed to crystalline silica dust in excess of Recommended Exposure Limit -NIOSH and Threshold Limit Value ACGIH (0.025 mg/m3). Several cases of silicosis and lung cancer are antic-ipated for this occupational group in near future.

Background: Every year many organizations formulate a Code of Ethics (COE) but when it comes to implementing, it does not achieve the desired purposes. Ineffectiveness of COEs can stem from different factors and surely, one of them is bad formulation. This research was conducted to identify the barriers to effective formulation of COEs in one of the main state universities of medical sciences in Iran.Methods: A qualitative approach using thematic analysis in three stages of descriptive coding, interpretative coding and overarching themes was adopted to analyze data collected through 27 semi-structured interviews. This study was conducted in 2014-15 at Shahid Beheshti University of Medical Sciences, Tehran, Iran.Results: Totally 135 descriptive themes, 12 interpretive themes and 3 overarching themes emerged through analyzing interviews.Conclusion: In order to have an implementable COE, 12 barriers in three categories including “goal-setting”, “ap-proach” and “content” of the COE, must be removed. In “goal-setting”, real cultural conditions of the medical uni-versity must be considered. Moreover, the COE must be in response to perceived internal needs and its philosophy must be clear for all members of the university. Besides, the formulation “approach” of the COEs must be specialist, participatory and expertised. Finally, in “content”, different stakeholders with diverse values, levels of knowledge and needs should be carefully addressed. In addition, it is proposed to emphasize religious and humane values to encour-age participation of people. As a final point, the university should avoid imitation in the content of the COE, and con-ceptualize the values in motivating, inspirational and guiding words.

Background: Tuberculosis (TB) spread pattern is influenced by geographic and social factors. Nowadays Geographic Information System (GIS) is one of the most important epidemiological instrumentation identifying high-risk popula-tion groups and geographic areas of TB. The aim of this study was to determine the correlation between climate and geographic distribution of TB in Khuzestan Province using GIS during 2005-2012.Methods: Through an ecological study, all 6363 patients with definite diagnosis of TB from 2005 until the end of Sep-tember 2012 in Khuzestan Province, southern Iran were diagnosed. Data were recorded using TB- Register software. Tuberculosis incidence based on the climate and the average of annual rain was evaluated using GIS. Data were ana-lyzed through SPSS software. Independent t-test, ANOVA, Linear regression, Pearson and Eta correlation coefficient with a significance level of less than 5% were used for the statistical analysis.Results: The TB incidence was different in various geographic conditions. The highest mean of TB cumulative inci-dence rate was observed in extra dry areas (P=0.017). There was a significant inverse correlation between annual rain rate and TB incidence rate (R=-0.45, P=0.001). The lowest TB incidence rate (0-100 cases per 100, 000) was in areas with the average of annual rain more than 1000 mm (P=0.003).Conclusion: The risk of TB has a strong relationship with climate and the average of annual rain, so that the risk of TB in areas with low annual rainfall and extra dry climate is more than other regions. Services and special cares to high-risk regions of TB are recommended.

Background: The current study’s objectives were to find any possible spatial patterns and hotspot of cardiovascular events and to perform a correlation study to find any possible relevance between cardiovascular disease (CVE) and location of industrial installation said above.Methods: We used the Acute Myocardial Infarction (AMI) hospital admission record in three main hospitals in Yazd, Yazd Province, Iran during 2013, because of CVDs and searched for possible correlation between industries as point-source pollutants and non-random distribution of AMI events.Results: MI incidence rate in Yazd was obtained 531 per 100, 000 person-year among men, 458 per 100, 000 person-year among women and 783/100, 000 person-yr totally. We applied a GIS Hotspot analysis to determine feasible clus-ters and two sets of clusters were observed. Mean age of 56 AMI events occurred in the cluster cells was calculated as 62.2114.75 yr. Age and sex as main confounders of AMI were evaluated in the cluster areas in comparison to other areas. We observed no significant difference regarding sex (59% in cluster cells versus 55% in total for men) and age (62.2114.7 in cluster cells versus 63.2813.98 in total for men).Conclusion: We found proximity of AMI events cluster to industries installations, and a steel industry, specifically. There could be an association between road-related pollutants and the observed sets of cluster due to the proximity exist between rather crowded highways nearby the events cluster.

Dear Editor-in-Chief: In clinical practice, regular exercise shows great potential as a method for promoting physical health measures such as weight management and preventing a variety of diseases. Further-more, regular exercise has been shown to yield both psychological (e.g., improve anxiety, mood, and depression) and social benefits (e.g., self-es-teem and social interaction). Several recent studies have reported greater effects of combined exercise on physical fitness and conditions. However, little existing evidence supports the ef-fects of combined exercise on elementary school students.

Dear Editor in Chief: Reducing the prevalence of smoking among teen-agers who smoked by increasing the rate of smok-ing cessation is among the feasible long term measures to reduce health problems related to smoking among Malaysian population. However, previous studies have revealed that addiction to nicotine is one of the identified barriers for ado-lescent smokers to quit smoking.

Dear Editor-in-Chief: Majority of dentists working in public and private health sector lack the adequate knowledge about recognition and reporting issues of suspected cas-es of child abuse presented clinically as sexual abuse. As mandated reporters, dental surgeons play a key role in recognizing child abuse. Sex-ual abuse cases may be presented as either ery-thematous, ulcerative, vesiculopustular, pseudo membranous or condylomatous lesions on lips, tongue, palate, face or pharynx.

Dear Editor-in-Chief: China’s ongoing health care reform, up to date so-cial health insurance include urban employee basic medical insurance (UEBMI), urban resident basic medical insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS). Health insurance can share economic risks, and enable populations to access health care ser-vices. HBV-related disease impose financial burden to society. It was therefore of great interest whether health insurance affect the finan-cial burden for those with Hepatitis B.

Dear Editor-in-Chief: The number of people living with HIV is increas-ing in the eastern Mediterranean region and the world but still the coverage of anti-retroviral therapy in the region is very low. In Iran, there are many observed gaps in the process of HIV testing, treating and retaining cascade. Iran has a long way to achieve the goals published by the UNAIDS fast- track, accordingly, by the year 2020, 90% of people living with HIV and AIDS have to know their HIV status; 90% of people who know their status be on treatment; and 90% of people on treatment have suppressed viral loads.

Dear Editor-in-Chief: Familial Mediterranean fever (FMF), the most fre-quent of the periodic fever syndromes, is an auto-somal recessive disease, predominantly affecting people of Mediterranean descent, although re-cently it has been described in many other popula-tions. Linkage between the gene responsible for FMF (MEFV) and the short arm of chromo-some 16 was first shown in 1992. Mediterranean Fever (MEFV) gene was identified by positional cloning.

Dear Editor in Chief: Multidrug-resistant TB (MDR-TB) is a major chal-lenge to TB control program. MDR-TB pa-tient is resistant to treatment with at least two of the common. Strong first-line treatment anti-TB drugs contain isoniazid and rifampicin.

Dear Editor in Chief: Central and dispersion indices of statistical distri-bution of a random phenomenon together show the behavior pattern of that phenomenon. In healthcare researches, researchers are mainly inter-ested in examining the impact of various factors on the behavior of a random phenomenon. One of the useful tools to achieve this goal is the use of statistical models such as linear regression model. Linear regression model estimates effect of differ-ent factors on the mean of a quantitative response variable, which is the variable that we examine effect of other factors on it.

Dear Editor-in-Chief: Tuberculosis (TB), after HIV, is the second lead-ing cause of death from infectious disease in the world. Currently, the treatment process for TB takes a minimum of six months. The World Health Organization recommends a drug treat-ment regimen in this time frame and prescribes four drugs (a combination of rifampicin, isoniazid, ethambutol and pyrazinamide for two months, followed by a four-month continuation phase of rifampicin and isoniazid).

Dear Editor-in-Chief We would like to congratulate Faraji et al for their recent publication entitled “Correlation between Fluoride in Drinking Water and Its Levels in Breast Milk in Golestan Province, Northern Iran”. However, there is a question on the Materials and Methods section of this paper. It seems that the inclusion and exclusion criteria have not been included accurately in this section. For example, the people who have been studied whether taking fluoride supplements or not, also what was their diet (e.g., the amount of drinking tea) ?