Iranian Journal of Public Health
Year:2019 | Volume:19 | Issue:5|Papers Count:30

Background: The Global Adult Tobacco Survey (GATS) is a global study to monitor tobacco use, and evalu-ate current measures and requisite policies on tobacco control. In this study, the key indicators from GATS Kazakhstan that address six tobacco control policies are assessed. Methods: GATS Kazakhstan was a nationally representative household survey of the adult population aged 15 yr or older (n=4425, 52. 8% females) implemented in 2014, in all regions of Kazakhstan. A multi-stage, geo-graphically clustered sample design was used to obtain the key indicators of tobacco use and tobacco measures in the country. The sampling weights were employed to ensure real national representation. A household and individual questionnaire were administered through electronic devices. Results: The majority of current tobacco users were cigarette smokers 22. 2%. Overall, 19. 0% of adults were exposed to secondhand smoke while at work. One third of smokers made a quit attempt in the last 12 months. Only, 74. 0% of adults believed that breathing other people’ s smoke causes serious illness in non-smokers. Al-most all current smokers (97. 6%) noticed pictorial health warnings on cigarette packages. Over half (58. 0%) of the current smokers had thought about quitting, having seen pictorial warning labels. Exposure to any cigarette advertisement, sponsorship or promotion had been experienced by 25. 7% of adults, with the highest rate of noticing cigarette advertisements being found in stores where cigarettes are sold (14. 0%). Cigarettes were large-ly affordable for the population. Conclusion: The GATS Kazakhstan results identified tobacco use indicators, as well as existing gaps in tobac-co control measures.

Background: The association between estrogen receptor-β (ESR2) rs4986938 polymorphism and the risk of various types of cancer have been investigated in previous studies. However, the results remained disputable. Here, we conducted a meta-analysis to investigate the association between ESR2 rs4986938 polymorphism and the risk of cancer. Methods: We searched for relevant articles collected by the PubMed, EMBASE, and Cochrane library up to March 30, 2018. The association was assessed using Odds ratios (ORs) and 95% confidence intervals (CIs). Results: The meta-analysis involved a total of 23 studies in 20 papers, including 24, 334 cases and 31, 707 con-trols. No significant association was detected between the rs4986938 polymorphism and cancer risk in the addi-tive model (A compared with G: OR=0. 97, 95% CI=0. 92-1. 02, P=0. 20), dominant model (AA+AG compared with GG: OR=0. 96, 95% CI=0. 93-1. 03, P=1. 00), recessive model (AA compared with AG + GG: OR=0. 94, 95% CI=0. 86-1. 03, P=0. 18), heterozygous model (AG compared with GG: OR=0. 97, 95% CI=0. 94-1. 01, P=0. 14), and homozygous model (AA compared with GG: OR=0. 96, 95% CI=0. 87-1. 06, P=0. 39). Results of subgroup analysis stratified by ethnicity and cancer types further validated the results. Conclusion: We found no evidence of an association between rs4986938 and the risk of overall cancer.

Background: To assess the effects of chlorhexidine dressing on health care-associated infection in hospital-ized patients. Methods: We searched for English-language published randomized controlled trials (RCTs) in Cochrane Li-brary, EMBASE and PubMed between January 1998 and January 2018. We used meta-analysis to calculate the risk ratios (RRs) and 95% confidence intervals (CIs) of the data, and using the I2 assessment to summarize the heterogeneity of RCTs and the funnel plot and Egger regression test to evaluate publication bias. Results: A total of 13 RCTs were included in our meta-analysis, including 7555 patients and 11, 931 catheters. The effects of chlorhexidine dressing on the incidence of catheter-related bloodstream infections (CRBSIs) were reported in 13 RCTs, and the incidence of CRBSIs were 1. 3% (80/6160) in the chlorhexidine group and 2. 5% (145/5771) in the control group. We used a forest plot to determine the risk ratio (RR) of chlorhexidine dressing on the incidence of CRBSIs, and our results showed that chlorhexidine dressing significantly reduced the incidence of CRBSIs (RR 0. 55, 95% CI 0. 39-0. 77, P<0. 001). Moreover, we also analyzed the effects of chlorhexidine dressing on the incidence of catheter colonization and catheter-related infections (CRIs), and our forest plot results showed that chlorhexidine dressing significantly reduced the incidence of catheter coloniza-tion (RR 0. 52, 95% CI 0. 40-0. 67, P<0. 001) and the incidence of CRIs (RR 0. 43, 95% CI 0. 28-0. 66, P<0. 001) in hospitalized patients. Conclusion: The use of chlorhexidine dressings for hospitalized patients significantly reduce the incidence of CRBSIs, catheter colonization and CRIs.

Background: Physical rehabilitation, as one of the rehabilitation disciplines, can play a great role in humanitar-ian reliefs. The effectiveness of physical rehabilitation services is completely dependent on time of intervention, the importance of good timing in providing services during disasters is not well understood. The objective of this study was to systematically review the physical rehabilitation services provided in disasters and emergen-cies. Methods: An electronic search of PubMed, Scopus, Cochrane, and PEDro (Physiotherapy Evidence Data-base) was undertaken from Jan 2000 to Sep 2017. All English studies reporting physical rehabilitation services in natural and man-made disasters were selected regardless of study design. The included studies were analyzed by descriptive and analytical method. Results: Thirteen studies were included after reviewing by title, abstract and full text in this study. Most of the physical rehabilitation studies come back to recent years. Most of the disaster physical rehabilitation services were physiotherapy and occupational therapy. The physical rehabilitation experts have been attended in the affected area from the few first hours until several months after disasters in order to provide the required ser-vices to the affected population. Conclusion: There are few studies about physical rehabilitation services provided in the disaster-affected areas and this study showed that the services were limited and at different times. Physical rehabilitation services post disasters should have a comprehensive service model, like other health services. Therefore, it is necessary to conduct further studies to achieve this aim.

Background: Breast cancer is known as one of the most common cancers among women and has severe psy-chological effects. This study aimed to identify the psychological consequences of breast cancer in previous studies based on meta-analysis. Methods: Meta-analytic procedures were conducted by Prisma guidelines. A literature search was conducted by using following electronic databases including scientific information databases (SID), Magiran, Medlib, Sci-enceDirect, PubMed, Google Scholar, Web of Science, Scopus, CINAHL and Medline from 1991 through 2017 regarding the psychological consequences associated with breast cancer in Iran. The content of all articles was evaluated by the Prisma checklist and analyzed meta-analysis in CMA software. Results: The final synthesis was carried out on 56 quantitative studies. Considering the findings of meta-analysis of the psychological consequences of patients with breast cancer in seven classes, anxiety (ES=-0. 76), body image (ES=0. 199), coping strategies (ES= 0. 214), depression (ES=-0. 700), fatigue (ES=0. 322), quality of life (ES= 0. 428), and sexual function (ES=0. 355) were achieved. Conclusion: Based on the results of the high level of psychological consequences of breast cancer in women with breast cancer, it is necessary to formulate appropriate therapeutic protocols in order to adjust the psycho-logical consequences.

Background: We aimed to investigate the effects of occupational stress on blood lipids, blood glucose and immune function of doctors. Methods: In 2017, 1291 doctors (565 males, 726 females) in The First Hospital Affiliated with Harbin Medical University (Harbin, China) were enrolled based on the principle of convenience of sampling and cluster sam-pling. Questionnaires were used to investigate demographic characteristics and occupational stress related fac-tors. Level of glycated hemoglobin was detected by immunoturbidimetric method. Concentration of triglycer-ide was determined by glycerol phosphate oxidase end point method. Total cholesterol concentration in serum was determined by total cholesterol oxidase end point method. Concentration of serum immuno-globulin was detected by immunoturbidimetry. Results: Levels of glycated hemoglobin and triglyceride in high tension group were higher than those in the low tension group. Levels of IgG and IgM in high tension group were lower than those in low tension group. The risk of elevated glycated hemoglobin levels in > 50-yr-old age group was higher than that of the =<35-yr-old age group. Those in the high coping strategy group was higher in the low coping strategy group. The risk of elevated total cholesterol levels in drinkers is 1. 158 times that of non-drinkers. The risk of IgG concentra-tion reduction in smokers was 0. 428 times that of non-smokers. The risk of a decrease in IgA concentration in doctors with good sleep quality is 1. 527 times that of those with poor sleep quality. Conclusion: Occupational stress can lead to increased blood lipids and sugar levels as well suppression of immune function in doctors.

Background: We aimed to establish the reference range of thrombelastogram (TEG) for Chinese healthy vol-unteers and pregnant women and analyze the influence factors. Methods: Blood samples were collected from healthy volunteers and pregnant women at five tertiary hospitals (the Third Xiangya Hospital of Central South University, the Second Xiangya Hospital of Central South Uni-versity, Hunan Provincial People's Hospital, Hunan Cancer Hospital and Changsha Central Hospital) in 2016. The effects of age, gender, blood type, and full-term pregnancy on the reference range of normal TEG for healthy volunteers and pregnant women were studied. The specificity of TEG in detecting coagulation disor-der. Results: For healthy volunteers, the normal ranges of TEG parameters were as follows: R, 4. 3-9. 3 min; K, 1. 2-3. 2 min; α , 50. 2-71. 2° ; MA, 54. 1-71. 3 mm; LY30: 0%-2. 2%; CI,-3. 8-2. 4. At least one parameter exceeded the normal range specified by the manufacturer in 20. 3% of the healthy volunteers; about 7. 6% healthy volunteers were diagnosed as coagulation disorder by the above standards; the specificity of detection was 79. 7%. There were significant differences in R, K, α , MA and CI between males and females (P<0. 01). For pregnant women, the normal ranges of TEG were as follows: R, 3. 9-7. 5 min; K, 1. 0-2. 4 min; α , 57. 6-74. 9° ; MA, 55. 7-75. 7 mm; LY30, 0%-0. 56%; CI,-0. 97-3. 6. Pregnant women having O blood group had a dramatically prolonged R. Full-term pregnancy had no significant impact on TEG results. Conclusion: Compared with pregnant women having non-O blood group, those having O blood group had a dramatically prolonged R and showed greater tendency to hemorrhage during and after parturition.

Background: Fomites (including money) can transmit diseases to humans. How the nature of money influ-ences contamination has not been adequately demonstrated. Moreover, such studies in church settings are non-existent. Thus, we studied how money collected from a church could serve as human disease transmission ve-hicles. Methods: Overall, 284 money samples (currency notes and coins) were collected during two Sundays in the months of Nov and Dec 2015 from a church congregation in Pretoria, Gauteng, South Africa. The presence of potentially pathogenic bacteria and fungi were investigated using culture (Colilert® method) and molecular methods (Sanger sequencing). Scanning Electron Microscopy (SEM) was used to visualize the possible posi-tions of the bacteria on various parts of a currency note. Results: Of the 192 samples (first sampling round), 76 (39. 6%) were positive for E. coli. Smaller notes (R10) recorded the highest E. coli counts per note. Of the 92 notes analyzed for potentially pathogenic bacteria and fungi (second sampling round), 76 (82%) showed growth on at least one of the six culture media used. Se-quencing revealed three bacterial (Bacillus, Staphylococcus and Corynebacterium) and two fungal (Clavispora and Rhodotorula) genera. SEM revealed that microorganisms could enter cracks of creased notes. Conclusion: Unlike previous studies conducted where recent contamination could occur, the current study shows that microorganisms can survive on money; samples were collected from a church, where little or no exchange takes place. Moreover, using SEM demonstrates that aged and creased notes favor attachment of bacteria to money and could be of public health concern by transmitting disease within a given population.

Background: To investigate the clinical efficacy of physical factors combined with early psychological inter-vention in treatment of patients with chronic limb pain. Methods: A total of 132 patients with chronic limb pain admitted to Affiliated Hospital of Hebei University, Baoding, China from June 2014 to June 2017 were enrolled. The patients were divided into control group (n=66) and observation group (n=66) according to the random number table method. Both groups of patients were treated with physical factors, and the patients in the observation group were also treated with early psy-chological intervention. PHQ-15 pain factor score, visual analog pain score (VAS score), Hamilton depression rating scale (HAMD) and clinical efficacy were compared between two groups. Results: Difference of PHQ-15 pain factor score, VAS score and HAMD score between two groups before treatment were not statistically significant (P=0. 091, 0. 161, 0. 078). At the end of treatment and at 8 weeks of follow-up, PHQ-15 pain factor score, VAS score, and HAMD score of observation group were lower than those of control group, and the differences were statistically significant (P=0. 045, 0. 014; 0. 011, 0. 025; 0. 030, 0. 015). Total clinical effective rates of observation group and control group were 92. 43% and 86. 37%, respec-tively, and the differences were statistically significant (P=0. 019). Conclusion: Compared with physical factors alone, combination of physical factors and early psychological intervention can significantly alleviate the pain and improve the depression of patients with chronic limb pain. It should be promoted in clinical practices.

Background: The aims of this study were to develop a hyperthyroidism-specific health status scale of Korea (K-HHSS) and to verify its validity and reliability. Methods: A methodological study was performed with hyperthyroid patients to assess the following properties: content validity, item analysis, Cronbach’ s α , intraclass correlation coefficients, and confirmatory factor analysis. The data were obtained from 80 patients with hyperthyroidism given medical care at C university hospital in Seoul in 2017. Results: The construct validity was supported by the item-analysis correlations ranging between 0. 31 and 0. 82. The internal consistency reliability was from 0. 70 to 0. 85, and the scale’ s stability was confirmed by intraclass correlation coefficients between 0. 57 and 0. 97. Construct reliability was 0. 81 and the average variance extracted (AVE) was 0. 72. These inclusion criteria resulted in the selection of 30 items in 7 categories. Conclusion: This scale will be useful as a limited health-measuring index for the nursing assessment of patients with hyperthyroidism in Korea.

Background: Dual practice by surgery specialists is a widespread issue across health systems. This study aimed to determine the level of dual practice engagement and its related factors among Iran’ s surgery specialists. Methods: A pre-structured form was developed to collect the data about surgery specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes and eventually a combination of the first name, surname and father's name. Multilevel logistic regression was used to assessing the association between dual practice with study variables. Results: Overall, 14931 surgeons were participated (93% response rate) and 6405 (57% of) engaged in DP on total. Urinary tract & genital and neurosurgery specialties had the highest rank with 69%. DP was more frequent in specialists with higher age and experience, populated provinces, higher deprivation, and share of private hos-pitals. Faculty physicians (OR=0. 69), full-time geographic physicians (OR=0. 17), specialists with more than 25 years’ experience (OR=2. 59) and age more than 40 yr (OR=1. 3) had significant association with dual practice. Conclusion: Multi-approach strategy is needed to control dual practice through tax regulations, income cap, and limitations in work hours and number of visits in private sector.

Background: Cutaneous leishmaniasis (CL) as a public health concern is increasingly circulating by causative agents of Leishmania tropica and L. major in Iran. As regard to recent treatment failure and controlling problems, the accurate elucidation of heterogeneity traits and taxonomic status of Leishmania spp. should be broadly ad-dressed by policymakers. This study was designed to determine the genetic variability and molecular characteri-zation of L. major and L. tropica from Iranian CL patients. Methods: One hundred positive Giemsa-stained slides were taken from clinical isolates of CL at Pol-e-Dokhtar County, Southwest Iran, from May 2014 to Sep 2016. DNAs were directly extracted and amplified by targeting ribosomal internal transcribed spacer (ITS) gene following microscopic observation. To identify Leishmania spp. amplicons were digested by restriction enzyme HaeIII subsequent PCR-RFLP technique. To reconfirm, the isolates were directly sequenced to conduct diversity indices and phylogenetic analysis. Results: Based upon the RFLP patterns, 84 and 16 isolates were explicitly identified to L. tropica and L. major respectively. No co-infection was found in clinical isolates. The high genetic diversity of L. tropica (Haplotype diversity 0. 9) was characterized compared to L. major isolates (Hd 0. 476). The intra-species diversity for L. tropica and L. major isolates corresponded to 3%-3. 9% and 0%-0. 4%, respectively. Conclusion: Findings indicate the L. tropica isolates with remarkable heterogeneity than L. major are predomi-nantly circulating at Pol-e-Dokhtar County. Occurrence of high genetic variability of L. tropica may be noticed in probable treatment failure and/or emerging of new haplotypes; however, more studies are warranted from various geographic regions of Southwest Iran, using large sample size.

Background: Contamination of hair dyes to heavy metals can threaten consumer's health. We investigated the concentrations of some important heavy metals in hair dyes and evaluates their non-carcinogenic effects. Methods: The most commonly used hair dyes were determined through questioners and 32 samples were col-lected from the market of Tehran in 2014. The concentration of 10 heavy metals (Fe, Ag, Co, Cr, Mn, Ba, Cd, Cu, Pb, and Al) was determined using ICP-MS. Based on the obtained data from distributed questionnaires and Monte Carlo simulation, the exposure to the evaluated heavy metals was estimated. Besides, using hazard quo-tient (HQ) and chronic hazard (HI), the risk of non-carcinogenic effects of investigated hair dyes consumption was specified. Results: Results indicated the average concentrations of Al, Ba, and Fe as 0. 54, 0. 86, and 1. 19 mg kg-1 and those of Cd, Cu, and Pb as 0. 45, 61. 32, and 185. 34 μ g kg-1, respectively. Pb with HQ of 7. 46e-4 had the highest risk and Fe with HQ of 3. 4e-6 had the lowest level of risk. Among the investigated dyes, the ones made by Iran (HI=2. 8e-4) and the dark brown color (HI=1. 93e-4) had the highest level of risk among all the studied samples. Conclusion: Two indices of HI and HQ showed that heavy metal contents in the investigated samples had not probable non-carcinogenic risks for the consumers of these products.

Background: Toxoplasmosis is an infectious disease caused by the coccidian protozoan parasite Toxoplasma gondii. The infection is life-threatening in congenital form because of transmission of the parasite from mother to fetus. In order to investigate the prevalence of congenital toxoplasmosis, the present study was performed for detection of IgG and IgM antibodies in cord blood samples of newborns by ELISA method in Tehran, Iran. Methods: This cross-sectional survey was carried out on 1000 cord blood samples collected from Shahid Mo-stafa Khomeini Hospital in Tehran, Iran in 2015. Sera were separated and evaluated for the presence of IgG and IgM antibodies against T. gondii by ELISA method. At the same time, whole cord blood samples were stored at-20 ° C for complementary PCR test. Results: From 1000 cord blood serum samples 198 cases (19. 8%) were positive for anti T. gondii IgG antibody. IgG positive samples were examined for IgM antibody, among them 1 sample had borderline levels of IgM anti-body. PCR was performed for this sample but no positive result was seen. Conclusion: Although congenital toxoplasmosis is of importance, no acute form of infection was seen in preg-nant women in this study.

Background: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) worldwide, especially among children and debilitated populations. The present study aimed to investigate a loop-mediated isothermal amplification (LAMP) technique for rapid detection of M. pneumoniae in clini-cal specimens collected from patients with pneumonia. Methods: Throat swabs were collected from 110 outpatients who suffered from pneumonia. Throat swab samples were obtained from patients referred to the hospital outpatient clinics of Tehran University hospitals, Iran in 2017. The presence of M. pneumoniae in the clinical specimens was evaluated by LAMP, PCR and culture methods. Sensitivity and specificity of the LAMP and PCR assays were also determined. Results: Out of 110 specimens, LAMP assay detected M. pneumoniae in 35 specimens. Detection limit of the LAMP assay was determined to be 33fg /μ L or ~ 40 genome copies/reaction. Moreover, no cross-reaction with genomic DNA from other bacteria was observed. Only 25 specimens were positive by the culture method. The congruence between LAMP assay and culture method was ‘ substantial’ (κ =0. 77). Specificity and sensitivity of LAMP assay were 88. 2%, 100% in compare with culture. However, the con-gruence between LAMP assay and PCR assay was ‘ almost perfect’ (κ =0. 86). Specificity and sensitivity of LAMP assay were 92. 5%, 100% in compare with PCR. Conclusion: Overall, the LAMP assay is a rapid and cost-efficient laboratory test in comparison to other methods including PCR and culture. Therefore, the LAMP method can be applied in identification of M. pneumoniae isolates in respiratory specimens.

Background: As dyslipidemia is a preventable risk factor for Coronary heart disease (CHD), precise estimation of its prevalence and determinants is crucial for proper development of health actions. This population-based study aimed at investigating the socioeconomic, dietary and psychological determinants of dyslipidemia in Iran. Methods: The data (n=700) for this study were collected in 2015 as a part of the major Lifestyle Promotion Project (LPP) conducted in East Azerbaijan (urban and regional parts). The data for socio-demographic status, dietary information, and physical activity and anxiety levels were collected through validated questionnaires. Then, physical examinations including blood pressure, body mass index (BMI) and conicity index were per-formed. The levels of serum lipids were measured by enzymatic colorimetric methods. Results: The prevalence of hypercholesterolemia, high LDL-C, hypertriglyceridemia, low HDL-C and dyslipidemia was 29. 4%, 10. 3%, 62. 3%, 41. 4%, 83. 3% respectively. The mean TC (184. 3± 41. 2 vs. 174. 5± 38. 1 mg/dl), LDL-C (94. 6± 30. 3 vs. 88. 1± 28. 7 mg/dl) and HDL-C (46. 7± 10. 4 vs. 39. 5± 8. 0 mg/dl) in women were significantly higher than men (P<0. 05). However, the mean of TG (182. 3± 119. 3 vs. 145. 1± 87. 8 mg/dl) was significantly higher in men compared to women (P<0. 05). Obesity, family history of dyslipidemia, sedentary lifestyle, smoking habits, salt intake, and anxiety were risk factors for different components of dyslipidemia in men and women. Conclusion: Dyslipidemia is a major health problem in northwest of Iran. Focusing on screening, regular drug intake, proper nutrition, physical activity, and changing lifestyles of patients with dyslipidemia are essential.

Background: The detection of Fasciola species in various geographical regions is essential for health policymak-ing. Here, we aimed to identify livestock (cattle and sheep) related Fasciola genotypes by restriction fragment length polymorphism PCR. Methods: Seventy adult Fasciola flukes were collected from 70 infected livers of 35 cattle and 35 sheep slaugh-tered in Zabol abattoir, outh-east Iran (Jan-Jul 2017). Fasciola species were determined based on molecular fea-tures. For molecular detection, Fasciola ITS1 region was amplified and sequenced. A 700 bp fragment was ampli-fied. These were digested with RasΙ enzyme. F. hepatica specific fragments were 47, 59, 68, 104, and 370, while those related to F. gigantica had 45, 55, 170, 370. Results: The two main species of F. hepatica and F. gigantica are responsible for fasciolosis in sheep and cattle in our region. From 35 Fasciola isolated from cattle, 3 and 32 were F. hepatica and F. giagantica respectively. From 35 Fasciola isolated from sheep, 4 were F. hepatica and 31 were F. gigantica. Conclusion: All Seventy Fasciola samples from two different hosts (cattle and sheep) were identified as either F. hepatica or F. gigantica by PCR-RFLP. Genotypic variability of Fasciola species was high in our region. It is rec-ommended to assess molecular variation of Fasciola isolates in other host livestock.

Background: Mucormycosis is an acute and invasive fungal infection with a high mortality rate. Mucorales are less sensitive than other types of fungi to most antifungal agents. Amphotericin B (AMB) is one treatment op-tion for this infection, but in recent studies, the antifungal activity of statins against Mucorales was shown. Therefore, therapy that combines AMB with these agents may have better effects in management of patients with mucormycosis. We evaluated the in vitro activity of AMB alone and in combination with statins, against Mucorales. Methods: Susceptibility profiles of AMB alone and in combination with two statins, atorvastatin (ATO) and lovastatin (LOV) determined against clinical (n: 15) and environmental (n: 5) Rhizopus oryzae isolates, obtained between Jan 2009 and Oct 2016 from patients with uncontrolled diabetes mellitus and cancer referred to the Department of Parasitology and Medical Mycology of Tehran University of Medical Sciences, Tehran, Iran. It was performed by microdilution method, based on the Clinical and Laboratory Standard Institute (CLSI) M38-A2 guideline. Results: All clinical and environmental isolates were susceptible to AMB (MIC≤ 1 μ g/mL). The results of the interactions between AMB and the two statins were positive. The AMB-ATO (GM: 0. 13 μ g/Ml) combination produced greater activity than the AMB-LOV (GM: 0. 26 μ g/mL) combination. AMB, in combination with ATO and LOV, reacts positively against clinical and environmental R. oryzae isolates. Conclusion: This combination strategy may lead to more effective treatment of mucormycosis and fewer side effects using low dose of AMB.

Background: Despite several reports on the clinical manifestations of sulfur mustard (SM) intoxication, there is no study on serum concentrations of thyroid hormones long-term after SM exposure. In this study, the changes in thyroid functioning parameters 20 yr after SM exposure were evaluated. Methods: This study is a part of a larger historical cohort study conducted in 2007 following 20 years of the exposure to SM, called Sardasht– Iran cohort study (SICS). We (SICS) comprised an SM– exposed group from Sardasht City, West Azerbaijan Province, Iran (n=169 as hospitalized group and n=203 as non-hospitalized exposed group); and control participants were selected from Rabat, a town near Sardasht (n=126). Peripheral blood samples were taken in fasting state and then the sera were separated. T4, T3, TSH, antithyroglobulin (an-ti– Tg), and antithyroid peroxidase (anti– TPO) concentrations in the sera were measured by the ELISA method. Results: The mean of T3 concentration was significantly higher in the exposed than control group (0. 88 ± 0. 26 nmol/L vs 0. 8 ± 0. 25 nmol/L, P<0. 001). The levels of TSH, T4, and T3up were not significantly different be-tween the exposed and control groups. Thyroglobulin level was significantly higher in the exposed non-hospitalized group (56. 07 ± 140. 22 μ g/L vs 17. 66 ± 41. 49 μ g/L, P=0. 004), but the level of anti– Tg and anti– TPO showed no significant differences between the two groups. Conclusion: More studies are needed on the alterations in thyroid hormones, their gene expressions, and mechanisms involved in SM exposure to clarify the causes of these alterations.

Background: This study aimed to psychometrically assess the HIV/AIDS items of MICS-6 in the Iranian population in the effort to collect valid and reliable data regarding the Iranian culture. Methods: This methodological study is a psychometric assessment of the HIV/AIDS items in the Multiple-Indicator Cluster Survey (MICS) as the AIDS module in MICS Round 6, which includes items on awareness and stigma in people aged over 15 and examines them for their HIV test history. First, the AIDS module was translated into Persian and then translated back into English; subsequently, the psychometric properties of the Persian version were assessed. The face, content and construct validities of this version were also evaluated. The test-retest and internal consistency estimates were also used to determine the instrument’ s reliability, and the questionnaire was implemented in 200 samples from the target population as a pilot study. Results: The validity of the instrument was confirmed with a CVR higher than 0. 78 and a CVI of 0. 79. The exploratory factor analysis was performed to confirm the validity of the five factors of the MICS-6. A high in-ternal consistency was reported with a Cronbach's alpha coefficient of 0. 98 for the questionnaire as a whole and questionnaire has good validity and reliability. Conclusion: The Persian version of the AIDS module of the MICS-6 has satisfactory reliability and validity. The present findings are consistent with the results of other studies on the psychometrics of the international AIDS questionnaire.

Background: The objective of the present study was to investigate the strength and weaknesses of healthcare management during the first 10 days after the earthquake in Sarpol-e Zahab in Kermanshah, Iran. Methods: This qualitative, observational study was conducted on November 13-23, 2017 in the disaster area, by using content analysis. Data was collected through experts and focus group interviews with professional and healthcare staff, and policy-makers. Results: Our findings were categorized into 7 major groups; environmental health; mental health; mothers, in-fants and children’ s health; field hospital; nutrition; contagious diseases; drug delivery. There were good coopera-tion and coordination regarding environmental health issues. However, other categories were handled by differ-ent organizations and resulted in a chaotic situation. Conclusion: The post-earthquake period is overwhelmed with considerable issues regarding the care of victims and therapeutic measures. Lack of quick, reliable, and appropriate management will result in extensive health issues, including epidemic, worsening of chronic diseases, and exacerbation of mental disorders.

Background: The purpose of this study was to evaluate the correlations between the nutritional status, nutri-tional habits, and physical activity in the representative population of 18-year-old students. Methods: A total of 1, 631 participants aged 18 years, originating from secondary schools/senior high schools in the city of Bialystok, Szpitalna, Bialystok, Poland were enrolled. Participants completed anonymous ques-tionnaires, and their body mass index was assessed. Data were analyzed using standard statistical procedures with Statistical PL 12. 0. Results: The analysis showed that consumption of only one to two or three meals was associated with an in-creased risk of overweight and obesity— in case of one or two meals among girls, OR=1. 78 (P<0. 05), in case of one or two meals among boys, OR=2. 325 (P<0. 01), and in case of three meals, OR=1. 771 (P<0. 05). First breakfast was consumed by 82. 1% of boys with normal BMI and 73. 1% overweight and obesity (OR=0. 593; P<0. 05). 24. 5% of the eutrophic compared to only 20. 3% of adolescents with elevated BMI reported attending all PE classes. Physical activity undertaken after school was associated with a 35. 9% decrease risk of overweight and obesity among girls and 57. 7% among boys. Conclusion: A specific pattern of nutritional habits, that is, decreased meal frequency in adolescents, skipping meals, appear the most frequent nutritional mistakes associated with overweight and obesity. Insufficient physi-cal activity and exposure to sedentary behaviors among adolescents are disturbing. The obesity problem re-quires monitoring, prevention and the change of nutritional habits and physical activity early in childhood.

Dear Editor-in-Chief As time passes, the growing old gradually drives to decrease physical structures and functions, and age-related changes reduce physical activities in daily life for old adults. However, they have not enough physical activities to maintain and im-prove their physical functions even they recog-nize it (1). Especially, while the aerobic exercise decreases body fat, heart rate in steady state, and blood pressure (2), the resistance exercise is more effective for improving basal metabolic rate, and muscular strength (3).

Dear Editor-in-Chief With the rapid economic and social development, the large epidemic of major non-communicable diseases (mNCDs) due to unhealthy lifestyles lead to a heavy burden and a tremendous chal-lenge in both advanced and developing countries. Just as “ the three big mountains” , cardiovascular disease, diabetes, and cancers affect greatly healthy life expectancy. Health is everyone’ s goal, it’ s also a dream from reality to the future (1). In fact, there are only 4. 3% population with entire health.

Dear Editor-in-Chief NADPH oxidase consists of six subunits: p47phox, p67phox, p40phox, and Rac in the cy-toplasm combined with gp91phox and p22phox in the cell membrane (1). Among these six subu-nits, p22phox is found in the NADPH oxidase of neutrophils and vascular smooth muscle cells. The p22phox subunit has been shown to play a role in reactive oxygen species (ROS) generation in blood and blood vessel cells as a component of flavocytochrome b558 (1).

Dear Editor-in-Chief As the prevalence rate of dementia in the elderly increases, to facilitate the early detection and management of dementia, it is important to de-tect cognitive impairment early by using simple and appropriate tools and to identify and manage related factors. Among oral diseases, it is associ-ated with dementia and periodontal disease and is caused by biofilm (1). Therefore, the purpose of this study was to evaluate the cognitive abilities, socio-demographic characteristics, and various oral health-related indices in the elderly popula-tion vulnerable to dementia, to understand the influence of cognitive abilities on oral health, and to utilize this information it for health promotion among the elderly.

Dear Editor-in-Chief Low Back Pain (LBP) is the common chronic pain among computer-based workers that con-tributes to disability, movement limitation and can lead to severe and long term impairment (1). Prevalence of LBP is high among computer-based workers in developing countries and they face several aspects of stress and pressures (2, 3). For example, more than 60% of office workers in Iran had one episode LBP during their working time and they had 92. 1% of LBP during their life-time (2).

Dear Editor-in-Chief Exposure to electromagnetic fields (EFM) is an indispensable part of our daily life and occurs in almost every situation. In developing countries, the main sources of these fields in the household are high-voltage power lines (1). In recent years, concern about its biological effects of people liv-ing next to high voltage power lines has been raised.

Dear Editor-in-Chief Toxoplasma gondii, the causative agent of toxo-plasmosis, is one of the more common parasitic zoonoses world-wide. Humans become primarily infected by oral ingestion of viable tissue cysts contained in undercooked meat, or by ingesting water or food contaminated with oocysts from infected feline faeces (1). Although, the infection with T. gondii is usually asymptomatic in immuno-competent humans, it can be fatal in the immun-ocompromised patients (1). Primary infection in a pregnant woman can also cause severe and disa-bling disease in the developing fetus (1).

Dear Editor-in-Chief Smallpox was always one of the terrible causes of massacre by its epidemics worldwide (1). Alt-hough some local societies like nomads of Balu-chistan (southeast of Iran) used natural vaccina-tion like method for Smallpox (2), finding vac-cination for eradication smallpox is credited for Edward Jenner in 1978 (3). In Iran, by spreading eradication of Smallpox in the early 20th century AD, there was a national effort to control it (4). Fars Province was one of the regions affected by this disease.