JOURNAL OF RESEARCH IN HEALTH SCIENCES (JRHS)
Year:2016 | Volume:16 | Issue:3|Papers Count:13

Background: Major Thalassemia is an autosomal recessive disease with complications, mortality and serious pathology. Today, the life expectancy of patients with major thalassemia has increased along with therapeutic advances. Therefore, they need lifelong care, and caring for them would incur many costs. Being aware of the patients’ costs can be effective for controlling and managing the costs and providing efficient treatments for the care of patients. Hence, this study was conducted to estimate the economic burden of the patients with major thalassemia.Methods: Totally, 198 patients with major thalassemia were randomly selected from among the patients with major thalassemia in Tehran, Iran in 2015. The economic burden of the patients was estimated from a social perspective and through a bottom-up, prevalence-based approach.Results: The average annual cost per patient was estimated $ 8321.8 regardless of the cost of lost welfare. Of this amount, $ 7286.8 was related to direct medical costs, $ 461.4 to direct non-medical costs, and $ 573.5 to indirect costs. In addition, the annual cost per patient was estimated $ 1360.5 due to the distress caused by the disease Conclusions: Considering the high costs of the treatment of patients with major thalassemia, adopting new policies to reduce the costs that patients have to pay seems necessary. In addition, making new decisions regarding thalassemia screening, even with higher costs than the usual screening costs, can be useful since the costs of treatment are high.

Background: It is unclear whether knowing of current HIV status is associated with change in injecting behaviors among people who inject drugs (PWID) in Iran. The objective of the present study was to determine whether awareness of HIV positive status is associated with a reduction in injecting risk behaviors, after matching for socio-demographic characteristics.Methods: Five hundred male PWID were recruited in 2014 from two drop-in centers (DICs) in Kermanshah west of Iran. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our primary exposure of interest was awareness of HIV status used to group participants into three categories: positive, negative, unaware. We used coarsened exact matching to make the three groups statistically equivalent based on age, place of residence, education and income, and then compared them regarding the proportion of borrowing, lending and reuse of syringes.Results: Matched sample (n=320) had a mean age ± standard deviation (SD) of 33.5±7.6 yr. Overall, 25% (95% CI: 14%, 32%) of participants reported "borrowing a syringe" in the past month and 15% (95% CI: 7%, 22%) of them reported "lending a used syringe" to others in the past month. In comparison to PWID who were unaware of their HIV status, those knew they were HIV positive (OR 1.68, CI95%1.32–2.81) or negative (OR 1.54; 95% CI: 1.28, 2.71) were both more likely to report borrowing syringes in past month.Conclusions: PWID WHO know they are positive for HIV are more likely to borrow another person’s syringe, to report reuse of their own used syringes and less likely to report lending their syringes to others. Strategies to scale up HIV testing and counseling for PWID, which also increase awareness of HIV status, may decrease injecting related the risk behaviors.

Background: There is disagreement on the effect of diabetes on oral hygiene. The purpose of this study was to assess the oral health and hygiene status of type 1 diabetic patients.Methods: In this case control study, periodontal health and hygiene of 80 children and adolescents (5–18 yr of age) with type 1 diabetes mellitus referred to Pediatric Endocrine Clinic of Besat Hospital Hamadan Iran 2013 – 2014 and 80 non diabetic control subjects were clinically assessed. The required data such as sex, age, duration of the diabetes, type and number of insulin injections per day were obtained from self-administered questionnaire and the patient’s medical records. Participants in both groups were examined for Decay-missing- filled teeth (DMFT); dmft (for primary teeth), oral hygiene using O' Leary plaque index (PI) and gingivitis index (GI). P<0.05 was considered significant.Results: The mean age of the study and the control group was 12.5±4.05 and 12.08±3.47 yr, respectively. There were no significant difference between two groups in terms of DMFT (P=0.158) and PI indices (P=0.373). The GI index difference was statistically significant in diabetic group (P=0.001). Interestingly, a higher dmft index was observed in the control group (P=0.008). In diabetic groups, GI and DMFT index increased significantly with duration of diabetes.Conclusions: Apart from higher scores of GI index, frequency of oral and periodontal disease was not different in diabetic patients compared with healthy subjects. Findings of present study are insufficient to support a significant effect of diabetes on increasing the risk of oral and periodontal diseases. However, diabetic children and adolescents should receive oral hygiene instructions.

Background: The women with breast cancer experience high rates of morbidity due to different treatments. The objective of this study was to evaluate the role of aerobic exercise in the quality of life (QoL) among women suffering from breast cancer in Hamadan, western Iran.Method: Participants who had consummated the eligibility criteria were randomly assigned in exercise group (n=30) and control group (n=30). Written informed consent was obtained from all participants. The mean age was 42.70±9.6 and 43.50±8.60 yr old in exercise and control groups, respectively. The quality of life was assessed by two widely used standard questionnaires (EORTC QLQ-C30 and EORTC QLQ-BR23). The exercise group received supervised exercise 2 days per week for 10 weeks. Through two stages (before and after intervention) these groups were evaluated. Analyzing the data was performed by SPSS/20.0, using t-test, chi-squared and ANCOVA. P<0.05 was regarded as significant level.Results: The global health status QoL, based on EORTC QLQ-C30, developed significantly in the exercise group (48.76±24.96 vs.81.79±16.34) in comparison with the controls (47.75±15.73 vs.52.88 ±14.51) (P<0.001). The exercise intervention was associated with substantial development in total score of functions and symptoms of QoL using EORTC QLQ-BR23 (P<0.001).Conclusions: The statistically and clinically crucial developments were indicated in functions and symptoms of QoL in response to exercise in breast cancer women.

Background: Heat stress evaluation and timely notification, especially using meteorological data is an important issue attracted attention in recent years. Therefore, this study aimed at answering the following research questions: 1) can enthalpy as a common environmental parameter reported by meteorological agencies be applied accurately for evaluation of thermal condition of outdoor settings, and 2) if so, what is it’s the best criterion to detect areas in stress or stress-free situations, separately.Methods: Nine climatic regions were selected throughout Iran covering a wide variety of climatic conditions like those, which exist around the world. Three types of parameters including measured (ta, RH, Pa and WBGT), estimated (metabolic rate and cloth thermal insulation), and calculated parameters (enthalpy and effective WBGT) were recorded for 1452 different situations. Enthalpy as a new indicator in this research was compared to WBGT in selected regions.Results: Altogether, a good consistency was obtained between enthalpy and WBGT in selected regions (Kappa value: 0.815). Based on the good ROC curve obtained using MedCal software, the criterion of the values more than 74.24 for the new index was determined to explain heat stress situation for outdoor environments.Conclusions: Because of simplicity in measurement, applicability of the indicator for weather agencies, the consistency observed between enthalpy and a valid as well as accurate index (WBGT), sensor requirements which take only a few seconds to reach equilibrium and so on, enthalpy indicator can be introduced and applied as a good substitute for WBGT for outdoor settings.

Background: Investigation of tuberculosis (TB) -specific indices including prevalence of TB, mortality of TB cases excluding HIV, HIV/TB mortality, incidence of TB (all forms), HIV/TB incidence as well as case detection and related trends is a crucial step in evaluation of program performance and strategies success. Besides, estimating the number and time of change points for TB incidence can help to detect effective factors in TB control. Therefore, the current study aimed to determine the trend of aforementioned indices in Iran during a 25 yr period (1990 to 2014).Methods: Data on trend of TB in Iran was extracted from WHO regional office reports during 1990-2014. For determining the trend of TB indices, Annual Percent Changes (APC) and Average Annual Percent Changes (AAPC) was estimated using segmented regression model.Results: AAPC (95% CI) for HIV/TB mortality and HIV/TB incidence were 11.5 (9.3, 13.6) and 14.8 (13.6, 16.1), respectively, which are sign of increasing trend during the period (P<0.05). Other indices showed significantly decreasing trend (P<0.05), except for case detection rate (P=0.803).Conclusions: The incidence, prevalence, and death rates of TB had shown a decreasing trend in general population, regarded as a useful indicator of achievements of Millennium Development Goals (MDGs) and effectiveness of interventional programs. Increasing trend of incidence and mortality of TB in HIV infected patients, needs conducting more intervention strategies in health care programs.

Background: Understanding the motives and reasons for drug treatment is very important. This study aimed to develop a psychometric evaluation to determine the reasons for addiction treatment among outpatients referred to addiction treatment clinics.Methods: This cross-sectional validation study included five phases (i) Item generation (ii) Making an initial questionnaire (iii) Content validity (iv) Reliability analysis and (v) Structure validity. Addiction treatment motivations were identified by reviewing literatures and interviews with 21 stakeholders. A 30-item questionnaire was used for data collection and a random sample of 300 participants completed the questionnaire. The data were analyzed using content validity (CVR & CVI), internal consistency (Chronbach’s alpha coefficient) and exploratory factor analysis (EFA) by SPSS version 16 software.Results: With exploratory factor analysis, 22 items that were remaining jointly explained 60.6% of the variance observed. Inconsistency assessment, Cronbach’s coefficient (α) of items was 0.9. Items with CVIs and CVRs greater than 0.84, remained and factor loading cut off ≥ 0.5 as valid items. They were loaded into four factor solution for the questionnaire, namely: family factors, threats, friend’s factors and self-efficacy.Conclusions: This study suggests a reliable and valid instrument with four factors related to motives of addiction treatment.

Background: Silicosis is considered an oxidative stress related disease that can lead to the development of lung cancer. In this study, our purpose was to analysis of volatile organic compounds (VOCs) in the exhaled breath of workers exposed to silica containing dust and compare peak area of these compounds with silicosis patients and healthy volunteers (smokers and nonsmokers) groups.Methods: In this cross sectional case-control study, the exhaled breath of 69 subjects including workers exposed to silica (n=20), silicosis patient (n=4), healthy non-smoker (n=20) and healthy smoker (n=25) were analyzed. We collected breath samples using 3-liter Tedlar bags. The VOCs were extracted with solid phase micro-extraction (SPME) and analyzed by gas chromatography-mass spectrometry (GC-MS). Personal exposure intensity was measured according to NIOSH 7601 method. Respiratory parameters were measured using spirometry.Results: Seventy percent and 100% of the exposures to crystalline silica dust exceeded from 8 h TWA ACGIH TLVs in case and positive control groups, respectively. A significant negative correlation was found between dust exposure intensity and FEV1/FVC when exposure and positive control groups were studied in a group (r2=-0.601, P<0.001). Totally, forty VOCs were found in all exhaled breath samples. Among the VOCs, the mean of peak area acetaldehyde, hexanal, nonanal, decane, pentad cane, 2-propanol and 3-hydroxy-2-butanone were higher in exhaled breath of the workers exposed to silica and silicosis patient compared to the healthy smoker and nonsmoker controls. In some cases the difference was significant (P<0.05).Conclusions: The analysis of some VOCs in exhaled breath of subjects is appropriate biomarker to determine of exposure to silica

Background: HIV, syphilis, hepatitis B and C (HBV & HCV) infections modify the epidemiology and presentation of each other. This study aimed to estimate the seroprevalence of these infections and their co-infections in sexually transmitted infections (STI) clinic attendees in New Delhi, India.Methods: A retrospective study including 220 patients was conducted during May 2014 through December 2014. Serodiagnosis of HIV was performed as per Strategy III of NACO guidelines; syphilis by VDRL followed by TPHA; HBV and HCV by rapid immuno-chromatographic test followed by ELISA.Results: Male subjects were slightly more in number as compared to females (56.36% vs.43.63%). Twelve (5.45%), 14 (6.36%), three (1.36 %) and one (0.45%) were reactive for HIV, VDRL, HBV and HCV, respectively. Three were both HIV and syphilis positive and one was both HIV and HBV positive; no co-infections of HBV/HCV, HIV/HBV/HCV and HIV/HBV/HCV/syphilis coexisted.Conclusions: High prevalence of HIV, HBV, HCV and syphilis in STI clinic attendees mandate routine screening to detect co-infections and follow prompt therapy in order to minimize their sequelae.

Background: This study was conducted to detect clusters of pulmonary TB cases in Hamadan Province, west of Iran.Methods: All patients with pulmonary tuberculosis recorded in the surveillance system from 2005 to 2013 were studied. The spatial scan statistic was used to detect significant clusters in status of unadjusted and adjusted for age, sex and location residence variables.Results: Clusters with high rate for both purely spatial and space-time analyses were seen in the same geographical areas composed of four city of Asadabad, Bahar, Toyserkan and Nahavand. Adjustment for mentioned variables did not change location of detected clusters with high rates.Conclusions: Findings revealed evidence of significant clusters in Hamadan Province. Study results may help the health system to develop effective public health interventions and extend preventive interventions. However more study are needed to better explain of detected clusters due to limited access to effecting factors.

Dear Editor-in-Chief: Incidence rates are increasing in many countries, including Iran where skin cancers are the most commonly diagnosed cases1. In the southeast of Iran, nearly 15% of all diagnosed cancers were related to the skin2. In Yazd, east western Iran, the incidence rates showed a mean of 28.6% over a 15-yr period from 1987 to 20013, during which, 1, 124 patients were diagnosed with skin cancers, with 2.7% malignant melanoma, as the most life-threatening type of skin cancer.

Dear Editor-in-Chief: The total fertility rate (TFR) or the number births over a woman's lifetime, has reached 1.8 in 2012 which is the lowest among Islamic countries, and even below the world average of 2.1 births per woman1-2. This is less than population replacement rate. Furthermore, increasing age of marriage and change in lifestyle such as exposure to environment toxins increased the incidence rate of infertility3. More than three million people and nearly 15% of couples suffer from infertility4. This dilemma results in adverse economic consequences and physical, mental, and emotional problems to families.

Dear Editor-in-Chief: We read with great interest the paper entitled validating the Heat Stress Indices for Using in Heavy Work Activities in Hot and Dry Climates published online in Journal of Research in Health Sciences in Jun 20161. The authors aimed to assess the precision and validity of some heat stress indices and select the optimum index for using in heavy work activities in hot and dry climates. According to their paper, there is a close correlation between wet-bulb globe temperature (WBGT) with predicted heat strain (r=0.93) and heat stress index (r=0.93).