JOURNAL OF SCHOOL OF PUBLIC HEALTH AND INSTITUTE OF PUBLIC HEALTH RESEARCH
Year:2009 | Volume:6 | Issue:3-4|Papers Count:14

Background and Aim: The district health information system (DHIS) converts raw data into useful manegerial information. The main purpose of DHIS is to improve quality of health services in service delivery points. This study was conducted to investigate the DHIS performance. Materials and Methods: A total of 200 health service-delivery units were selected by systematic random sampling, and the calculation of 47 primary health care indicators were assessed by the provincial health center statistics supervisor. Results: On the average, 41.9% of the indicators had been calculated in each unit. In the district health center, the proportions of outcome measures and process performance indicators calculated were 50% and 5.6%, respectively. On the basis of the indicators obtainable from the vital horoscope, 79% of the indicators in the district health center and 66% of those in the health service-delivery units had been calculated. Finally, there were 97 disease-surveillance forms, 35 environment-health forms, 21 family-health forms, and 23 other forms at the district level. Conclusion: Re-designing the structure of the health information management process and determining indicator packages at the district and service-delivery level are vital steps for improving the health information system at the district level.

Background and Aim: Case-Control studies provide evidence in the area of health. Validity and accuracy of such studies depend to a large extent on the similarity (similar distributions) of the case and control groups according to confounding variables. Matching is a method for controlling or eliminating the effects of important confounders. Matching using propensity score has recently been introduced to control the effect of confounders, especially when there are many of them in a study. Materials and Methods: Matching according to propensity score was used in a genetic association study-a case-control study involving 300 subjects-to assess the effect of candidate genes on Alzheimer's disease in the Iranian population. Propensity score was calculated using STATA.8 software; age, sex, education level, job and genetic background were included in the model to calculate the score. Results: A total of 385 blood samples were taken from the participants. We managed to extract DNA in 155 of the 173 case subjects and in 161 of the 212 control subjects. The model for propensity score was statistically significant. Of the total of 316 DNA samples, 302 were matched based on their calculated propensity scores, while the individual matching method could only deliver 28 pairs.Conclusion: The propensity-score matching method results in selection of a larger number of pairs, as compared with the conventional individual matching method. We propose to use this method, which also ensures a similar distribution of confounders between the case and control groups, particularly when there are limitations in the number of subjects available for matching.

Background and Aim: Leishmaniasis is a parasitic disease transmitted by sand-flies. Seventeen out of the 30 Iranian provinces are contaminated. Although many therapeutic modalities have been suggested, no definite treatment for this widespread infection is available. Many drugs currently used for cutaneous leishmaniasis have their side effects and create complications-drug resistance, etc. This has prompted researchers to get interested in drugs of a natural origin. The aim of this study was to investigate and compare the efficacies of an extract of propolis and systemic glucantime against cutaneous leishmaniasis in Balb/c mice.Materials and Methods: Groups of inbred, female Balb/c mice, aged 4-6 weeks, were inoculated with 1.6×10 6 viable stationary-phase promastigotes in the base of tail. The mice were provided by Iran Pasteur Institute, Tehran and were randomized into three groups of 9 mice each. Groups 1 to 3 was treated with pure 70% ethanol, systemic glucantime, or the propolis hydroalcoholic extract for a 6-week period; the 4th group served as control. The statistical tests including student t-test were used for data analysis. Results: Overall, 27 mice were studied. We did not observe any statistically significant difference among the groups with regard to the size of the ulcer at the beginning (P>0.01). At the end f the period, there was a significant difference with regard to reduction of ulcer size between the propolis extract and glucantime groups in favor of the propolis extract (P=0.001). Further analysis of the data showed that the largest reduction in the ulcer size was caused by the propolis extract, as compared with the control, glucantime and alcohol groups.Conclusion: Our results suggest that the propolis extract is more effective in the treatment of cutaneous leishmaniasis in mice. We suggest that the efficacy of this extract alone or in combination with drugs be assessed against human cutaneous leishmaniasis, using randomized clinical trials.

Background and Aim: The normal plasma fatty acid (FA) composition changes in hypertriglyceridemic obese and overweight indiuviduals. The objective of this study was to determine the plasma fatty acid composition in hypertriglyceridemic obese or overweight subjects with different FABP2 genotypes. Methods and Materials: Forty-six hypertriglyceridemic subjects (33 men and 13 women, 25-60 years old) referred to the Endocrinology and Metabolism Research Center (EMRC), Shariaty Hospital in Thehran, between Mehr and Esfand 1386 (September 2007-March 2008), were genotyped for FABP2 polymorphism by PCR-RFLP. In addition, their blood lipid profile was determind enzymetically, photometrically and immunoturbidometrically, and their plasma fatty acid composition by gas-choromatography. Also, body weights and heights were measured and body mass index calculated. Results: Positive associations were observed between Thr54 polymorphism in FABP2 protein and plasma lipid fractions (SFA, PUFA, w-6-, w-3- and total fatty acids (P<0.001)). No significant differences were observed between PPARa polymorphism and plasma fatty acid composition, except for w-3 fatty acids,Conclusion: In obese or overweight hypertriglyceridemic subjects the plasma fatty acid compositions are different. The levels of some fatty acids are higher, while those of some others are lower, in different FABP2 genotypes. On the whole, higher levels of SFA, PUFA, w-6, w-3, and total fatty acids were more pronounced in Thr54- than in Ala54-carrieres.

Background and Aim: Organophosphate compounds are cholinesterase activity inhibitors. Contact with them cause changes in the blood antioxidant enzyme levels and lipid peroxidation. The aim of this research was to investigate the simultaneous changes in cholinesterase, total serum antioxidant levels, and activities of some of the erythrocyte antioxidant enzymes and find possible correlations among these variables in pesticide factory workers. Materials and Methods: This research was a cohort study carried out, during 2006, on the employees of a pesticide factory in Golestan Province, Iran. Blood samples were taken at the beginning (n=81 subjects) and after 3 months (n=63, of the initial 81). Erythrocyte glutathione peroxidase (GPx), superoxide dismutase (SOD) and total antioxidant levels were determined enzymatically (Randox, UK) and serum SOD was measured by the ELISA method (IBL, Germany). For the determination of malondialdehyde (MDA) a chemical method (based on thiobarbituric acid) was used. Confidence interval was 95% for all statistical tests.Results: Levels of serum and erythrocyte SOD, serum MDA, and both serum and eryhthrocyte GPx significantly increased (paired t-test, p<0.05), while the serum total antioxidant level decreased (paired t-test, p<0.05). No statistically significant correlation was seen between cholinesterase and changes in the other variables. Conclusion: Contact with organophosphorus compounds will cause increases in lipid peroxidation and decreases in total antioxidants. It is suggested that, while more severe physical protective measures are taken, nutritional supplements be taken by the personnel to increase protection against hazardous materials.

Background and Aim: One of the most prevalent occupational diseases and conditions is musculo-skeletal disorders (MSDs) that impose expensive medical-recompense expenses, organic damages, and work-time wasting. The aim of this study was to detect spine curvatures (cervical, back/ low back, lumbar) and prevalence of musculo-skeletal disorders in assembly workers of Bahman automobile company, Tehran, Iran. Materials and Methods: In this cross-sectional, descriptive-analytical study 160 assembly workers of Bahman Automobile Manufacturing Company (vans, cars), Tehran, Iran were included. In the descriptive part data were collected on the demographic characteristics of the subjects. In the analytical section associations among the dependent variables, as well as between the dependent and independent variables, were determined. The Nordick Questionnaire, a scale, and a flexible ruler were used for data collection. The SPSS software was used for data analysis.Results: Although the mean age of the participants was low (30.89 yrs), the prevalence of MSDs was high (69.4% 1.58). The most prevalent of the MSDs was in the lumbar part (n=83; %51.9) and the least in the hip and femoral region (n=9: %5.6). Significant associations (p<0.05) were found between MSDs prevalence and independent factors (age, years of working, marital status). However, cervical, back, lumbar curvatures and the Delmax index were not statistically related with MSDs. Conclusion: This study shows that associations exist between muscleo-skeletal disorders and age, years of working, height, and marital status. The findings also reveal that there is no relation between MSDs and the vertebral curvatures (cervical, back, lumbar), except the neck curvature in the car (not van) assembly workers. It may be concluded that genetics and environmental conditions can adversely affect the musculo-skeletal health. We cannot control the genetic factors. However, one can provide more favorable environmental conditions. For example, employing younger workers may help decrease the musculo-skeletal disorders.

Background and Aim: Hospital disaster-management planning and preparedness are essential, considering earthquake threats in Iran. The objective of this study was to assess preparedness of hospitals affiliated to Iran University of Medical Science (IUMS) in Tehran against earthquakes in 2007 (1386 Iranian year).Materials and Methods: This was a cross-sectional, descriptive-analytical study, involving 21 governmental and private hospitals affiliated to IUMS selected by random sampling. Data were gathered using checklists, questionnaires, interviews, and observation. The SPSS software was used for analysis of the data, and the Fisher exact test was employed for statistical analysis.Results: The data showed that, on the whole, 28.6%, 61.9%, and 9.5% of the hospitals were at a weak, moderate, and good preparedness level, respectively. The hospitals preparedness level with regard to equipment safety and hazardous materials planning increases with their degree of specialization, the association being statistically significant (p=0.038). The findings also show that there is a significant relationship between the hospital preparedness level (as regards planning for building dangers reduction) and crisis management training courses (p=0.034).Conclusion: Training courses are very effective for creating hospital preparedness against earthquakes.

Background and Aims: The ready-to-eat foods, before and after preparation, usually kept in a refrigerator before consumption for a relatively long time, increase the risk of food poisoning. The aim of this study was to determine the effect of refrigeration in the fast-food shops on the microbial contamination of fast foods.Materials and Methods: A total of 100 samples, including 46 cooked beef livers and 54 cooked sausages were collected from fast-food shops in the south of Tehran and analyzed according to the procedures of the Office of Food Control Laboratories (OFCL). The samples were tested randomly for the microbial contamination on the first, third, fifth and seventh days of storage in the refrigerator. Results: Results of microbial analysis showed that 35 cooked sausage samples (64.8%) and 34 cooked liver samples (73.9%) on the first day, 44 cooked sausage samples (81.5%) and 42 cooked liver samples (91.3%) after the third day, 47 cooked sausage samples (87.1%) and 44 cooked liver samples (95.6%) after the fifth day, and 50 cooked sausage samples (92.3%) after the seventh day were unfit for consumption Frying of the food items before consumption would decrease, though to a small extent, microbial contamination (P<0.05). Increased total micrbial counts of the food items, exceeding the respective standards, is the most important inhibitory factor for their consumption.Conclusion: The results of this study showed that keeping cooked foods for a long time in the refrigerator causes increased microbial contamination over time.

Background and Aim: Amblyopia is an important cause of weak vision and blindness. A preliminary study on validity of the current screening program in Shahrood City's kindergartens showed that this method may not be efficient enough, especially because of low sensitivity and referral problems. We tried to compare efficiencies and costs of screening by trained staff and optometrists in detecting patients. Materials and Methods: We conducted a cost-effectiveness analysis using the decision-tree method. We replaced nurses with optometrists to compare costs per detected case by the two screening methods. The number of detected cases and costs per each detected case are compared. Also, the cost-effectiveness of four criteria screening examinations (with different validities) used by optometrists was estimated. Results: Costs per case detected by optometrists and by current screening methods were 270000 and 556000 Rails (Rs), respectively (with baseline examination criteria and 6.4% prevalence). With a lower prevalence of amblyopic patients, CER (cost-effectiveness ratio) will increase in both methods, but the increase in the current screening method is less than the optometric method. In the optometrist method, avoidable costs and savings per detected case vary from 250000 Rs at a prevalence of 7.4% to 1185000 Rs at a prevalence of 1.4%. Sensitivity analysis showed that costs of "monitoring of screening" in the optometrists method and costs of "follow up in the current screening method" have strong effects on CER; CER will decrease by 9.6% and 15%, respectively, if this costs decrease to 25%.Conclusion: The cost, per detected case, of screening amblyopia by optometrists in kindergartens is half that by the current method. In areas with a low prevalence, the efficiency of screening by using optometrists increases remarkably.

Background and Aim: Application of modern technologies and changes in industries and work practices, particularly in assembly lines, has resulted in increased work-related musculoskeletal disorders (MSDs). This has led to reduced occupational competence in both industrialized and developed countries. This study was conducted to determine the prevalence of MSDs in the upper limbs, postural loading on the upper limbs (using the LUBA technique), and ergonomic risk factors among assembly workers of an Iranian Telecommunications Manufacturing Company (ITMC) in Shiraz, Iran. Materials and Methods: In this cross-sectional survey data were collected, using the Nordic Musculoskeletal Disorders Questionnaire (NMQ) and LUBA Checklist, on 193 randomly selected registered assembly workers from 8 units of the assembly line of ITMC, Shiraz, Iran. The statistical tests used were as follows: 1. The qui-square test, to determine factors causing MSDs; 2. One-way analysis of variance and Kruskal-Wallis to determine postural loading index; 3. Logistic multiple regression analysis, to determine risk factors. Results: Lower-back symptoms were found to be the most prevalent problem (67.9%) among the workers. The findings also showed that the upper limb disorders were significantly associated with age, sex, job, daily working time, work environment conditions, and twisting (P<0.01). Based on LUBA, a large majority of the workers (89.64%) had experienced high postural loading (PLI = 5). In addition, significant associations were found between postural loading and symptoms of upper limbs and units of work (P<0.05).Conclusion: Based on these findings, MSDs are prevalent among Telecommunication Manufacturing Company in Shiraz, Iran. The most important factors likely to cause MSDs are postural loading on the limbs and unfavorable working conditions. Interventional programs aimig at preventing musculoskeletal problems among assembly line workers should focus on reducing postural loading.

Background and Aim: Laboratory fume-hoods are the first-level protection for the laboratory staff against hazardous chemical pollutants. Considering the large numbers of personnel, especially in petrochemical industry laboratories, this project was carried out in order to assess the performance of laboratory hoods based on tracer gas (SF6).Materials and Methods: In this project 22 hoods in the laboratories of a petrochemical industry were studied. Operation of the hoods was assessed based on quantitative (with SF6 as tracer gas) and qualitative (face velocity measurement, using thermal anemometer) tests, according to ASHRAE 110 standard.Results: In comparison with the minimum acceptable face velocity (80 fpm), the mean values of face velocities of only 9.09% of the hoods passed the test (P=0.001) and were at an acceptable level. As regards the tracer gas test, the results were even worse: only 4.5% of the hoods passed the acceptability test (p=0.001). In addition, non of the hoods having an acceptable face velocity passed the tracer gas test. Similarly, no hood with an acceptable tracer gas performance had an acceptable face velocity.Conclusion: Since there is no consistency between face velocity and tracer gas tests, performance of laboratory hoods can necessarily be assessed on the basis of the tracer gas quantitative test. The face velocity test is a supplementary test, which, if used alone will give false results.

Background and Aim: Acrylonitrile (ACN) is widely used as a main raw material in the Acrylonitrile-Butadiene-Styrene (ABS) resin-manufacturing units and other industrial and commercial processes. ACN, due to its toxicity, is not easily decomposed by microorganisms. The discharge of improperly treated ACN-containing wastewater into a natural water body may cause serious environmental problems and severe adverse impact on the aquatic ecology. This study attempts to isolate and identify bacteria which utilize ACN as the sole source of carbon and nitrogen from the activated sludge of petrochemical wastewater treatment system. The performance of the isolated strains in treating different initial ACN concentrations was also investigated under aerobic conditions. In addition, the performance of biodegradation and the metabolic intermediates and end-products in the process were determined.Materials and Methods: Experiments were conducted with three batch reactors, the volume of each one being 250mL. The activated sludge samples as a microbial seeding were taken from the return sludge line of the aeration tank of the wastewater treatment facility in Tabriz Petrochemical Complex. Phosphate-buffered medium (PBM) was used to make available minerals and trace elements, and ACN was used as the sole carbon and nitrogen source for microbial growth. R2A medium was used to obtain pure colonies, and to identify the isolated strain, Gram staining and microscopic examination followed by biochemical and physiologic analyses using selective media such as O-F glucose, MacConkey agar, TSI agar, EMB and SS agar, nitrate reduction, gelatin liquefaction, lactose fermentation, oxidase, catalase and SIM were used. In the final stage, the performance of biological systems in degrading different initial concentrations of ACN and its intermediate and end-products were investigated. Results: The findings indicated that when the ACN concentration was 500mg/L, the average removal efficiency after 46 and 70 h reached 46% and 98%, respectively. But at an initial concentration of 700mg/L, the removal efficiency of the ACN in the biological system was 50% after 46 h and 98.6% after 94h. However, when the ACN concentration was increased to 1000mg/L, the removal efficiency after 46 and 94 h was only 30% and 40%, respectively, and after 118 h of reaction, the remaining concentration of ACN was about 580mg/L. Furthermore, the results of isolation and identification experiments revealed that at the optimum operation of the biological system the strain belonging to the gamma group of Proteobacteria as Pseudomonas putida had the best ability to degrade ACN.Conclusion: Biological processes can degrade ACN and the abilities of different bacterial strains in this degradation vary. The rod-shaped Gram-negative P. putida could easily adapt to ACN concentrations up to 700mg/L and utiliz ACN and its intermediate- and end-products as a carbon and nitrogen source for growth in the process. Thus, this strain is expected to play an important role in aeration tanks for treating ABS resin-manufacturing wastewater.