JOURNAL OF SCHOOL OF PUBLIC HEALTH AND INSTITUTE OF PUBLIC HEALTH RESEARCH
Year:2007 | Volume:5 | Issue:2|Papers Count:11

Background and Aim: Public-private partnership is a type of privatization in which the public sector continues to participate in the provision of services. Based on an agreement between the Ministry of Health and the Ministry of Cooperatives, Tabriz University of Medical Sciences started the process of creating health cooperatives in the Eastern Azerbaijan Province. In this study we compare the function of various health service processes between public health centers and health cooperatives. Material and Methods: This study looks at coverage, quality and continuity of primary health care in 9 health centers handed over to cooperatives as compared to 18 current public health centers. Data were collected over a period of three months and analyzed by the SPSS-10 statistical package. Chi-Square and t tests were used for data analysis.Results: Family planning coverage rates, infant health care, 1- to 6-year-old health care, prenatal care and the number of households covered by volunteers were all higher in cooperatives compared to public health centers. The mean care delivery volume was smaller in health cooperatives. The mean numbers of screening visits, outpatient visits, control visits, consultations, injections and dressings as well as follow-ups were higher in health cooperatives. Despite the greater numbers of family planning visits, vaccinations, health certificates issued and water chlorimetry tests in the public sector, the differences were not statistically significant. Concordance of data between forms and registers was higher in health cooperatives in the case of child health care, periodic visits and vaccination forms.Conclusion: Compared to the public sector, health service delivery through cooperatives not only functions well but also yields better indices in many health domains. This is an example that a private institutions functioning under the supervision of the public sector can implement nationwide health care programs better than the public sector itself.

Background and Aim: We studied the biosorption of lead (II) and cadmium (II) from aqueous solutions by the brown algae Sargassum sp. biomass in a batch system.The heavy metal uptake was quite rapid, reaching 88-96% of the equilibrium capacity of biosorption in 15 minutes.Material and Methods: Kinetic data were analyzed using the pseudo first-order, pseudo second-order, and saturation and second-order rate equations. Results: The pseudo second-order and saturation rate equations gave the best fit with the experimental data (R2>0.99). The data obtained from experiments of single component biosorption isotherm were analyzed using the Freundlich, Langmuir, Freundlich-Langmuir and Redlich-Peterson isotherm models. The Redlich-Peterson equation was found to provide the best fit with the experimental data (R2> 0.99). Also the other models described the isotherm of lead (II) and cadmium (II) biosorption with relatively high correlation coefficients (R2> 0.93).Conclusion: Using the Langmuir model, the maximum uptake capacities (qm) of Sargassum sp. for Pb2+ and Cd2+ were 1.70 and 1.02 mmolg-1 respectively.

Background and Aim: Breastfeeding is one of the most important health determinants in infancy and childhood: physical growth and mother-child bonding in this period are two factors that program cognitive ability in later life. The main aim of this study was to examine the long-term effects of breastfeeding on subsequent cognitive performance.Material and Methods: A cohort of 5362 births registered over a period of one week in March, 1946 was selected by stratified sampling, based on the subjects' social class. We collected data for ages 2, 8, 11, 15, 26, and 46 years, and these data were analyzed in 2004-2005 at the school of public health, Tehran. Linear structural equation models were fitted to the data by LISREL 8.12 software in order to find path models. Results: Descriptive findings showed that children weighing ³3500 grams at birth acquired the ability to walk, talk, stand, and sit earlier than others. Also, subgroups within the cohort showed different patterns of change in their cognitive scores. Analysis of variance revealed that after adjustment for sex, social class, age of talking, and age of walking breastfed children still had higher means of verbal and nonverbal scores at ages 8 and 15 compared to never-breastfed children. Path analysis indicated that breastfeeding and birth weight could program later-life cognitive performance directly or indirectly through the ages of 2, 8, 11, 15, 26, and 43 years. For instance, path coefficients from breastfeeding to ages of talking and walking, to 8-15 verbal scores, to 26-year cognitive scores, and then to memory and visual scores at age 43 were estimated -for females and males, respectively- and form left 0 the right as follows: -0.12 (se=0.02), -0.05 (se=0.02), 0.71 (se=.05), 0.10 (se=0.04) for women; -0.01 (se=0.02), -0.07 (se=0.01), 0.75 (se=0.06), 0.13 (se=0.06) for men.Conclusion: There are significant relationships between some early life determinants and later cognitive performance; we conclude that in longitudinal studies of later life abilities, early-life nutrition and birth weight should be incorporated in the path analysis of aging.

Background and Aim: 2,4-Dichlorophenol (DCP) is a compound generated in a variety of industrial processes and also by chlorine disinfection of water polluted with phenolic compounds. Dumping of DCP into the environment and water resources is of great concern because of the compound's intense odor and toxicity. DCP is very soluble and resistant to biodegradability so it cannot be removed through conventional water and wastewater treatment processes. On the other hand, pollution prevention (P2) strategies have not been able to resolve the problem.Material and methods: In this study, one of the AOPs named Fenton was used for DCP degradation. The method is based on simultaneous use of hydrogen peroxide and ferrous sulfate.Results: Results of treatment with hydrogen peroxide and ferrous ion (as Fenton reagent ingredients) indicate that by oxidation of 50 mg/L DCP at 60 minutes contact time with iron concentration kept at 15 mg/L and various concentrations of H202 (50 and 100 mg/L), the efficiency of COD (Chemical Oxygen Demand) reduction would go up from 65% to 80% with higher concentrations of H202. We also determined the effect of various concentrations of ferrous ion on DCP oxidation rate. The results showed the prominent role of this ion in DCP treatment: increasing Fe concentration from 5 to 15mg/L produced a 60% reduction in COD occurred in 10 and 60 minutes contact times. Another conclusion was that the oxidation of DCP solutions by Fenton had a major effect on biodegradability so that BOO: COD ratios of these solutions increased significantly after this oxidation.Conclusion: Pretreatment of waste containing dichlorophenol by the Fenton reagent can enhance the biodegradability of this chemical and perhaps of similar compounds in a short time interval.

Background and Aim: Breast cancer is an increasingly important social problem throughout the world. Rate of disease-free survival can be used to evaluate the effects of treatment and disease outcome and assess indices of disease prevention, diagnosis and treatment. With this aim in mind we made an assessment of 5-year disease-free survival in breast cancer patients.Material and Methods: 403 breast cancer patients attending the radiotherapy chemotherapy center at Rajaii Hospital, Babolsar were studied with regard to first time recurrence over a period of 5 years. Data were gathered through questionnaires and statistical analysis included the Kaplan-Meier method and the Cox regression model.Results: The median local/regional recurrence time was 15.9±5.2 months and the median systemic recurrence time was 22±14.8 months. The most common sites of recurrence were bones (46.6%), especially the lumbar vertebrae. The median disease free survival time was 38.2±22 month. The total rate for 5-year disease-free survival was 45%. The rate ranged from 85% for stage 1 tumors to 5% for stage 4 disease. Age £35 years, disease stage, and lymph node involvement was found to be independent prognostic factors in time of the first recurrence of disease. Conclusion: Comparison of our results with those from of European and American countries showed lower rates of disease-free survival. This could be related to higher disease stage and younger age at diagnosis. These findings stress the importance of planning for earlier diagnosis and appropriate.

Background and Aim: Undercounting is a common problem in surveillance systems and registries. One of the procedures has been used for assessing sensitivity of a surveillance system or completeness of a registry is capture-recapture method. The objective of the present study was to estimate the number of deaths due to road traffic injuries applying capture-recapture method and using three data sources: police, legal medicine organization and hospital.Material and Methods: All of the deaths due to traffic injuries occurred within Kerman district in the year 2000 were derived from police, Shahid Bahonar hospital and Kerman legal medicine data sources. Matching cases between the lists was based on three characteristics: first name, family name and date of accident. Loglinear model was used for statistical analysis.Results: The total number of identified cases was 471; the best fitted loglinear model estimated the actual number of deaths as 596 (CI 95%: 543-686). Based on Iranian Statistical Center estimates, the population of Kerman district in the year 2000 has been 644673; so the cause-specific mortality rate of traffic injuries is estimated as 92 (CI 95%: 84-107) per 100,000 population. Therefore the proportion of deaths egistered in police, legal medicine and Shahid Bahonar hospital are 16%, 58% and 48% respectively. The coverage of total deaths (471) is about 79%. Conclusion: The findings showed that none of the data sources had enough coverage of all deaths due to traffic injuries. Capture-recapture estimates can help for obtaining better estimates.

Background and Aim: We studied 1800 pregnant women receiving routine prenatal care in the urban and rural health centers of Shahr-e-Rey in south of Tehran, for a comparative assessment of 5-minute neonatal Apgar Scores in wanted versus unwanted pregnancies. Material and Methods: The subjects were studied in 2 groups, each comprising 900 pregnant women. Group A consisted of mothers with wanted pregnancy and group B of mothers with unwanted pregnancy. Inclusion criteria were gestational age less than 28 weeks at the time of entering the study. The two groups were followed through their prenatal care to the time of delivery. For each neonate, we extracted the 5-minute Apgar score from the birth certificate.For a more precise assessment, the impact of conditions affecting the Apgar score of newborns (such as normal vaginal delivery vs. caesarean section, premature birth, low birth weight, congenital anomalies, and birth place (hospital and health center, or house) was assessed by logistic regression.Results: We found 15 cases (0.4%) of low 5-minute Apgar score (under 8) among newborns of wanted pregnancies and 4 such cases (1.1%) among those of unwanted pregnancies. The difference between the 2 groups was significant (P=0.011). After applying the logistic regression model to adjust for other factors, unwanted pregnancies still had a significant association with low Apgar scores (increasing the risk 3-fold).The attributable risk for low 5-minute Apgar score in unwanted pregnancies was 0.54 (CI95= 0.132 to 0.813).Conclusion: The estimated attributable risk means that with 95% confidence, between 13.2% and 81.3% of the low Apgar scores could have been prevented by eliminating unwanted pregnancy. As there have been no similar studies in Iran, more research with larger samples must be performed to assess these results more precisely.

Background and Aim: Iran managed to eradicate the wild poliovirus in 2000. However, a large number of AFP cases are still detected each year because of close surveillance: there were 450 reported AFP cases in 1382. The expected number of cases for the year 1382 in the province of West Azarbayjan (with an under-IS population of 1100000) was 11, while the observed number was more than 6 times greater (70 cases). In this study we investigated the non-polio enteroviral agent which could cause the AFP cases especially in Azarbayjan Province. Hence, the main purpose of the study was to identify circulating non-polio enteroviruses, using cell lines RD, Hep2, L20 and RT-PCR.Material and Methods: All stool specimens of AFP cases were treated with chloroform and then injected into the above-mentioned cell lines. The isolated viruses were identified by the NT method. In cases where polioviruses were isolated, intratypic differentiation (wild vs. vaccine strains) using hybridization and ELISA tests. Finally, we performed RT-PCR with pan-EV primers on all samples.Results: Using cell cultures, we were able to isolate 10 viruses, 9 of which were isolated by the RD cell line and this is regarded as the most sensitive cell line. The RT-PCR also identified 16 different viruses, 7 of which were not isolated on the RD line. Thus, RT-PCR could increase viral detection by 10%, indicating a high degree of high sensitivity.Conclusion: Although the combination of cell culture and RT-PCR for detection and identification of non-polio enteroviruses causing AFP is invaluable, more than 75% of AFP patients were enterovirus negative. Therefore, they must be checked for other agents such as flavivirus (viral) and Campylobacter jejuni (bacterial).