JOURNAL OF SCHOOL OF PUBLIC HEALTH AND INSTITUTE OF PUBLIC HEALTH RESEARCH
Year:2006 | Volume:4 | Issue:2|Papers Count:9

Background and Aim: Looking at population pyramid from the 1996 census and its estimates for the years 2003 and 2004, it is clear that the size of the elderly population will be greater in men than in women. According to Iran's Ministry of Health, the life expectancy for women is greater than that for men. This article is devoted to the discussion and analysis of this paradox.Materials and Methods: Analysis of the population sex ratio. Results: Its trend- based on data generated by censuses from 1956 to 1996- indicate that a large proportion of women did not live beyond the age of 35; women were most likely to die in years 35-45 of their life. It is possible that this age group, which included many women who were still of reproductive age, suffered the effects of war and socioeconomic crises of the 1940's. The trend had improved by the time of the 1376 census and there is no singe of an increase in the sex ratio thereafter. This change is probably due to the improvement in socioeconomic status and the development of an effective health care system.Conclusion: Since the life expectancy estimates are based on the probability of death and are thus affected by socioeconomic conditions, the apparent incompatibility between the population age pyramid and life expectancy among elderly women and men is due to higher mortality among women of reproductive age before the 1970's.

Background and Aim: Limitations of the traditional methods for assessing G*E interaction- including case control studies- led to development of several non-traditional approaches. This study aims to assess the interaction between the genetic background (history of breast cancer in first degree relatives) and environmental influences (reproductive/menstrual factors) in patients with breast cancer; we also compare the statistical efficiency and power of case-control and case-only designs in this setting.Materials and Methods: In a matched case-control study in Mazandaran province (Iran), 250 incident biopsy-proven cases of breast cancer and 250 age-matched neighbor controls were interviewed. History of breast cancer in mother and/or sister(s) was taken as a surrogate measure of genetic predisposition, while age at first birth, parity, breast feeding, age at menarche and irregular menstruation were considered as relevant environmental factors. For the matched case-control design, we used a conditional logistic regression model to examine main effects and the G*E interaction. In the case-only design, logistic regression analysis was applied to obtain an estimate of G*E interaction, after checking for the independence assumption. We also calculated the power for detecting the interaction by matched case-control and case-only analyses.Results: Age at first delivery did not meet the assumption of independence (p=0.02), and so was not included in the case-only analysis. No statistically significant interaction effect was seen in the case-control analysis, while case-only analysis showed significant negative interaction between diseases in first-degree relatives on the one hand and parity and breast feeding on the other. We also detected a significant positive interaction between genetic predisposition and age at menarche. All the estimated 95% confidence intervals for OR in G*E interactions were narrower in the case-only analysis. For all factors, the power for detecting G*E interaction was greater in the case-only analysis compared to the case-control analysis, with ratios ranging from 1.08 to 2.23.Conclusion: The case-only design is more efficient and powerful than the case-control design for detecting gene-environment interaction under the assumption of independence. Baseline disease risk, interactions and independent effects should be considered in using the control data for checking the assumption of independence. Considering the existence of another explanatory variable, egoa mutant gene which may have passed unnoticed, would be the safest approach in a case-only study.

Background and Aim: Logistic regression is an analytic tool widely used in medical and epidemiologic research. In many studies, we face data sets in which some of the data are not recorded. A simple way to deal with such "missing data" is to simply ignore the subjects with missing observations, and perform the analysis on cases for which complete data are available.Materials and Methods: We consider methods for analyzing logistic regression models with complete data recorded for some covariates (Z) but missing data for other covariates (X). When data on X are Missing At Random (MAR), we present a likelihood approach for the observed data that allows the analysis as if the data were complete.Results: By this approach, estimation of parameters is done using both Maximum Likelihood and Bayesian methods through the Markov Chain Monte Carlo numerical computation scheme and the results are compared. The illustrative example considered in this article involves data from lung auscultations as part of a Health Survey in Tehran.Conclusion: In comparing different methods, Bayesian estimates using the model described in this study are much closer to those generated by analysis of the full data by the standard model.

Background and Aim: Domestic violence against women is a major public health problem throughout the world. Feelings of shame, guilt and fear on the part of women, together with an unresponsive health care system continue to silence and isolate women who suffer abuse and negligence- with major effects on their physical and mental health. Mental health consequences include depression, anxiety, stress disorders, and somatization. This study estimates the prevalence of domestic violence and its associated effects on the victims' mental health.Materials and Methods: This cross-sectional study used data from 1189 married women over the age of 15, selected randomly among the residents of Tehran.Results: The overall prevalence of domestic violence was 35.7%. Thirty percent of the subjects had experienced physical violence, 29% suffered mental violence and 10% had been victims of sexual violence; many of these women had suffered all the three types. The most frequent types of physical violence included beating in the form of kicks, punches, and slaps (91%); common types of mental abuse included humiliation, verbal abuse and insults (93%), and threats of violence (83%). Data on mental health status indicate that overall, as many as 34.1% of women could be suffering from disorders such as depression and anxiety. The risk of psychiatric disease was 3.5 times higher in victims of violence compared to other women (OR = 3.5, CI 95%= 2.72 - 4.58). Major factors contributing to domestic violence were husband addiction, low economic status, and the number of children (P<0.001). These results are consistent with the current literature on domestic violence and illustrate the high prevalence of this phenomenon. Victims are commonly depressed and have a higher rate of anxiety.Conclusion: Violence is an important indicator of women's health. Screening programs for domestic violence could be effective, along with community support and referral to health care and legal facilities. It is also crucial to promote knowledge and awareness of violence among health care providers. This study shows that a community-wide effort to establish links between health care settings and community services may be important in addressing the needs of victims.

Background and Aim: Designing, presenting and implementing a model for assessing work-related risk factors for musculoskeletal disorders and subjective pain, using a combination of Quick Exposure Check (QEC) and the Body Mapping Questionnaire in Babol city in 1382. Nowadays, Work-Related (WMSDs) are considered to be the most common occupational disorders in Iran. Because of their debilitating potential, it is necessary to find a quick, user-friendly and valid technique to assess risk factors for WMSDs in this country.The city of Babol has a larger number of industrial centers in comparison with other cities in Mazandaran province. Therefore, it is surprising that there are virtually no reports of WMSD cases in the city. There is a need for a tool capable of showing the real number of cases and evaluate WMSDs in the city.Material and Methods: It is hoped that the Quick Exposure Check and the Body Mapping Questionnaire, when used in combination, will constitute a highly effective tool for the detection and prevention of a wide range of work-related musculoskeletal disorders.In this survey we try to show the utility and usability of a designed job assessing combination model in a factory in Babol city with at least three results.Results:1) We show that not only the number of WMSD cases in the city is not zero, but that there is indeed a substantial amount of disease among industrial workers.2) According to these findings and other subjective findings of pain, it is urgent to determine the severity of the problem and to recommend appropriate ergonomic interventions (according to QEC's action level score) accompanied by Body mapping Questionnaire as soon as possible. 3) Considering the significant correlation between QEC action level and subjective findings of pain in the Body Mapping Questionnaire, (Spearman's rho> 0.5), the model is very useful in periodic examination of workers in factories.Conclusion: We hope that this highly valid model (QEC/Body mapping) will prove useful in improving the health and thus the quality of the current workforce in the country.

Background and Aim: Infectious complications after renal transplantation are associated with significant morbidity and mortality. We evaluated post-transplant complications due to infections and their relationship with graft function, immunosuppressive drugs and mortality.Materials and Methods: Over a 2-year period (2002-2004), 179 renal transplantations were performed in our center. Of these, 142 cases were followed for a period of one year. The immunosuppressive regimen included cyclosporin A, mycophenolate mofetil and prednisolone. Each patient was assessed through regular visits and according to the ward protocol. Results of the investigations (infections and their relationship with age, sex, donor type, creatinine level, acute rejection, immunosuppressive drugs, graft and patient survival) were recorded and analyzed.Results: The overall incidence of infection was 54%. The most common sites were lower urinary tract (42%) and respiratory tract (6%). The most frequent causes were Klebsiella (24%) and Cytomegalovirus (18%). Wound infection occurred in 5% of the patients. The overall mortality was 7.7%, and almost half of the death cases (3.5%) involved sepsis development. Graft loss occurred in 16 (11%) of the cases: 2 developed Cytomegalovirus infection, 2 experienced urinary tract infection (UTI) and 5 developed sepsis (and expired). Mycobacterial and hepatitis C infections were noticeably low compared to other studies. The hazard rate in occurrence of UTI, CMV, acute rejection and mortality were higher in cadaveric transplant recipients than in others.Conclusion: This study identifies infections as a major cause of morbidity and mortality in the post transplant period. Patients having higher creatinine levels and those receiving high doses of drugs at discharge are considered to be at high risk and should be evaluated thoroughly.

Background and Aim: At the outset of the third millennium, vitamin D deficiency is still a common and serious health problem among women of reproductive age and their infants in developing countries. Precise information on the vitamin D status of urban lactating women in Islamabad -Gharb is not available. But it seems that, like in other areas of Iran, vitamin D deficiency may be common in this region. The aim of this study was to determine the vitamin D status in urban lactating women and its association with the following variables: number of pregnancies, total duration of lactation, length of exposure to sunlight, and literacy.Materials and Methods: Using a simple random sampling technique, a total of 155 lactating women with children under the age of 1 year were selected from 8 urban health clinics. In the interview, the subjects answered questions on the above-mentioned independent variables and fasting blood samples were taken for analysis. The concentration of 25-hydroxyvitaminD in serum was measured by a chemiluminescence method. Normal status was defined as concentration of 25-HydroxyvitaminD serum³  10 ng/ml, moderate deficiency as concentration ³6ng/ml and <10 ng/ml, and severe vitamin D deficiency as concentration of 25- Hydroxyvitamin D < 6 ng/mt.Results: The results indicate that only 8.4% of women were normal, 18.7% had moderate deficiency, and 72.9% had severe vitamin D deficiency. The vitamin D status had a statistically significantly negative association with the number of pregnancies and the total duration of lactation.Conclusion: The vitamin D status of urban lactating women is very poor and needs immediate attention.

Background and Aim: Lack of quantitative and qualitative data on the current status and the possible adverse effect of poor illumination necessitate the evaluation of the illumination system in the industrial section.To perform quantitative and qualitative assessments of illumination conditions in factories located in the west of Tehran and to look at the adverse consequences of insufficient illumination.Materials and Methods: Data were collected through objective measurements and interviews with 616 factory workers. We used a structured questionnaire for data collection.Results: Out of the total number of work sites inspected, 19.8% sufficient illumination, 46.1%hadmoderate illumination, and 29.7% work sites had illumination levels considered to be inadequate for precise tasks.Among those who worked in places with moderate illumination, 56.7% belonged to the 16-20 years age group; 86.7% of individuals within this age group had to perform very precise tasks. Besides, 46.4% of the female workers and 45.7% of the males worked in places with moderate illumination .Work site observations and interviews revealed that those working under moderate and insufficient light commonly inhaled hazardous fumes and suffered from headaches and glare.Conclusion: Factory work entails a variety of visual tasks. Besides creating a pleasant working environment, illumination of the workplace should provide sufficient amounts of light, visibility, luminance and contrast.