مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال هشتم شماره 2 (پیاپی 30، تابستان 1389)

The most common cancer in Iran is digestive system cancer, the highest incidence of which is reported from the Caspian Sea littoral. This study aimed to determine factors affecting the survival of patients with gastrointestinal cancer using the Cox and parametric models; the 2 models were compared. This survey was a prospective study conducted between 1990 and 1991. Data were collected through the Cancer Registry Center in Babol, which functions under supervision of the School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences. We tried to identify cases of gastrointestinal cancers. The individual characteristics of 484 patients, namely, age, sex, family history, marital status, smoking status, occupation, ethnicity, medication status, education, residence (urban, rural), and type of cancer were recorded. The patients were followed up for a period of 15 years, i.e., until 2006 year. To determine the effective factors on survival of patients, the Cox model and parametric models such as exponential, weibull, log-normal, log-logistic, and the AIC criteria and residuals were used to compare the effectiveness of the models. The SAS and STATA software were used for data analysis, with a significant level of 0.05. Sixty-six percent of the patients (total n=484) were males and 34% females, with a mean age of 59 and 55 years, respectively. Their distribution according to type of cancer was as follows: esophageal cancer, 359 (74.2%); stomach cancer, 110 (22.7%); colorectal cancer, 15(3.1%). Estimated one-, three-, and five-year survival rates were 24%, 16% and 15%, respectively. The results of this study reveal that gender and family history can be strong risk factors for GI cancer. Log-normal and log-logistic models in multivariate and univariate analyses gave almost similar results. However, based on AIC criteria and residuals analysis, the log-logistic model gives the best fit as compared to other parametric models and can be used instead of the Cox model for determining factors affecting survival of patients with gastrointestinal tract cancer.

Nowadays Clinical Skills Centers are important structural components of medical education systems globally. In these centers medical students are trained using a variety of methods and techniques, one method being teaching in structured stations. The objective of this study was to determine the efficacy of this method by comparing the student's self-assessment of their own basic surgical skills before and after structured stations teaching. This quasi-experimental study was conducted in 2004-08 in Tehran University of Medical Sciences. The participants included 268 medical students at the clerkship stage; there were 3 trainer groups. The pre- and post-self assessment techniques were used to assess the learning progress. ANOVA & Paired-t and non-parametric tests were used for data analysis. Irrespective of which year the students were in, self- scoring on 17 cognitive subjects and 10 procedural skills showed a significant improvement after the instruction (p<0.001). There were significant differences among the 3 trainer groups (p<0.001). This study suggests that teaching basic surgical skills using structured stations is effective in improving practical skills.

Sex education of children, a complex issue in any culture, has always been a controversial subject. Schools can play a vital role in imparting sex education to children, particularly in more conservative communities. The objective of this study was to find out primary school teacher's beliefs, attitudes, values, and understandings regarding sex education of school pupils. In this qualitative study we employed a community-based approach to design the project. Purposeful, voluntary and maximum variation sampling was used to recruit 22 teachers from selected schools in Western Tehran (21 female and 1 male teacher). Information was collected in 4 focus-group discussion sessions. Grounded theory and thematic analysis were used. Findings revealed three major themes: 1) organizational role, 2) institution construction, and 3) individual characteristics. These themes were described by subthemes as follows: 1. for organizational role: organizational culture and policies; 2. for institution construction: family and educational institutions; 3. for individual characteristics: biology, gender, instincts, curiosity, knowledge, and behaviors. From the participant's point of views, the school and the family are two important institutions in children sex education. However, teachers are not sufficiently competent in sex behavior education. Inappropriate policies, resource limitations, and the family cultural structure are obstacles in sex education of children in schools. The participants believe the following are priorities in children's sex education: changing cultural attitudes in organizations and institutions, such as cultural diffusion; sound training approaches in sex-related topics; providing sufficient resources; improving knowledge and skills of teachers in the area of sex education of pupils; and effective interaction between families and school authorities.

Inadequate management of biomedical waste can be associated with risks to healthcare workers, patients, communities and their environment. In this study a comprehensive survey was conducted to obtain information on the management of solid wastes in Qom hospitals. Field visits were made to 2 private and 4 governmental hospitals to collect the required information and weighing the solid wastes generated. In addition, supplementary information was collected using a modified World Health Organization questionnaire. The results showed total the average generation rate of solid waste in Qom hospitals was 3057.55 kg/day. The shares of general, infectious, sharp, and pharmaceutical and chemical solid wastes were 1523.6, 1520.6, 12.72 and 0.93 kg/day, respectively. The results on various aspects of solid waste management indicate that practices in the hospitals do not comply with the principles stated in the respective Iranian regulations. Similarly, the segregation process was inefficient. No information was available concerning the quantity and quality of solid wastes. Development of suitable waste management schemes and plans are strongly recommended. In addition, establishing training programs on proper waste management for all the personnel involved (managers, physicians, nurses, workers) are essential. These actions, plus effective supervision, will result in considerable reductions in hospital solid waste disposal cost

Food insecurity implies a limited ability to secure adequate and safe food or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.The nutrition transition in Iran is taking place in the context of rapid demographic change and urbanization in spite of underweight, obesity and overweight increased, especially among women. It is usually expected that food-insecure people have an inadequate food intake, less body fat, and body weight. However, several studies in developed countries have shown a higher prevalence of overweight/obesity among food-insecure household members, especially women. Under weight and overweight or obesity is the most common nutritional disorder in the developed countries and is assuming to become a serious health problem in developing countries. This study aimed to assess the association between food insecurity and socio-economic factors in households and body mass index among urban women in Dezful in 2008. A total of 400 household were randomly selected by two stage sampling from different areas in Dezful. Heights and weights of all women were measured based on standard protocols, and body mass index (BMI) was calculated. BMI status was defined based on cut-off values recommended by NIH(under weight = BMI<18.5, normal weight 18.5< BMI< 25, overweight 25≤BMI<30 and obesity BMI≥30Women provided detailed demographic and food insecurity information via a face- to- face interview. Information on food insecurity was collected using the instrument originally developed by USDA. All analysis was conducted using the SPSS statistical package. The prevalence of household food insecurity was %37.6 and 42.8% of the women were overweight, and 12% obese, respectively. Results showed that, BMI was positively associated with food insecurity, women's age and family size and inversely associated with, race and economic status (p <0.05). It is evident that household food insecurity, overweight and obesity coexist in Dezful. Women age, family size, race and economic status were recognized as associated factors with food insecurity but other factors didnt show significant relationship. There is lack of published information regarding food insecurity and some factors affecting with body weight status; therefore, it is necessary to perform such studies in other regions too.

This study was undertaken to determine the effectiveness of a safe community program, as an international community-based program, for injury prevention and safety promotion, in Kashmar

In this retrospective study, the data on injured patients consulting hospital emergency wards in Kashmar and 44 other districts (as control) for a period of 3 years (March 20 2005 to March 19, 2008) were analyzed and compared.

The number of injuries/100,000 population in Kashmar was 4654.6, 4570.9, and 4949.2 in March 2005-2006, 2006-2007, and 2007-2008, respectively. The corresponding figures (means) for the control districts were 822.7, 1130.0 and 1245.5. The injury- related fatality rate in the emergency ward for the 3 periods was 57.6, 52.9, and 44.2 per 100,000 in Kashmar and 12.2, 13, and 11.9 per 100,000 in the control districts. The injury rate showed an increase and the injury- related fatality rate showed a decrease in both Kashmar and the control districts over the 3 year period, but there was a statistically significant difference between the decreased injury-related fatality rate in Kashmar (p<0.0001).

The Kashmar International Safe Community Program resulted in no significant decrease in the rate of injuries in Kashmar. However, as compared to the control distrcts, it caused a decrease in the injury-related fatality rate over the 3-year period. Long-term studies are necessary to confirm these results.

Patients who consult hospital due to physical or mental damages have legal rights. Observation of patient's rights will result in patient satisfaction, which will help to improve hospital services. The aim of this study was to determine awareness and observation of patient's right in hospitals affiliated with medical universities in Tehran. This was a cross-sectional study conducted in 2009 in hospitals affiliated with medical universities in Tehran. A total of 601 patients were randomly selected from 11 hospitals affiliated with three medical universities in Tehran. Data were collected using a 50-item questionnaire the validity and reliability of which had been confirmed. Chi-square and Kruskal-Wallis tests were used for statistical analysis. The software used was SPSS.17. The mean age of the patients (59% females and 41% males) was 43.3 (SD=18.5) years and the average length of hospitalization 7.1 (SD=7.4) days. Data analysis showed that the proportions of the patients with a poor, intermediate and desirable patient's rights awareness were 71.5%, 22.0% and 5.8%, respectively. Observation of patient's rights was good in 13.8% of the cases, medium in 82.9% of the cases and poor in 3.3% of the cases. There was a significant statistical relationship between observation of patient's rights on the one hand and the hospital ward and length of stay on the other hand (p=0/007). Further analysis of the data showed that the strongest and the weakest observed rights were patient awareness right and the right of making objections and lodging complaints, respectively. The results of this study showed that patients are not well aware of patient's rights and that observation of patient's rights is not at a desirable level. We recommend organizing public educational programs including components on patient's rights and follow-up of patient' rights violations, as well as passing a comprehensive act to ensure observation of patient's rights and specific programs designed for monitoring and supervising it.

Multiple sclerosis (MS) is considered as a common inflammatory disease of the human central nervous system (CNS). 4 amino pyridine (4-AP), a potassium channel blocker, is used widely in MS treatment to reduce fatigue and cachexia often experienced by the patients. The objective of this study was to get a better understanding of the mechanism of action of this drug, using the cell culture model. More specifically, we attempted to determine the effects of the drug on 1. The profileration of, and its cytotoxicity on, the neurons, and 2. The activity of MMP-9 in the neurons.

Considering the available reports on the wide range of 4-AP effects, we designed this study to investigate its possible role in proliferation or cytotoxicity of the MS cellular model, i.e. astrocytoma U373-MG, using the MTT assay technique. We also analyzed the effect of 4-AP on cell functionality as assessed by matrix metalloproteinase-9 (MMP-9) zymography.

The results showed that while 4-AP at a concentration of 0.1 and 1 mM has no significant cytotoxic effects on the treated cells, it has remarkable MMP-9 inhibitory effects (p<0.01). The proliferation analyses confirmed the stability of 4-AP effects on cell functionality.

On the whole, the results of the present study show the desirable effect of 4-AP on MMP-9 activity at non-cytotoxic doses, promising its further therapeutic applications.