Iranian Journal of Public Health
Volume:39 Issue: 3, Autumn 2010

Understanding the nature and causes of medical adverse events may help their prevention. This system­atic re­view explores the types, risk factors, and likely causes of preventable adverse events in the hospital sector. MEDLINE (1970-2008), EMBASE, CINAHL (1970-2005) and the reference lists were used to identify the stud­ies and a structured narrative method used to synthesise the data. Operative adverse events were more common but less preventable and diagnostic adverse events less common but more preventable than other adverse events. Preventable adverse events were often associated with more than one con­tribu­tory factor. The majority of adverse events were linked to individual human error, and a significant proportion of these caused serious patient harm. Equipment failure was involved in a small proportion of adverse events and rarely caused pa­tient harm. The proportion of system failures varied widely ranging from 3% to 85% depending on the data collec­tion and classifi­cation methods used. Operative adverse events are more common but less preventable than diagnostic adverse events. Adverse events are usually associated with more than one contributory factor, the majority are linked to individual human error, and a proportion of these with system failure.

Globalisation has given birth to medical tourism. Health and medical tourism are the fastest growing seg­ments in not only developed nations but in developing countries too. India has become a hot des­tina­tion, as the Indian medical standards match up to the highly prescribed international standards at a very low cost. However, it is an unmixed blessing; along with advantages, it has many unintended side effects also.

Mortality refers to the death that occurs within a population. It is linked to many factors such as age, sex, race, occupation and social class. The incidence and prevalence of mortality could affect the population's stan­dard of living and health care. The aim of this study was to explore the pattern of mortality trends in Iran, south-south west Asia and the world in 1970-2010. A descriptive study was conducted on the registered data in the Statistical Center of Iran and National Organiza­tion of Civil Registration. The data were analyzed using statistical methods and graphs. Finally, the ana­lyzed data were com­pared with the world and south-south west Asia data. In Iran, 61.1% of all the registered deaths were in male and 60.4% were in urban areas. Crude death rate, in­fant mortal­ity rate and under five mortality rate decreased from 13, 164 and 281 per 1000 in 1970-75 to the estimated val­ues of 5, 25 and 35 per 1000 in 2005-2010, respectively. The results showed that similar to other countries, the trends of all mortality indicators in Iran have been changed and decreased, which is related to many factors such as improvement health situation and medical interven­tions.

Gastric cancer is a common and lethal disease throughout the world. In Iran with 7300 new cases annually, it is the first cause of cancer related death in both sexes. Regarding the high incidence (10.5/100000 individuals) of gastric can­cer and priority of prevalence index in cancer management, in this study we tried to determine 1, 2-3 and 4-5 year point preva­lence of the disease according to survival data. Survival and incidence data were used for determination of cancer prevalence. Incidence data were extracted from can­cer registry in Iran and survival data were determined in a descriptive study by following up 3439 gastric cancer patients in Cancer Research Center (CRC). 1, 2-3 and 4-5 year prevalence was estimated from incidence rates in different years and the proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years from the time of diagnosis. patients with survival of 0.5, 1.5, 2.5, 3.5 and 4.5 years from the time of diagnosis were 46.38%, 26 %, 19.36%, 15.47% and 12.8% respectively. The prevalence of 1, 2-3 and 4-5 year was 3392, 3118and 1824 respectively. The cumula­tive 5 year prevalence was 8334 cases. These estimates of the point prevalence of gastric cancer at 1, 2-3 and 4-5 years are applicable to the evalua­tion of initial treatment, clinical follow-up, and point of cure. Therefore 1, 2-3 and 4-5 year point prevalence estimates, are neces­sary in health service planning for gastric cancer management and should be considered by public health managers.

IgE is an antibody class that regarded as an important factor in the pathogenesis of allergic diseases, asthma, im­mune responses to parasitic infection and it could be responsible for the late- phase allergic response. The objective of this study was to evaluate total IgE in healthy Iranian adults, establishment of reference range of total IgE and assess helpful­ness of this value in clinical diagnosis atopic and allergic diseases. Three hundred sixty six healthy adults from blood transfusion volunteers (18 to 60 years) were selected in this study. A specific questionnaire (including demographic factors, smoking status and. ..) was filled out for each person. Also, we evaluated effect of race and education on total IgE. These adults had no history of allergic disease. The total serum IgE level using a commercial enzyme immunoassay and CBC (Eosinophil count) was determined in them. Mean of age was 37.32± 10.93 yrs and 219 cases were males and 147 females. The geometric mean of total IgE was 20.84 IU/ml (2-373 IU/ml) (95% percentile= 250) (95% confidence interval=46.27-62.70). No differences was observed between mean of IgE log in males and females (P= NS) but mean of total IgE log in females is more than males. Normal range of serum total IgE obtained in this study could be helpful for diagnosis of IgE-dependent allergic dis­ease, as reference ranges in Iranian healthy adults.

This study examined the relationship between lifestyle factors and hypertension in Korean women. The subjects were 8,836 women, aged 20 to 81 yr, who visited a health promotion center for a medical check up during 2004-2008. The diagnosis of hypertension was defined in the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) report. Statistical significance was set at α<0.05 and SPSS ver. 12.0 software (SPSS, Chicago, IL, USA) was used. The prevalence of hypertension was 12.8% in this study population. Multivariate logistic regression demonstrated that the odds ratio (95% CI) of hypertension across age groups were 3.43 (1.68-7.02) for forties, 7.13 (3.48-14.60) for fifties, 12.97 (6.27-26.81) for sixties, and 24.28 (11.09-53.14) for over seventies compared to the twenties. In addition, compared with the normal weight group, the odds ratio (95% CI) of hypertension in the over-weight and obese groups were 2.41 (2.00-2.89) and 3.50 (2.95-4.16), respectively. The odds ratio (95% CI) of hypertension in those who consumed more than 3 drinks per week was 1.88 (1.29-2.76, P=0.001) compared with non-drinking group. The significant risk factors of hypertension were age, BMI, and alcohol drinking among Korean women and that smoking, exercise, and diet were not related to the risk of hypertension.

The prevalence of vitamin D deficiency and its causative factors has been estimated more frequently in elder popula­tion, women, and patients with osteoporosis in different countries, but this issue is less defined in male population within different age groups especially in Asian countries. Therefore, we studied the role of effective factors in vitamin D defi­ciency and its prevalence in Iranian healthy men. This study was a multi center and carried out in five metropolitans in Iran. Serum 25 Hydroxy vitamin D and other biochemical variables were determined in 2396 healthy men in late winter of 2001. 68.8% of participants suffered from vitamin D deficiency. Vitamin D levels were the highest in Bushehr (n= 111, 40.3%) (P< 0.05) and between Shiraz and Tabriz, Shiraz had the better values (P< 0.05). Tehran had the highest prevalence of vitamin D deficiency (n= 380, n= 85.7%). Geographical zone independently predicted vitamin D status (P< 0.05). There was not any association among age (r= 0.035, P> 0.05), physical activity (r= 0.023, P> 0.05), and exposure of face & hands to sunlight (r= 0.022, P> 0.05) with vitamin D levels. Prevalence of vitamin D deficiency in Iranian male population is high, considering Iranian cultural and geographi­cal zones, food fortification and life style modification is recommended.

Leber hereditary optic neuropathy (LHON) is an inherited form of bilateral optic atrophy leading to the loss of central vision. The primary cause of vision loss is mutation in the mitochondrial DNA (mtDNA), however, unknown secon­dary genetic and/or epigenetic risk factors are suggested to influence its neuropathology. In this study folate gene polymor­phisms were examined as a possible LHON secondary genetic risk factor in Iranian patients. Common polymorphisms in the MTHFR (C677T and A1298C) and MTRR (A66G) genes were tested in 21 LHON patients and 150 normal controls. Strong associations were observed between the LHON syndrome and C677T (P= 0.00) and A66G (P= 0.00) polymor­phisms. However, no significant association was found between A1298C (P =0.69) and the LHON syndrome. This is the first study that shows MTHFR C677T and MTRR A66G polymorphisms play a role in the etiology of the LHON syndrome. This finding may help in the better understanding of mechanisms involved in neural degeneration and vision loss by LHON and hence the better treatment of patients.

Medical journals are scientific resources where utilization of knowledge is availed and create an environment of competitiveness. To speed up the growth and increase scientific production and in order that the rank of Iranian journals be defined regionally and globally, journal standardization is necessary. This study was done to evaluate the country's medi­cal journals from 2004-2006. This is a descriptive/analytical study. Evaluation was based on the following; scientific credibility, registry and year of service, journal management, technical quality and accessibility. The number of journals evaluated during 2004-2006 were 86, 103 and 93, respectively and the process involved 3 phases 1) defining the journal's structural indicators and de­signing the evaluation form 2) collection, sharing and final confirmation of information with the publication staff 3) data en­try, analysis and ranking Improvement and growth of publication depends largely on 5 parameters and its development were based on the follow­ing; publication management (61.62 points), scientific credibility (43.80 points), quality of accessing the journals (37.05 points), quality of publication (14.80 points) and registry and year of service (0.02 points). Based on the study, an up­ward developmental trend of the country's medical journals can be seen and the tools were sufficient in terms of validity and reliability. A revised and more comprehensive checklist that would evaluate all aspects of a publication basing on latest indi­cators is developed. Evaluations of the country's medical journals not only promote compliance to international standards but also led to more indexing of journals in accredited international indices.

In general, measurements of solar ultraviolet (UV) radiation are related to horizontal surfaces. While the hu­mans walking and standing outdoors expose to the natural solar UV radiation, their eyes, cheeks, extremities, trunks, or many other anatomical sites are close to vertical plane and random orient to different directions. In this study, we character­ized the diurnal variations in solar UV on horizontal and vertical plane which may be helpful to obtain more relevant informa­tion on UV exposure of humans. The were measured using Solar-UV Sensors in Shenyang (41°51′N, 123°27′E) and Sanya (18°19'N, 109°42'E), PR China.Results As the well known, the diurnal variations in solar UV on horizontal plane in a sunny day exhibited unimodal distribu­tions, reached a single UV peak exposure at around solar noon. However, the diurnal variations on vertical plane presented bimodal distributions, with two peaks in summer in Shenyang and Sanya, and a unimodal distribution in winter in Shenyang. In spring and autumn in Shenyang, the UV exposure around noon were slightly flat with no significant peaks but relative high. When the Solar Elevation Angle (SEA) is about 40°, the vertical plane may potentially receiving maximal unweighted total solar UV radiation exposures. The results potentially showed that the protection of some vertical and near-vertical anatomical sites of human body from high UV exposure should not only focused on the periods of before and after noon especially in high SEA places.

Diabetes mellitus is associated with chronic changes in peripheral arteries because of oxidative stress and insufficient antioxidative defense mechanism. Omega-3 fatty acid supplementation could be effective in some diabetes complications; however, polyunsaturated fatty acids may increase lipid peroxidation. This study aimed to determine whether eicosapentaenoic acid alone or in conjunction with vitamin E had differential effects on serum antioxidants and peroxidation indices. This double-blind, placebo-controlled trial was carried out on 136 patients with type II diabetic mellitus (age 48.8±4.4 yr, BMI 27.8±1.7 kg/m²). The four groups of the study either received two grams of omega-3 fatty acids, 400 IU of vitamin E, a combination of the two or placebo for three months. Their serum total antioxidant capacity, enzymatic antioxidants and peroxidation indices were assessed. Fasting serum TAC increased in EPA+E (10.7%, P< 0.001) and E groups (7.5%, P< 0.05). SOD, G-PX and G-RD increased in EPA group (7.3%, 5.1%, and 8.4%, P< 0.05, respectively). MDA and protein carbonyl decreased in EPA and E groups (respectively, 12.5%, 7.6% P< 0.05, P< 0.05; 13%, 15.3% P< 0.001, P< 0.05). After adjustment for baseline values, age, sex, BMI and duration of diagnosed diabetes, protein carbonyl decreased in EPA+E and E group (30.7%, 15.3%; P< 0.05 respectively) relative to the placebo group. EPA, by itself has a statistically significant effect on serum total antioxidant capacity, enzymatic antioxidants and peroxidation indices in diabetic patients compared to EPA+E or E alone.