Iranian Journal of Public Health
Volume:40 Issue: 3, Autumn 2011

Q fever is a worldwide zoonosis with many acute and chronic manifestations caused by the pathogen Coxiella burnetii. Farm animals and pets are the main reservoirs of infection, and transmission to human beings is mainly accomplished through inhalation of contaminated aerosols. Persons at greatest risk are those in contact with farm animals and include farmers, abattoir workers, and veterinarians. The organs most commonly affected during Q fever are the heart, the arteries, the bones and the liver. The most common clinical presentation is an influenza-like illness with varying degrees of pneumonia and hepatitis. Although acute disease is usually self-limiting, people do occasionally die from this condition. Endocarditis is the most serious and most frequent clinical presentation of chronic Q fever. Vascular infection is the second most frequent presentation of Q fever. The diagnosis of Q fever is based on a significant increase in serum antibody titers. The treatment is effective and well tolerated, but must be adapted to the acute or chronic pattern with the tetracyclines to be considered the mainstay of antibiotic therapy. For the treatment of Q fever during pregnancy the use of long-term cotrimoxazole therapy is proposed.

Several studies pertaining to current status of Iodine Deficiency Disorder Control Programme in India have revealed goiter prevalence in the range of 1.5- 44.5%, mean urinary iodine excretion level ranging from 92.5-160 mcg/L and iodized salt coverage ranging from 37-62.3%. Most of these studies were based on school children. How­ever, very few studies have focused on pregnant women. This population is very sensitive to marginalized iodine defi­ciency throughout their gestational period. This 40 cluster cross sectional study was done in Raipur district. Iodine content of salt was estimated by using "Rapid Salt Testing Kits" along with observing salt storage practices, at household and in shops. Pregnant women were interviewed by using semi structured comprehensive questionnaire, which was based on knowl­edge attitude, and practices about salt use pattern and awareness about IDDCP, UIE level were also estimated. Prevalence of goiter was 0.17%. Many (41.12%) pregnant women had <15ppm iodine content in the salt sam­ple and 51.58% of women had subnormal iodine uptake. Wrong salt storage practice was observed in 36.3% of households. There were lacunae in Iodine deficiency control program in Chhattisgarh. Implementation and monitoring of program was weak. Thus for monitoring purpose IDD Cell & IDD Laboratory should be established at district level. This will lead to periodic assessment of Iodine Deficiency Disorders, by monitoring of Iodine intake and all other preventive, promotive as well as curative measures in the state.

The pregnancy was a risk factor for excessive weight gain for women. However, there is no information about the prevalence of obesity and its relationship with a history of pregnancy in girls. Therefore, the purpose of this study was to investigate differences in the prevalence of obesity in adolescent females with a history of pregnancy and fac­tors associated with it, in Korea. In 2009, 69 of 34,247 female students revealed that they had experienced pregnancy in response to the 5th Ko­rea Youth Risk Behavior Web-based Survey (KYRBWS-V) project by the Korea Centers for Disease Control and Pre­vention (KCDCP). The body mass index (BMI) and experienced pregnancy categories of the KYRBWS-V were as­sessed, and, for data analysis, the independent t-test, chi-square test, and multivariate logistic regression were used. The risk of pregnancy was increased by approximately 47% per unit increase in age, and 331% per unit in­crease in depression, respectively. Conversely, the risk decreased by 19% per unit increase in BMI and 33% per unit in­crease (ranged from 1: very rich to 5: very poor) in the family economic state. Obesity in adolescent females is minimally affected by a history of pregnancy, if at all, despite the fact that pregnancy was a risk factor for excessive weight gain in women. However, adolescent females with a history of preg­nancy have higher levels of depression than do normal peers in Korea.

Obesity is a significant risk factor for metabolic disorders including increase in blood pressure. Body mass index (BMI), waist circumference (WC) and Waist/Hip ratio (WHR) are simple and effective indicators of obe­sity. The objectives of this study were to examine the relationships between obesity anthropometric indicators and hy­pertension and to identify the best anthropometric indicator/s that can predict hypertension risk among youth in the UAE. A 110 first year students in a Medical University in Ajman, UAE, during the year 2009-2010 were included in a cross-sectional study. The height, weight, WC, hip circumference and blood pressure were measured and the BMI and WHR were calculated for each student and used in the analyses. The mean values for BMI, WC, hip circumference and WHR, were significantly higher in the Pre/Hyperten­sive group compared to normal blood pressure group. The risk of Pre/ hypertension was significantly increased by 4.3 times for participants who had general obesity (BMI³ 30) or abdominal obesity (identified from high WC). Highly sig­nificant correlations were noticed between systolic and diastolic blood pressure and all anthropometric indicators except that for Hip circumference and systolic blood pressure. Step-wise linear regression model showed that when all obesity indicators were studied together, the waist circumference was the only indicator which showed significant relationship with both systolic and diastolic blood pressure. Waist circumference is the best anthropometric indicator that can predict hypertension risk among youth in the UAE.

Many epidemiological studies reported significant associations between air pollution and respiratory hos­pital admissions. Proximity of industries to the residential areas may have considerable impacts on air quality and sub­sequently public health. This paper describes the indirect impacts of closing a large steel industry, Broken Hill Proprie­tary (BHP), in the Lower Hunter region, Australia. The number of hospital admissions for a group of respiratory diseases including all respiratory disease, Chronic Obstructive Pulmonary Disease (COPD) and asthma were incorporated in this study. The study location com­prised the entire Lower Hunter, Newcastle, as the closest location, and Port Stephens, as the most distant area to the indus­try. Two series of data set for 3.5 years before and after industry closure allowed a comparison of daily hospital admis­sions. Mixed Model was employed to calculate significant changes in the time series by month. While the rest of the disease categories decreased, COPD 65+ increased after BHP closure. All-age asthma in New­castle showed the highest decrease whereas the least difference was observed for respiratory disease in Port Stephens. The decrease of admission rates was generally more significant in Newcastle, where the industry was operat­ing, than in the other areas. Inconsistent results challenged the publically viewed significant role of BHP closure on public health. The study expected consistent decreases of respiratory admissions after industry closure; however, the district results sug­gested some impacts on community health. Incompatible findings could be attributable to other factors that dominated the possible impacts of BHP closure.

Diabetic peripheral neuropathy (DPN) accounts for 80% of diabetic foot ulceration; therefore neurologic examination plays a critical role in screening at risk patients. Our objective was assessment the prevalence of DPN and related factors based on clinical findings. This cross-sectional study was conducted on 124 diabetics who were randomly recruited from Diabetes Clinic of Dr. Shariati University Hospital (Tehran/Iran) in 2004. After gathering demographic data and blood sampling for fasting blood sugar (FBS), the questionnaires United Kingdom (UK), Michigan, Diabetic Neuropathy Score (DNS), and 10-g monofilament testing were administered. Analysis tests were chi-square, pearson correlation and logistic regression. The patient's age ranged 17 -75 years; with 44% male. Ninety one percent suffered from type two diabetes and the mean duration of diabetes was 10 years. The mean FBS level was 181.5 mg/dl. While the prevalence of DPN based on Michigan, DNS, and monofilament testing was about 32-38%, some 54% were diagnosed by UK test. Tingling in the lower extremity was the most frequent complaint (42%). The strongest linear correlation was reported between Michi­gan and DNS (r= 0.7), and then between monofilament test and DNS (r= 0.6). The age > 50 years, length of diabetes > 10 years, and FBS >200 mg/dl were the main risk factors for DPN based on DNS. It seems that the combination of Michigan and monofilament test can provide an accurate screening tool for detecting DPN. In addition, tight glucose control, regular assessment of the lower extremity, and to educate diabetics is urged in elderly diabetics, longer duration of diabetes, and those with high FBS.

To assess the epidemiological characteristics of hypertensive patients in urban population of Yazd, A cen­tral city in Iran. This cross sectional study was conducted from 2005-2006 and carried out on population aging 20-74 years. It is a part of the phase I of Yazd healthy heart program that it is a community interventional study for prevention of car­diovascular disease. Data obtained from questionnaires were analyzed by SPSS version 13. P value less than 0.05 were consid­ered significant level. This study comprised of 2000 participants that 847 (42.5%) were diagnosed as being hypertensive. After age ad­justment, prevalence of hypertension was 25.6% (23.3% for women and 27.5% for men (P< 0.001). Age, Total cho­lesterol, LDL-cholesterol, triglyceride, fasting blood glucose, impaired glucose tolerance test, body mass index and waist were significantly higher in the hypertensive groups. 53.7% of hypertensive cases were aware of own condition, 45% were treated, and 33.9% of treated were controlled (30.7% and 35.4% in men and women re­spectively). In other word, 24% of all hypertensives (aware or unaware about own blood pressure condition) were treated and only 8% of them were controlled. Men significantly had less awareness (P< 0.001), lower tendency to take medi­cation (P< 0.001), and less were controlled (P= 0.046). We understand high prevalence, low awareness, treatment, and control of hypertension and higher preva­lence of other traditional metabolic risk factors in these cases. It seems that urgent preventional studies should be con­ducted in this population.

Although, the roots of criminal behaviours clearly lie in social, economic, and cultural factors, the in­crease criminal offences in urban settings has raised the issue of prevention through urban environmental health, plan­ning and design. The approach of the study was based on the scientific research methodology and indicators were compiled from observations and comparative analyses of those urban spaces that are most often the sites of crime. Pearson's correlation coefficient showed that 37% of sampled males and 51% of females emphasized on ef­fec­tiveness of environmental factors. The urban space observations show that the environmental and physical factors af­fect on security and sensation of community safety among the citizens. Crime is committed in a particular place; place-related factors play a role in creating the potential for crimes to be committed. The results show the close bond between crimes and environmental problems.Recognition of the influ­ence of location-specific characteristics and the correct environmental response may make it possible to prevent or at least reduce criminal acts in urban places.

Depressive disorder is globally estimated to be as many as one in five visits to primary health care. Approximately more than 50% of depressed women in primary care are not diagnosed. As a part of a major investigation into perceptions of women's depression, this study explored how female patients and their relatives conceptualize patient's conditions in three ethnic groups in Iran (Fars, Kurds and Turks). Qualitative methods were used for data collection. Depressed women and their relatives were purposively selected from the public psychiatric clinics affiliated to university of medical sciences in the three study cities. Twenty-five depressed women and 14 relatives were interviewed in three ethnic groups. One theme "illness meaning", including three categories: perceived symptoms, label of the illness, and effects of the illness was found through the content analysis. The participants perceived symptoms of illness as somatic and psychological depending on the participant's assumed reason for the onset of the illness. There were most similarities in term used for of the illness in the three ethnic groups. Most of the study participants described the illness in terms of nerve problems/illness, and depression "afsordehgi". The most important effects that depressed women had experienced because of their illness were marital conflict or a guilt feeling originating from their inability to support family. These findings suggest the need to recognize and choose appropriate diagnostic approach for depressed women in the context of Iran.

The objective was to measure the sensitivity of a group of physicians regarding the ethics-related situa­tions, which they faced during patient care and treatment. All of 306 physicians who joined the Turkish Army for compulsory military service in December 2008 were included in the study. A "Moral Sensitivity Questionnaire", formed by Kim Lutzen, was applied to all of them. From total, 95% of physicians performed their job willingly, 88% of physicians attended ethic lessons (n=265), 72.4% (n=218) followed ethic publications, 67.4% (n=203) stated that there was an ethic committee at their institutions, and 5% worked as a member of the ethic committee. There were statistically significant differences between autonomy, benevolence meaning, conflict, and total scores according to workplace of physicians, employment period, and being specialists. Points of autonomy were found lower in physicians working at private hospital and health center than those at public hospital. Ethical sensitivity of physicians changed due to work place. We conclude that organizational arrangements are of beneficial effects to increase ethical sensitivity.

Listeria monocytogenes is of major concern to the food industry in general and the dairy industry in particular. Little is known about incidence of this pathogenic bacterium in dairy products in Iran. A survey was made from 23 September 2006 to 22 June 2007 for Listeria species in ninety samples of tradi­tional and industrial cheeses, in milk and surface where the cheeses were manufactured from unpasteurized raw milk in the province of Isfahan (Iran). Listeria murrayi, L. grayi and L. ivanovii, were detected in nine traditional cheeses and one raw milk sample. None of the different Listeria species were isolated from the industrial cheeses and their environment. There are almost good hygienic conditions in domestic cheese manufacturing farmhouses in Isfahan area, but we should try to improve hygienic levels until we have none of the Listeria spp. in our samples.

There is long-term interest in the effects of stress on health, due to the strain that it places on individuals which can lead to an increased risk of disease. The present study examined degree of perceived job stress related to incidents reporting rate and its dimensions among worker's Isfahan Steel Company. A self-administered anonymous was distributed to 189 workers. The survey included demographic factors, incidents reporting rate and its components (physical symptoms, psychological symptoms and accidents) and the Job Stress Questionnaire. The data were analyzed by multivariate (MANOVA) and correlation techniques. 1) there was internal significant correlation between perceived job stress with incident reporting rate as well as with its two components namely physical symptoms and psychological symptoms; 2) there was not a significant relationship between perceived job stress and accident; 2) In multivariate analysis, perceived job stress respectively about 12%, 18% and 19% of the variance of variables of incidents reporting rate, physical and psychological symptoms significantly predicted (P< 0.05). Perceived job stress influences to physical and psychological symptoms. Therefore, decreasing job stress can be important to prevent the development of stress-related diseases and to promote workers health.

This study was performed to compare the prevalence of HPV infection and high risk HPV genotypes [16, 18] between monogamous and polygamous women, in Zabol, Iran. This cross sectional study was conducted in Zabol in 2006 - 2007. Two hundred sixty five married women attend­ing the Gynecology Clinic for Cervical Disease Screening entered to this study. One hundred sixty two cases had mo­nogamous, and 103 had polygamous husbands. HPV PCR samples were obtained from scrape of papsmear speci­mens. The biotinylated primers MY09/MY11, GP5+/GP6+, were utilized to enable amplification and detection of posi­tive PCR products. Confirmation of HPV-16 and -18 were done by type-specific PCR primers HPV-16/F, HPV-16/R and HPV-18/F, HPV-18/R. Prevalence of HPV infection in monogamous and polygamous groups was 29% and 37.9%, respectively. The most HPV infection was found in 15-25 years group. The most prevalence of infection in monogamous group was HPV-18 and HPV- non16, 18 in 15-25 years, and HPV-16 in 26-35 years group. In polygamous group the most preva­lent type was HPV-16, 18 in 15-25 years group. The most prevalent HPV-16 was seen in sever inflammation and dys­plasia cytology in both groups. Prevalence of HPV infection in Zabol is high, and in women with polygamous husbands group is slightly more than monogamous. Screening for this infection must be recommended in this region of Iran.

A lot of studies have shown periodontal diseases as a risk factor for adverse pregnancy out­comes. The as­sociation between periodontitis and preeclampsia has been studied recently with contro­versy. Considering the importance of preventing preeclampsia as a dangerous and life-threatening disease in pregnant women, the pre­sent study was carried out. Two hundred and ten pregnant women participated in this case-control study (105 controls & 105 cases) during years 2007 and 2008. Preeclamptic cases were defined as blood pressure ≥140/90mmHg and protein­uria +1. Control group were pregnant women with normal blood pressure with­out proteinuria. Both groups were examined during 48 hours after child delivery. Plaque Index (PLI), Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding On Probing (BOP), Gingival Recession (GR) were measured on all teeth except for third molars and recorded as periodontal examination. Data was ana­lyzed using t-test, chi-square, and Mann-Whitney U statistical tests. There was no significant difference between the two study groups for PD. CAL, GR, BOP signifi­cantly in­creased in the case group (P< 0.02). This study showed that preeclamptic cases were more likely to develop perio­dontal disease (P< 0.0001). Eighty three percent of the control group and 95% of the case group had perio­dontal disease (P< 0.005) which had shown that preeclamptic cases were 4.1 times more likely to have periodontal disease (OR= 4.1). Preeclamptic cases significantly had higher attachment loss and gingival recession than the con­trol group.

The relationship between socio demographic status and Health Related Quality of Life (HRQOL) has not been well documented in most population of Asian countries including Iran. This study aimed to investigate the determinants of HRQOL in general population living in Bandar Abbas. This cross sectional study was conducted among general population living in Bandar Abass, Iran from Jun to Jul, 2007. Using a multistage sampling method, a random sample of individuals aged 15 years and over were inter­viewed through SF-36 questionnaire. Multiple logistic regression analysis were used to predict determinant factors on health related quality of life. Overall, 1675 Iranian adults were interviewed. The majority of the participants were female (50.4%), married (70.9%) and employed (36.8%). The range of education years of most participants (56.7%) were from 6 to 12 years. Female participated in this study had significantly poorer HRQOL than male in all aspects of SF-36 except for Role Emotional (P< 0.001). Furthermore there were significant differences between different age groups in all individually scales and two summaries (P< 0.001). After adjusting for the impacts of other socio demographic factors, variable such as older age, female gender and lower educational level could independently decrease both mental and physical aspect of HRQOL (P< 0.01). Female, older and less educated people are at higher risk of poorer health quality of life in both mental and physical aspects and should be considered as high risk groups in priority health programs.

WHO suggest that family physician is the core in the world efforts for quality improvement, cost ef­fectiveness, and equity in the health care systems. This study evaluates the impact of the program on accessibility of the services, case finding, patient referral, feedback process and insurance coverage in the rural health units. This study was quasi experimental. It compared the function of four health centers and eight health houses in the last three months of year 2004 with 2008. Data extracted from the available documents in the health units. Descrip­tive and analytical analysis was performed by using SPSS software. The presence of physicians in health centers were 75 and 100 percent for 2004 and 2008 respectively, this rate for midwives were 50 and 100 percent for the same years respectively. The total referral cases to the hospitals were 2676, the feedback rate was recorded in 36% of the cases. In this case the follow up rate by physicians was 0% in 2004 and 3.17% in 2008. Insurance coverage rate was 27% and 97% for 2004 and 2008 respectively within a meaningful P value range at 95% CI.‍ The findings of this study show that the family physician program has the positive impact on function of health units in terms of availability of physicians and midwives and also insurance coverage at health centers in rural area, No impact on patient follow up and case referral rate was detected.