Iranian Journal of Public Health
Volume:41 Issue: 1, Jan 2012

Malaria remains a complex problem during the pregnancy, which threatens > 35 millions pregnant women every year. Malaria pathogenesis in pregnancy results in accumulation of infected RBCs in the intervillous spaces causing severe alterations leading to the reduced materno-foetal exchanges. In this article we have revisited the current evidences of clinical implications and overall burden of malaria in pregnancy. Many adverse aftermaths including, low birth weight, intrauterine growth retardation, preterm delivery, stillbirth and anemia were found associated with malaria in pregnant women. Despite of worldwide comprehensive control programmes for malaria in pregnancy, the disease control has been a daunting task everywhere. Socio cultural, economical, lack of awareness and various logistic problems compound the disease in developing countries. Thorough evidence based information and estimates, education and awareness and strengthening of prevention programmes are needed urgently to achieve success in malaria control in pregnancy.

A case-control study was carried out to investigate the roles of prior allergies and family history of cancers and their interaction in the etiology of adult leukemia. Prior allergies status and family history of cancers in first-degree relatives were compared between 131 incident leukemia cases and 206 hospital-based controls. Odds ratios (OR) were estimated using an unconditional regression model taking into account potential confounding factors. Significant association between adult leukemia and prior allergies and family history of cancer (OR=2.09, 95% CI: 1.22-3.58 for prior allergies; and OR=2.35, 95% CI: 1.09-5.03 for family history of cancer, OR=15.88, 95% CI: 1.77-142.55 for both the two factors (+), respectively) was found after adjusting for potential confounding factors. Prior allergies and family history of cancers may be risk factors for adult leukemia; their interaction was likely to be synergistic rather than additive for the risk of leukemia.

Sick leave from work due to psychiatric disorders is a major public health problem, not only in Japan but also worldwide. As males and females in Japan tend to differ in their approach to work, a gender difference in perfectionism might be expected. We investigated the background factors leading to long-term absence from work due to sickness among psychiatric outpatients in Japan. We surveyed 73 psychiatric outpatients who were absent from work for a long time (POAWs) and 228 employees without long-term sickness absence as controls. GHQ-30, NEO-FFI, MPS, RSS and questionnaires inquiring about background factors, including relationships with others, was used, and the data were compared between males and females. Male POAWs had a significantly higher tendency for depression and perfectionism than the controls, but in females this difference was not significant. With regard to personal relationships of POAWs, males had worse relationships with superiors and colleagues, whereas females had worse relationships with superiors, colleagues, and family. The data suggested that male workers exhibiting perfectionism tend to undertake too much work and become exhausted when trying to cope with complex human relationships in the workplace. Female workers having the double burden of family commitment and perfectionism tend to be isolated in terms of personal relationships, leading to exhaustion both in and outside the workplace.

This was a cross-sectional study on the gender differences in weight-control behavior. The strategies used, weight status, weight satisfaction, and proportion of individuals attempting to lose weight among 233 government employees (104 men and 129 women) working in the Federal Government Building in Penang, Malaysia, were assessed. Anthropometric indicators such as body mass index, waist-to-hip ratio, and body fat percentage were measured to determine the subjects'' body weight status. A questionnaire covering the following items was used to assess weight-control behavior: social support, self-monitoring, self-efficacy, outcome expectations, planning, preparation/buying, portion control, social interactions, and cognitive behavioral strategies. About 50% of the subjects were classified as overweight. Based on percent body fat percentage, 70% of them were classified as having unhealthy levels of body fat. Women were found to be more dissatisfied with their current weight, and were more likely to attempt weight reduction compared to men. Women reported higher levels of social support for dieting and had better expectations for diet and exercise (P < 0.05). They also reported higher use of weight control strategies. For self-monitoring, although no gender-dependent differences (P > 0.05) were observed, women reported more frequent self-monitoring of diet, whereas men reported more frequent self-monitoring of exercise. Health care professionals and researchers should be aware of the different strategies used by men and women in order to plan and/or implement community-wide weight management programmes.

The aim of this study was to detect the prognostic significance of survivin level and the expression of total p53 in acute lymphoblastic leukemia (ALL) and its correlation to patients'' outcome. Sixty two children newly diagnosed with acute lymphoblastic leukemia were treated with chemotherapy and followed up for 2 years or until death. Twenty apparently healthy volunteers with matched age and sex were taken as control. Survivin protein was measured by quantitative sandwich enzyme immunoassay and total human p53 was measured by Flow cytometry in peripheral blood at diagnosis and at complete remission. A highly significant elevation (P<0.0001) was found in survivin protein and total p53 levels in acute lymphoblastic leukemia children patients at diagnosis compared to controls. At complete remission a significant decrease of the two indices were found in ALL patients compared to those at diagnosis (P<0.0001). Survivin protein and total p53 was significantly higher in non-survived compared to survived group (P<0.0001 & P=0.016, respectively). A positive correlation was found between survivin level and total human p53 level in children with ALL (r=0.501 & P<0.0001). survivin protein is related to anti-apoptotic proteins and its high expression lead to unsuccessful treatment of ALL. Survivin and TP53 are new prognostic tools in ALL, independent of age and sex.

The aim of this study was to assess the association between insulin resistance, metabolic syndrome and nonalcoholic fatty liver disease (NAFLD) in Chinese adults. Fifty five subjects with NAFLD and 55 controls were enrolled for the study. Waist circumference, blood pressure, plasma triglyceride, high density lipoprotein cholesterol and fasting plasma glucose concentrations and homeostasis model assessment of insulin resistance (HOMA-IR) values as an index used to quantify insulin resistance were measured and analyzed. Logistic regression was analyzed to predict independent risk factors of NAFLD. The prevalence of metabolic syndrome in NAFLD group was obviously higher than in controls group (47.3% VS 3.6%, P<0.001). There were all significant differences of each component of metabolic syndrome and HOMA-IR values in comparison of nonalcoholic fatty liver disease (NAFLD) and controls group. In a logistic regression analysis, age, diastolic blood pressure, waist circumference and HOMA-IR were the covariates independently associated with the presence of NAFLD (Odds Ratio=1.107, 1.083, 1.218 and 16.836; 95% CI: 1.011～1.211, 1.001~1.173, 1.083～1.370 and 3.626~78.168, respectively; P<0.05) NAFLD was closely associated with metabolic syndrome and insulin resistance was a very strong predictor of NAFLD.

In 1999, Duzce suffered two consecutive devastating earthquakes above magnitude 7 in August and November. In the present study, we aimed to evaluate the indoor air quality of coffeehouses by determining carbon monoxide (CO) levels and their contributing factors in coffeehouses built before and after the earthquake. We conducted our study in 76 Turkish coffeehouses in Duzce in winter (November 2007-March 2008) during rush hours (18:00-23:00). The Turkish coffeehouses included in the study were evaluated under four categories based on smoking status and construction date. The characteristics of the coffeehouses, such as their CO levels and temperatures both indoors and outdoors, were all measured. These analyses were carried out with the SPSS 15.0 program. The CO levels in Turkish coffeehouses were above the values indicated as being safe by the WHO. While stoves and cooking equipment were determined to contribute to indoor CO levels, cigarettes were found to be the main source. Indoor CO levels at second hour were very strongly correlated (r: 0.84, P<0.001) (r: 0.91, P<0.001) with indoor CO levels at initial and first hour as well as with smoking status (r: 0.69, P<0.001); they were also moderately correlated with the room volume (r: 0.34, P<0.001) and construction materials (r: 0.31, P<0.001) of the coffeehouse. Elevated CO levels in Turkish coffeehouses indicate the possible presence of other pollutants, particularly when the main source is smoking. In such cases, both individuals and the whole of society are affected negatively in many ways. Therefore, smoking should be prohibited by law in Turkish coffeehouses and national awareness programs should be developed based on peoples'' lifestyles. Moreover, the standards for construction and management of Turkish coffeehouses should be improved as well.

The T allele of the hepatic lipase (HL) C-514T polymorphism was previously found to be associated with lower plasma HL activity. Here, we examined the association between this polymorphism and plasma HDL-cholesterol concentrations in patients with coronary arteries stenosis. We studied 342 subjects undergoing coronary angiography in two groups of non CAD (n=146) and CAD (n=196). -514C→T polymorphism was determined using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). After adjustment for age, smoking and body mass index, HDL-cholesterol concentrations were significantly higher in men with the C/T&T/T genotype than those with the C/C genotype(mean 38.6 and 34.7 respectively P=0.01). The frequency of T allele in non CAD was 0.136 and 0.226 in female and male respectively and 0.170 and 0.223 for female and male in CAD subjects. There was no difference in T allele frequency in CAD and none CAD groups in male and female (P=0.466 and 0.722 respectively). -514C→T of LIPC gene have a positive effect on HDL-C concentration especially in male gender. However, no difference was determined in frequency of T allele between CAD and normal arteries subjects.

Diagnostic models are frequently used to assess the role of risk factors on disease complications, and therefore to avoid them. Missing data is an issue that challenges the model making. The aim of this study was to develop a diagnostic model to predict death in HIV/ AIDS patients when missing data exist. HIV patients (n=1460) referred to Voluntary Consoling and Testing Center (VCT) of Shiraz southern Iran during 2004-2009 were recruited. Univariate association between variables and death was assessed. Only variables which had univariate P< 0.25 were selected to be offered to the Multifactorial models. First, patients with missing data on candidate variables were deleted (C-C model). Then, applying Multivariable Imputation via Chained Equations (MICE), missing data were imputed. Logistic regression was fitted to C-C and imputed data sets (MICE model). Models were compared in terms of number of variables retained in the final model, width of confidence intervals, and discrimination ability. About 22% of data were lost in C-C model. Number of variables retained in the C-C and MICE models was 2 and 6 respectively. Confidence Intervals (C.I.) corresponding to C-C model was wider than that of MICE. The MICE model showed greater discrimination ability than C-C model (70% versus 64%). The C-C analysis resulted to loss of power and wide CI''s. Once missing data were imputed, more variables reached significance level and C.I.''s were narrower. Therefore, we do recommend the application of the imputation method for handling missing data.

Academic medicine is in a state of dramatic transformation. For this reason strategic thinking is the most essential part of educational planning. The main purpose of the present study was developing the strategic educational planning of Ophthalmology in Iran from 2007 to 2010 A qualitative investigation using focus group discussion has been implemented successfully for developing educational planning. Six to twelve representatives of key stakeholders in the ophthalmic education of Iran participated to this study. Strengths, weaknesses, opportunities and threats of ophthalmology education in Iran were analyzed. Strategic goals in education, research, and health service providing domains were being developed. Educational goals were defined as training of human resources in accordance with the community needs at the level of general practitioner, specialist, and fellowships in ophthalmology. Research goals of the program were defined as scientific inter-departmental and international communications, in order to promote the level of education, research, and treatment in the country. Also, in the field of health services according to the community needs, providing services by the means of advanced and cost effective methods were defined as strategic objectives. Based on this strategic plan in the last three years ophthalmic education in Iran shall be many changes in educational, research and health care provision for social accountability.

Ferroportin (Fpn), a regulator of iron homeostasis is a conserved membrane protein that exports iron across the enterocytes, macrophages and hepatocytes into the blood circulation. Fpn has also critical influence on survival of microorganisms whose growth is dependent upon iron, thus preparation of Fpn is needed to study the role of iron in immunity and pathogenesis of micoorganisms. To prepare and characterize a recombinant ferroportin, total RNA was extracted from Indian zebrafish duodenum, and used to synthesize cDNA by RT-PCR. PCR product was first cloned in Topo TA vector and then subcloned into the GFP expression vector pEGFP-N1. The final resulted plasmid (pEGFP-ZFpn) was used for expression of Fpn-EGFP protein in Hek 293T cells. The expression was confirmed by appearance of fluorescence in Hek 293 T cells. Recombinant Fpn was further characterized by submission of its predicted amino acid sequences to the TMHMM V2.0 prediction server (hidden Markov model), NetOGlyc 3.1 and NetNGlyc 3.1 servers. The obtained Fpn from indian zebrafish also contained eight transmembrane domains with N- and C-termini inside the cytoplasm and harboured 78 O-glycosylated amino acids. The recombinant Fpn from Indian zebra fish was successfully expressed in Hek 293 cell line. Although the discrepancy in two amino acids was observed in our produced Fpn and resulted in an additional O-glycosylation site, but had no effect on the topology of the protein compared to other Fpn described by other researchers. Therefore this construct can be used in future iron studies.

The aim of the article is demonstrating an application of multiple imputation (MI) for handling missing clinical data in the setting of rheumatologic surveys using data derived from 10291 people participating in the first phase of the Community Oriented Program for Control of Rheumatic Disorders (COPCORD) in Iran. Five data subsets were produced from the original data set. Certain demographics were selected as complete variables. In each subset, we created a univariate pattern of missingness for knee osteoarthritis status as the outcome variable (disease) using different mechanisms and percentages. The crude disease proportion and its standard error were estimated separately for each complete data set to be used as true (baseline) values for percent bias calculation. The parameters of interest were also estimated for each incomplete data subset using two approaches to deal with missing data including complete case analysis (CCA) and MI with various imputation numbers. The two approaches were compared using appropriate analysis of variance. With CCA, percent bias associated with missing data was 8.67 (95% CI: 7.81-9.53) for the proportion and 13.67 (95% CI: 12.60-14.74) for the standard error. However, they were 6.42 (95% CI: 5.56-7.29) and 10.04 (95% CI: 8.97-11.11), respectively using the MI method (M=15). Percent bias in estimating disease proportion and its standard error was significantly lower in missing data analysis using MI compared with CCA (P< 0.05). To estimate the prevalence of rheumatic disorders such as knee osteoarthritis, applying MI using available demographics is superior to CCA.

As insomnia is common, especially among the elderly in the nursing homes, we aimed to estimate insomnia prevalence among the elderly residing in nursing homes as well as to determine factors associated with insomnia in the elderly. This cross-sectional study was carried out in 2009 on 772 elderly residents at Kahrizak Nursing Home, Tehran Iran. The information was gathered through 5-part questionnaires by interviewing either the individuals or the nurses in charge and also reviewing the subjects'' medical files. Eventually, the necessary data were analyzed using one-way ANOVA and Chi-square tests. The mean age of the participants was 76.8 ± 8.05 years (range, 65 to 107 years). Based on the results, 303 (39.2%) of the elderly, including 86 (34.7%) men and 217 (41.1%) women, had insomnia syndrome. 433 (56.1%) participants complained of difficulty initiating sleep, 357 (46.2%) of disrupted sleep, 362 (46.9%) of early morning awakening, and 313 (40.5%) of non-restorative sleep. Our findings also showed that age (P =. 004), number of diseases (P =. 019), motility status (P =. 017), sleep environment satisfaction (P <. 001), cognitive status (P =. 023), and functional autonomy (P =. 003) were significantly associated with insomnia. Insomnia is a prevalent disorder amongst the nursing home elderly population, especially elderly women, and several pharmaceutical and nonpharmaceutical factors may trigger its occurrence. However, to prevent this problem, further studies are required in Iran and Middle Eastern region to establish a reliable understanding about insomnia patterns, causes, and cures.

The purpose of this research was to determine the traffic noise level and changes in the Kerman City, southeast Iran in recent years. This cross-sectional study was carried out in 2008 to investigate the existing noise situation in Kerman. Sound levels (LMax, LMin, Leq, L99, L90, L50 and L10) were determined throughout 13 stations using sound level measurement system (model, CEL-440). Number of passing vehicles was also assessed at the sampled stations. Sound level in all sampled stations was higher than Iran and World Health Organization guidelines. Comparison of Leq in different hours using statistical tests showed significant difference between different hours with 95 % confidence coefficient (P=0.01). Comparison of Leq throughout the week also showed that there was a significant difference (P=0.001) between Friday and workday. The comparison of Leq with the number of passing vehicles using Pearson correlation statistical test showed significant difference between the number of heavy vehicles passed and the level of Leq (P=0.001). It also showed that number of heavy vehicles caused the most noise levels. The results of this study compared to a similar study conducted in 1999 showed an increasingly high noise level. Noise level increased from 1999 to 2008 by 3.89 % which is indicative of an increase in noise emission sources.