Iranian Journal of Public Health
Volume:41 Issue: 3, Mar 2012

Non-communicable disease continues to be an important public health problem in India, being responsible for a major proportion of mortality and morbidity. Demographic changes, changes in the lifestyle along with increased rates of urbanization are the major reasons responsible for the tilt towards the non-communicable diseases. In India, there is no regular system for collecting data on non-communicable diseases (NCDs) which can be said to be of adequate coverage or quality. Lack of trained health care workers, primary care providers armed with inadequate knowledge and skills along with ill-defined roles of various health sectors i.e. public, private, and voluntary sectors in providing care have played key hurdles in combating the growing burden of non-communicable diseases. Empowerment of the community through effective health education, use of trained public health personnel along with provision of free health care and social insurance would prove beneficial in effectively controlling the growing prevalence of NCDs.

Ethiopia''s childhood mortality has continued to decline although at a swift pace. The drop in urban childhood mortality decline, duration of breastfeeding is the principle reason for the overall decline in mortality trends in Ethiopia. Data from the Ethiopian Demographic and Health Surveys 2000 and 2005 were used. Indirect estimation of Brass and Trussell''s methods were adopted. Selected demographic and socio-economic variables were included in the analysis with statistically significant effects. Findings clearly show neonatal and post neonatal mortality decline gradually. Even though, Ethiopia''s childhood mortality rates are still high. The result shows less than 2 years birth interval have higher infant mortality rates than higher birth interval (113 deaths per 1000). The proper spacing of births allows more time for childcare to make more maternal resources available for the care of the child and mother. Therefore, further research is urgent for regional level and national level investigation.

To determine the prevalence and characteristics of birth defects in perinatal infants in Hubei Province during 200l-2008. The prevalence of birth defects in perinatal infants delivered after 28 weeks or more was analyzed in Hubei surveillance hospitals during 200l-2008. The incidence of birth defects in perinatal infants from 200l to 2008 was 120.0 per 10,000 births, and was increased by about 41% from 81. 1 in 2001 to 138.5 per 10,000 births in 2008. The incidence in the first 4 years (2005-2008) was much higher than the latter four (2001-2004) (χ2=77.64, P <0.05). The difference in prevalence between urban and rural was of no significance in 2008 (χ2=0.03，P >0.05), but that between male and female was significant (χ2=5.24, P <0.05), as the former prevalence was much higher. The prevalence of birth defects was slightly higher among mothers over 35 years old than those under 35 years old, but with no significance (χ2=1.98, P >0.05). The two leading birth defects were cleft lip and/or palate and polydactyly, followed by congenital heart disease, hydrocephaly, external ear malformation and neural tube defects. The prevalence of congenital heart disease was rising. Eight years'' birth defects data indicate that the birth defect rate was on the rise and the birth defects prevalence in Hubei province should be valued

Heavy metal pollution in the sediment of the Yellow River draws wide attention in the recent years. The Yellow River Wetland Nature Reserve of Zhengzhou is one of the major wetlands of the river and located at the beginning of the lower reach. In this article, we aimed to investigate the degree and the sources of the metal pollution in the reserve. Metals as Cu, Pb, Cr, Cd and Mn in the sediment were monitored using flame atomic absorption spectrometry. The index of geo-accumulation (Igeo) and the modified degree of contamination (mCd) were developed to evaluate individual metal pollution and overall enrichment impact of the elements. Compared with sediment quality guidelines, the effect of Cr and Pb are more serious than others. Igeo values show Pb pollution are moderate at the Xinzhai, Langchenggang and Nansutan sites, and mCd analysis indicate the whole contamination at the Wantan, Langchenggang and Nansutan sites was low. Principal component analysis indicated that the first factor was Cu, Mn and Cd, mainly from soil erosion and the irrational use of phosphate fertilizers; the second Pb from fossil fuel burning; and the third Cr from weathering process. We conclude that Pb contamination is serious in the reserve, and the main sources of the metal are crude oil consumption and coal combustion of the brick kilns around. We also draw a conclusion that it is vital to evaluate contamination degree with both individual elements and overall average.

Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as post-procedural data were collected. The data were, subsequently, compared between the men and women. Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26-2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to «The Health Transformation Programme». Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection.

Group B streptococcus (GBS) is one of the most important cause of morbidity and mortality among newborns especially in developing countries. It has been shown that the screening approach rather than the identification of maternal clinical risk factors for early-onset neonatal GBS disease is more effective in preventing early-onset GBS neonatal disease. The objective of this study was to detect GBS among clinical samples of women using PCR and standard microbiological culture. Samples were taken from 375 women at 28-38 weeks of gestation during six month from January 15 till June 15, 2011 from a hospital in Tehran, Iran. Samples were tested by standard culture using Todd-Hewitt broth, blood agar and by PCR targeting the cfb gene. Among the 375 women, 35 (9.3%) were identified as carriers of group B streptococci on the basis of the results of the cultures of specimens, compared to 42 (11.2 %) on the basis of PCR assay. We found that GBS can be detected rapidly and reliably by a PCR assay in vaginal secretions from women at the time of delivery. This study also showed that the rate of incidence of GBS is high in Iranian women.

Now the increasing growth of chronic diseases is the major health challenge worldwide. This survey was conducted to assess noncommunicable diseases related risk factors. A population-based cross sectional study was conducted in 2005 and repeated annually by 2009 in Hamadan province, the west of Iran using two-stage cluster sampling method. A total sample of 6500 subjects 15 to 64 years old were enrolled. The total prevalence of cigarette smoking was 18% [95% CI 17% to 19%], 35.1% in men versus 1.1% in women. The smokers consumed on average 15 cigarettes per day. Almost 26.3% [95% CI 24.8% to 27.7%] of the target population eat five or more servings of fruits and vegetables per day; 52.8% [95% CI 51.2% to 54.3%] had work related physical activity; 28.1% [95% CI 26.7% to 29.4%] had physical activity during leisure time; 80.3% [95% CI 79.0% to 81.5%] had transportation related physical activity; 47.2% [95% CI 46.0% to 48.4%] were either overweight or obese; 8.1% [95% CI 7.1% to 9.2%] had impaired fasting blood sugar or were confirmed diabetes; 33.7% [95% CI 31.9% to 35.5%] had hypercholesterolemia; and 15.6% [95% CI 13.0% to 18.3%] had hypertriglyceridemia. There was a statistically significant association of age and gender with body mass index, systolic and diastolic hypertension, hyperglycemia, hypercholesterolemia and hypertriglyceridemia. The evidences of the present survey promise a silent progressive epidemic of chronic diseases among Iranian citizens that may lead to an increasing growth of noncommunicable diseases in the next decade.

Dermatophytes are the most common causative agents of superficial mycoses. Species identification of these fungi is important from therapeutic and epidemiological point of wive. Traditional approaches for identification of dermatophytes at the species level, relying on macroscopic and microscopic features of the colonies, usually are time-consuming and unreliable in many circumstances. Recently a broad varieties of rapid and accurate DNA-based techniques were successfuly utilized for species delineation of dermatophytes. The ITS1-5.8S-ITS2 region of rDNA from various reference strains of dermatophyte species were amplified using the universal fungal primers ITS1 and ITS4.The PCR products were digested by a single restriction enzyme, MvaI. The enzyme was evaluated in both in silico and practical PCR-RFLP assay to find the exact differentiating restriction profiles for each species. To validate the standardized PCR-RFLP system, all tested strains were subjected to sequencing and sequence analysis. The obtained RFLP patterns were specific for many species including T. interdigitale, T. rubrum, T. violaceum, M. persicolor, M. audouinii, M. nanum (A. obtusum) and E. floccosum but were similar for some closely related species such as M. canis / M. ferrugineum. Sequencing of the ITS1-5.8S-ITS2 fragment from all type strains affirmed the RFLP findings. It was practically revealed that the ITS-PCR followed by MvaI-RFLP is a useful and reliable schema for identification and differentiation of several pathogenic species and can be used for rapid screening of even closely related species of dermatophytes in clinical and epidemiological settings.

The objective of this study was to evaluate the efficacy of Sanitization of Lettuce according to the protocols set forth by Iranian Ministry of Health and Medical Education for reducing populations of total coliform, fecal coliform, and helminth eggs present on lettuce. In the present study, we determined the load of total coliform, fecal coliform, and parasites of lettuce. The lettuce was sanitized by protocol of Iranian Ministry of Health and Medical Education. The protocol consists of 3 levels to disinfect the fruits and vegetables. The procedure was as follows: first washing stage. The leaves of leafy vegetables washed with tap water, second stage, separation of helminth eggs by 3 to 5 droplets of detergent per liter for 5 min; third stage, disinfection of vegetables by calcium hypochlorite solution (with 200 mg/l free chlorine) for 5 min; and finally the disinfected vegetables were washed with tap water. The average initial levels of total coliform and fecal coliform in the samples were 3.36 log10 cfu/g and 2.31 log10 cfu/g, respectively. Helminth eggs were not detected in any of the samples tested. The efficiency of total coliform and fecal coliform removal were 78.1% (0.75 log10cfu/g) and 79.6% (0.67 log10cfu/g), respectively, after washing. This increased up to 94.8(1.44 log10cfu/g) and 98.5% (1.90 log10cfu/g) after the use of detergent. Chlorine disinfection rose these amounts up to 98.3% (2.18 log10cfu/g) and 100% (2.31 log10cfu/g), respectively. By applying the protocol large parts of microorganisms existing on lettuce have indeed been removed.

Hepatitis B virus (HBV) gene and protein variations are frequently been seen in chronic patients. The aims of study were to determine the genotypes as well as the patterns of variations distribution in chronically-infected patients from the central part of Iran. The surface gene was amplified, sequenced and subsequently aligned using international and national Iranian database. All strains belonged to genotype D, subgenotype D1 and subtype ayw2. Of all 62 muta­tions occurred at 39 nucleotide positions, 31 (50%) were missense (amino acid altering) and 31 (50%) were silent (no amino acid changing). At the amino acid level, 30 substitutions occurred, however, 3 were in positions 122 and 127, corresponded to subtypic determination. 22 (73%) out of 30 amino acid mutations occurred in different immune epitopes within surface protein, of which 12 (54.54%) in B cell epitopes in 10 residues; 5 (45.45%) in T helper epitopes in positions; 5 (22.73%) in inside CTL epitopes in 4 residues. The distribution of amino acid mutations as well as the ratio between silent and missense nucleotide mutations showed a narrowly focused immune pressure had already been on the surface protein in these patients, led to the emergence of escape mutants in these patients.

Sandhoff disease is an autosomal recessive disorder caused by β-hexosaminidase deficiency and accumulation of GM2 ganglioside resulting in progressive motor neuron manifestations and death from respiratory failure and infections in infantiles. Pathogenic mutations in HEXB gene were observed which leads to enzyme activity reduction and interruption of normal metabolic cycle of GM2 ganglioside in sandhoff patients. Six infantile index patients with typical biochemical and clinical picture of the disease were studied at the molecular level. After DNA extraction and amplification, probands and their parents, were evaluated by direct sequencing of amplicons. We identified 7 different mutations among which 4 were novel. The most prevalent finding (50%) among our population was a 16 kb deletion including the promoter and exons 1-5. The other findings included c.1552delG and c.410G>A, c.362 A>G, c.550delT, c.1597C>T, c.1752delTG. We conclude that Cys137Tyr and R533C mutations may be pathogenic because of changing amino acid and locating at the conserved region and also they have not been observed in hundred controls. Besides, four mutations including: Cys137Tyr, c.1552delG, c.1597C>T and c.550delT fulfilled almost criteria for pathogenic mutation.

The occurrence of aflatoxin M1 (AFM1) in milk, especially breast milk, is a valuable biomarker for ex-posure determination to aflatoxin B1 (AFB1). In the present study, the risk of exposure to AFM1 in infants fed breast milk was investigated. An enzyme-linked immunosorbent assay (ELISA) was used for the analysis of AFM1 in breast milk samples from 132 lactating mothers referred to four urban Mothers and Babies Care Unit of Hamadan, western Iran. AFM1 was detected in eight samples (6.06%) at mean concentration of 9.45 ng/L. The minimum and maxi-mum of concentration was 7.1 to 10.8 ng/L, respectively. Although the concentration of AFM1 in none of the samples was higher than the maximum tolerance limit accepted by USA and European Union (25 ng/kg) however, 25% had a level of AFM1 above the allowable level of Australia and Switzerland legal limit (10 ng/L). Lactating mothers and infants in western parts of Iran could be at risk for AFB1 and AFM1 exposure, respectively. Considering all this information, the investigation of AFM1 in lactating mothers as a biomarker for post-natal exposure of infants to this carcinogen deserves further studies in various seasons and different parts of Iran

Resistance to contemporary broad-spectrum b-lactam antibiotics mediated by extended-spectrum b-lactamases (ESBLs) is increasing worldwide. Klebsiella pneumoniae, an important cause of nosocomial and community acquired urinary tract infections has rapidly become the most common ESBL producing organism. We examined ESBL production in urinary isolates of K. pneumoniae in relation to the presence of blaSHV, blaTEM and blaCTX-M genes. Antibiotic resistance of 51 clinical isolates of K. pneumoniae was determined to amoxicillin, amikacin, ceftazidime, cefotaxime, cefteriaxon, ceftizoxime, gentamicin, ciprofloxacin and nitrofurantoin by disc diffusion. Minimum inhibitory concentrations were also measured for ceftazidime, cefotaxime, cefteriaxon, ceftizoxime and ciprofloxacin. ESBL production was detected by the double disc synergy test and finally, presence of the blaSHV, blaTEM and blaCTX-M genes were shown using specific primers and PCR. Disc diffusion results showed that 96.08 % of the isolates were resistant to amoxicillin followed by 78.43 % resistance to nitrofurantoin, 49.02 % to amikacin and ceftazidime, 41.17 % to ceftriaxone, 37.25% resistance to cefotaxime and ceftizoxime, and 29.42 % to gentamicin and ciprofloxacin. Both resistant and intermediately resistant organisms were resistant in MIC determinations. Twenty two isolates (43.14%) carried blaSHV, 18 (35.29%) had blaTEM and 16 (31.37%) harbored blaCTX-M genes. ESBL production was present in 14 isolates (27.45 %) of which, 3 did not harbor any of the 3 genes. Among the non- ESBL producers, 9 lacked all 3 genes and 2 carried them all. No relation was found between gene presence and ESBL expression.

«Travel broadens the mind» and people have been extolling the merits of travel for a very long time. The general belief is that travel is good for travelers'' mentally and physically. But while travel can indeed be interesting and exciting, and good for mental and physical wellbeing, all too often it can be harmful to a traveler''s health (1). The increase in numbers of travellers and the speed at which they travel has not only had economic, cultural, and social repercussions, but medical, epidemiological, and medico-legal consequences as well. Travel medicine or Emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers (2). «The art of travel medicine is selecting the necessary prevention strategy without unnecessary adverse events, cost or inconvenience» (3). Travel health advice is primarily aimed at prevention, and is therefore offered before travel. It includes steps taken before travel like Medical examinations and screening, Psychological preparation, Provision of a medical kit, First aid training, Preventive measures for prevention of thermal injury, Insure and plan for aeromedical evacuation and repatriation, Advice regarding accidents and related hazards, Special provisions for specific travel hazards and Protection against tropical diseases. There is also an aspect of travel health which is provided after return from travel, which is usually diagnostic (4, 5). Giving adequate advice on travel health requires a good knowledge about local health hazards overseas, public health measures, and the effectiveness of immunization and prophylaxis. In summary, travel medicine will be established as an interdisciplinary special discipline in the next years and will be characterized by new risks and on the other hand by new methods of therapy and prophylaxis.