Iranian Journal of Public Health
Volume:41 Issue: 11, Nov 2012

An explosion of research has been done in discovering how human health is affected by environmental factors. I will discuss the impacts of environmental cancer causing factors and how they continue to cause multiple disruptions in cellular networking. Some risk factors may not cause cancer. Other factors initiate consecutive genetic mutations that would eventually alter the normal pathway of cellular proliferations and differentiation. Genetic mutations in four groups of genes; (Oncogenes, Tumor suppressor genes, Apoptosis genes and DNA repairing genes) play a vital role in altering the normal cell division. In recent years, molecular genetics have greatly increased our understanding of the basic mechanisms in cancer development and utilizing these molecular techniques for cancer screening, diagnosis, prognosis and therapies. Inhibition of carcinogenic exposures wherever possible should be the goal of cancer prevention programs to reduce exposures from all environmental carcinogens.

To glean insights into the relationship among hepatitis B virus (HBV) genotype/subgenotypes, A1762T/G1764A mutations and advanced liver disease such as liver cirrhosis (LC) and hepatocellular carcinoma (HCC) in Southeast China. A case-control study was performed, consisting of chronic hepatitis B (CHB) patients (n=160), LC patients (n=150), and HCC patients (n=156). Fluorescence quantitative polymerase chain reaction (FQ-PCR) was used to detect A1762T/G1764A mutations. HBV genotypes/subgenotypes were determined by multiplex PCR. All patients'' clinical data was systematically collected from the hospital records. Our study revealed HBV genotypes C (63.95%) and B (33.69%) were predominant in chronically infected patients, subgenotype B2, C2 and C1 were the major subgenotypes. Both subgenotype C2 infection and A1762T/G1764A mutations were associated with LC and HCC with cirrhosis, subgenotype C2 (OR=2.033, 95%CI=1.246-3.323, P=0.003 for LC vs CHB; OR=3.247, 95%CI=1.742-6.096, P=0.001 for HCC with cirrhosis vs CHB; respectively), and A1762T/G1764A mutations (OR=1.914, 95%CI=1.188-3.085, P=0.005 for LC vs CHB; OR=2.996, 95%CI=1.683-5.353, P=0.002 for HCC with cirrhosis vs CHB; respectively), but no differences in the frequencies of both variants between LC and HCC with cirrhosis groups were found. HBV subgenotype C2 infection and A1762T/G1764A mutations are both risk factors of LC and HCC with cirrhosis development in the patients with CHB in Southeast China, but all no helpful for predicting HCC development in LC patients.

The acceptance of HIV testing among patients with tuberculosis (TB) is low in South Africa. The aim of this study was to assess the prevalence, associated factors and reasons of non-uptake of human immunodeficiency virus (HIV) testing by tuberculosis public primary care patients in three districts, South Africa. In May-October 2011, this cross-sectional survey was conducted amongst 4726 TB patients across 42 primary health care facilities in three districts in South Africa. All new TB and new retreatment patients (N=4726) were consecutively interviewed within one month of anti-tuberculosis treatment. The outcome was self-reported HIV testing after TB diagnosis, validated using clinic registers. Almost one in ten (9.6%) of the 4726 participants had not undergone HIV testing, with the most often offered explanation being that they were not knowing where to get tested (21.3%), followed by believing not to have or at risk for HIV (24.3%), emotional concerns (not ready for test: 13.2%; afraid to get to know: 12.1%; concerns over confidentiality: 6.3%) and concerns about stigma (3.3%) and losing the job (2.0%). In multivariable analysis being male, severe psychological distress, having sex with someone HIV negative or unknown and frequency of sex without a condom were associated with not having been tested for HIV. The level of HIV testing among TB public primary care patients was suboptimal, as per policy all patients should be tested. The South African Department of Health should continue to scale-up HIV testing and other collaborative TB-HIV services at health facilities.

Soil is well known to support the transient or ongoing existence of keratinophilic fungi and potential source of infection for human and animals. Samples were collected from 67 sites of university campus like PG study centers, playgrounds, gardens, hostels, administrative blocks, library, bank, canteen and road side for the estimation of keratinophilic fungi using the hair baiting technique. Totally, 192 isolates belonging to 14 genera and 21 species were reported. Soil pH range varies from 6.5 to 9.0 pH. Most of the fungi isolated from neutral to slightly alkaline soil. Chrysosporium tropicum (20.83%) was the most predominant fungi reported from all sites. Trichophyton mentagrophytes (15.10%) was the second most commonly reported fungi. Chrysosporium indicum (11.45%), T. simii (9.37%), C.evolceanui (8.83%) T. terrestre (4.68%) and Cephaliophora irregularies (4.68%) were frequently reported. Microsporum audouinii, Paceliomyces sp., Cladosporium sp. and Sporothrix schenckii were isolated for the first time from Jaipur. Road sides were found most suitable for the occurrence of all most all keratinophilic fungi. Higher incidence of keratinophilic fungi was found in hostel sides followed by road sides, PG study centers and play grounds.

In order to provide guidance on the efficient allocation of health resources when handling public health emergencies in the future, the study evaluated the H1N1 influenza prevention and control program in Hubei Province of China using cost-benefit analysis. The costs measured the resources consumed and other expenses incurred in the prevention and control of H1N1. The assumed benefits include resource consumption and economic losses which could be avoided by the measures for the prevention and control of H1N1. The benefit was evaluated by counterfactual thinking, which estimates the resource consumption and economic losses could be happened without any measures for the prevention and control, which have been avoided after measures were taken to prevent and control H1N1 in Hubei Province, these constitutes the benefit of this project. The total costs of this program were 38.81 million U.S. dollars, while the total benefit was assessed as 203.71 million U.S. dollars. The net benefit was 164.9 million U.S. dollars with a cost-effectiveness ratio of 1:5.25. The joint prevention and control strategy introduced by Hubei for H1N1 influenza is cost-effective.

Many alternative interventions are practiced in an effort to reduce symptoms of fibromiyalgia. The aim of this study was to determine the effects of sleep and touch therapy accompanied by music and aromatherapy on the symptoms of fibromyalgia and depression. The study was carried out between September 2009 and March 2011 in the Physical Medicine and Rehabilitation Polyclinic in Trabzon, Turkey. The sample consisted of 162 female patients and had been diagnosed with fibromyalgia at least 6 months prior to the study. Since the sample contains two intervention groups and one control group, each group was assigned 54 patients. Data were collected through a Personal Information Form, a Fibromyalgia Symptom Form and the Beck Depression Index. The study employed a pre-test/post-test control group design. A paired sample t-test was used in the comparisons of the in-group scale points; the chi-square in the intergroup comparisons, and the McNamer test in the in-group comparisons. After the interventions, it was observed that the depression levels in the touch-music-aroma therapy group showed a larger decrease (before: 22.01±5.3; after: 14.52±3.7) than in the sleep-music-aroma therapy group (before: 24.81±5.1; after: 20.16±4.9) and control groups (before: 23.73±4.4; after: 21.05±2.6). Symptoms such as restless sleep, headache, morning fatigue, exhaustion, feeling like crying and bowel complaints were also significantly reduced (P<0.05). It is suggested that nurses providing healthcare to FMS patients should also offer these patients aromatherapy, sleep, music and touch therapies.

This study was conducted to develop a questionnaire in order to evaluate knowledge, attitude and practice (KAP) of the faculty members and students toward plagiarism. A KAP study was conducted from June to October 2011 enrolling 390 volunteers anonymously (response rate 96%). The questionnaire included the following four parts: (a) general characteristics like gender, academic degree and education level; (b) nine questions regarding knowledge (Min=0, Max=9); (c) nine questions regarding attitude (Min=9, Max=27); and (d) eight questions regarding practice (Min=0, Max=8). A pilot study was conducted to assess reliability of the questions regarding knowledge and attitude. Cronbach''s alpha coefficient for the knowledge and attitude questions was 0.70 and 0.74 respectively. The overall prevalence of at least once plagiarism commission was 38% (SD=0.035). The overall mean score of knowledge, attitude and practice was 5.94 (SD=1.66), 24.12 (SD=2.99), and 0.66 (SD=1.15) respectively. Knowledge of plagiarism was significantly higher among higher academic degrees and females. Their negative attitude toward plagiarism was stronger too. No statistically significant difference regarding plagiarism commission was observed among different academic degrees in both sexes. According to linear regression analysis, plagiarism commission decreased 13% per one unit increase in score of knowledge (P=0.005) and 16% per one unit increase in score of attitude (P<0.001). This knowledge, attitude, and practice (KAP) questionnaire was developed as a standard tool in order to assess perception of subjects toward plagiarism and to estimate the prevalence and the type of plagiarism commission.

Lack of information regarding biochemical changes in women during labor and its outcomes on maternal and neonatal health still is an unanswered question. This study aims to explore the effectiveness of oral carbohydrate intake during labor on the duration of the active phase and other maternal and neonatal outcomes. A parallel prospective randomized controlled trial, conducted at the University Affiliated Teaching Hospital in Gonabad. Totally, 190 women were randomly assigned to an intervention (N=87) or control (N=90) group. Inclusion criteria were low-risk women with singleton cephalic presentation; and cervical dilatation 3-4 cm. Randomization was used by random number generator on every day. Odd numbers was used for intervention and even numbers for control group. Intervention was based on the preferences between: 3 medium dates plus 110 ml water; 3 dates plus 110 ml light tea without sugar; or 110 ml orange juice. The protocol is only run once but women ate and drank gradually before second stage of labor. Control group were fasted as routine practice. Neither participants nor care givers or staff could be blinded to group allocation. Differences between duration of the active phase of labor were assessed as primary outcome measure. There was significant difference in the length of second stage of labor (P <.05). The effect size for this variable was 0.48. There were no significant differences in other maternal and neonatal outcomes. Oral intake of carbohydrate was an effective method for shortening the duration of second stage of labor in low-risk women.

Thalassemia is the most common monogenic disease in South-East of Iran. Despite the 70% reduction in Iranian thalassemia cases after thalassemia control comprehensive program، 601 affected babies were born in Sistan and Balouchistan Province، Iran from 2002 to 2010، so this study aims at investigating the causes of new thalassemia cases. Data from this retrospective cross-sectional study was collected through interviews and information in the patients'' hospital records. Data revealed that 52. 4% of fathers and 78. 4% of mothers of thalassemic children had elementary education or less. In addition، 78. 6% of the couples did not undergo premarital screening for thalassemia and 71. 2% of the couples were not notified of their own minor thalassemia until a child was born with major thalassemia. Of the diagnosed minor couples، about 25% did PND and the others did not carry out because mothers were unaware of proper gestational age and of the importance of this issue، financial problems، and the husbands'' disagreement to take the tests. Moreover، 16 mothers، in spite of being diagnosed of having a major fetus، refused to terminate the pregnancy. The most preventable causes for affected births include couples'' unawareness of being minor and unawares of the PND importance and process.

Crimean Congo Hemorrhagic Fever (CCHF) is an acute febrile haemorrhagic disease. This study was conducted to ascertain the infection status amongst slaughterhouse workers in Iran''s north-eastern provinces (Razavi and northern and southern Khorasan), so that analysis of the results could help clarification of the epidemiology of this disease in the aforementioned provinces and eastern regions of Iran. In this cross-sectional study, conducted in 2004 and 2005, 108 slaughterhouse workers from 24 cities of the three previously mentioned provinces were randomly entered into the study. An IgG specific ELISA test was carried out on the participants'' serum samples. Sixteen out of 108 (14.8%) participants under study were shown to have IgG against CCHF. The highest rate of infection was seen in Razavi Khorasan and southern Khorasan at 17.5% and 16.7%, respectively. The study showed a relatively high frequency of this disease amongst slaughterhouse workers in these provinces. Taking into account the small number of reported cases from these provinces, it would seem that more focus is required on primary diagnosis and on referral of suspected patients.

Quality of life in post-menopausal women and menopausal symptoms are closely related concepts. Influence health education policy in order to promote health and adopt a menopause lifestyle requires alternative strategies, including health training programs with community - based interventions. The current study aims to survey the effects of support groups on quality of life of post-menopausal women. A blind field trial (2010) was conducted at Saadatmandii Clinical Center (Robat Karim, Iran). 110 women were selected randomly divided into test and control groups (consisting of 55 ones). Menopause specific quality of life questionnaire (MENQOL) was used for evaluation of life quality before and three months after intervention; there was no intervention in the control group. Data were analyzed by using SPSS/16. Qualitative variables were analyzed using chi-square tests and quantitative variables were analyzed using Mann-Whitney and Wilcoxon test, paired T-test and independent t-test. There was significant difference between vasomotor, psychosocial, physical, sexual aspects and life quality of this group pf women (P<0.001). There was no statistically significant difference in the quality of life of women in control group. According to the results method of support group can lead to improved quality of life for post-menopausal ones and it can be appropriate healthcare policy to promote health and improve life quality of this group of women.

The aim of this study was assessment the risk management status of waste anesthetic gases in academicals hospitals in Iran to prevent from harmful effects of these gases on employees'' health. A descriptive-analytic study was designed in 2011. Standard structured checklist developed by ECRI institute (Emergency Care Research Institute) was applied. Checklists were filled onsite through direct observation and interviews with anesthesia personnel in 46 operating rooms at 4 hospitals from all of the hospitals under affiliation of Isfahan University of Medical Sciences. These hospitals were selected based on the number of surgical beds. Total means score of WAGs risk management status was 1.72 from the scale of 3. In the studied operating rooms, only 28% complied with predetermined standards, 16% needed improvement and 56% had no compliance. Total mean scores of compliance in planning, training and evaluation and monitoring of waste anesthetic gases were weak and equipment and work activity was at medium level. The risk management status of waste anesthetic gases in the hospitals to be weak, therefore operating room personnel are exposed to medium to high level of these gases. The hospital mangers should prepare and apply scavenging equipment, development of control program, quality improvement, risk management and maintenance of anesthesia equipment. Finally, ongoing monitoring and evaluation, education to personnel and modification of policy and procedures and improvement of work activities should be considered.

To study the outcome of cases with nuchal translucency (NT) ≥ 95th centile in the first trimester of pregnancy. This cross sectional study was performed at Iranian Fetal Medicine Foundation (FMF) between January 2009 and December 2011. Totally, 186 cases with NT≥ 95th centile who attended for the first trimester screening were studied. All cases with increased NT including those with normal karyotype were followed up with anomaly scan at 18-22 weeks and fetal echocardiography at 22-24 weeks. Pregnancy outcome was extracted from delivery records and pediatrics notes and telephone interviews. Of screened cases, 186 fetuses had an NT≥95th centile, of them 19.8% were abnormal karyotype, including 29 cases of trisomy 21, three of trisomy 18, two of trisomy 13, three of Turner syndrome. 77.8% did not show any abnormalities on follow-up examinations. 4.6% of cases were found to have malformation antenatally and 4% cases postnatally. 11.4% women elected termination of pregnancy without further follow up. There were 4.6% fetal loss and 1.3% hydrops fetalis. In this unselected population, the study showed one out of four fetuses with enlarged NT had an adverse pregnancy outcome (miscarriage, fetal loss, and fetal abnormalities), however the chance of having a normal child after exclusion of chromosomal abnormalities and adverse pregnancy outcome was 95%.

In the modern medical era it has been known as well that physical activity and exercise are important factors to prevent from different chronic diseases. Scientifically, there are numerous evidence based studies about protective role of exercise against chronic diseases such as cardio- respiratory diseases, diabetes, and hyperlipidemia etc, which have been completely explained. Historically, ancient physicians such as Avicenna had described this topic several hundred years ago. However, ancient principles of medicine are too different in comparison with modern medicine and description of diseases which Avicenna has talked about them and their managements are too much different, yet reviewing the protective role of sports and physical activity in his masterpiece, «The Canon of Medicine», reveals that Avicenna has made a significant contribution to the evolution of following knowledge. The present review discusses Avicenna''s opinion about protective role of exercise against some diseases through a comparison with modern medical views and also emphasizes aspects that need further investigation for these opinions to be useful in clinic in the future.