Iranian Journal of Public Health
Volume:42 Issue: 7, Jul 2013

Participation in clinical trials can be useful for the health of a person, in who it is conducted, but it does not have to be – it can even be harmful. Therefore, primary motive to accept such risk is humanity and human wish to contribute to the progress of medicine; this is expressed by personal consent. The consent, however, can be an expression of personal humanity, and for this, it is not logical that someone can give consent on behalf of someone else, as it is done by a legally authorized representative on behalf of a minor. Therefore, authors raise 3 questions: What are the reasons to consider representative''s consent acceptable? How should a model of regulations look like in order to provide the most complete possible protection to a minor? Is actual regulation of minors'' position within international and Serbian law, analyzed here by authors for their specific solutions, acceptable? Representative''s consent is acceptable only for therapeutic research, because these can bring benefits to everyone''s health, including a minor in which those are conducted – this is an acceptable (secondary) motive of participation in the research. Expression of humanity on other''s behalf, typical for non-therapeutic research, is not acceptable; this makes ban of minors'' participation in non-therapeutic research more appropriate regulation model. International regulations are not in accordance to results presented in the paper for allowing participation of minors both in therapeutic and non-therapeutic research. Serbian regulation is closer to the most acceptable regulation model.

In recent years, the main focus of health sector reforms in Iran is the family physician and referral system plan. Fundamental changes in the goals and strategies, has increased the necessity of the need to reform the organizational structure. This study tries to review and summarize all cases about the organizational structure of Iran and its challenges in primary health care system. This study was a systematic review of published and grey literature. We searched the relevant databases, bibliography of related papers, and laws, using appropriate search strategies and key words. The CASP tool was used by two experts to evaluate the quality of retrieved papers and inconsistencies were resolved by discussion. After removal of duplicate citations, a total of 52 titles were identified through database searching, among which 30 met the inclusion criteria. Considering the research quality criteria, 14 papers were recognized qualified, which were categorized into two groups of: articles and policies. The results showed ineffectiveness of the current organizational structure at different level. The majority of the papers recommend performing reforms in the system because of changes in goals and strategies. Also, some suggest an appropriate information system to be designed in the current structures. Centralization and delegation process are the main discussions for the studies. Because of fundamental changes in goals and strategies, reforms in the organizational structure of primary health system in Iran especially in peripheral levels are highly recommended.

In Korea, hypertension has become more prevalent with the Westernization of Korean diets and lack of exercise. This study aimed at investigating the associations between physical fitness variables and hypertension status in Korean women. The subjects were 9,216 women aged >20 years who visited a public health promotion center for physical fitness tests. Cardiovascular respiratory fitness was evaluated using VO2max, resting heart rate (RHR), double product (DP), and vital capacity and coordination-related physical fitness was measured using grip strength, number of sit-ups completed, sit-and-reach score, vertical jump height, number of side steps performed, and 1-leg standing with eyes open. The prevalence rates of prehypertension and hypertension were 30.3% and 12.9% in this study, respectively. After adjusting for age, body mass index, drinking frequency, smoking intensity, and exercise intensity, the odds ratios (95% confidence interval) were calculated, and no statistically significant association was found between hypertension and physical fitness as measured by grip strength (P = 0.056), number of sit-ups completed (P = 0.140), and vertical jump height (P = 0.121). However, significant associations were found between hypertension and VO2max (P < 0.001), RHR (P < 0.001), DP (P < 0.001), vital capacity (P < 0.001), sit-and-reach score (P = 0.012), the number of side steps performed (P = 0.001), and 1-leg standing with eyes open (P < 0.001). We found that all the cardiovascular respiratory fitness variables and half of the motor- and coordination-related physical fitness variables were closely related with hypertension status.

Diabetes type 2 is a world wide spread disease with a multifactorial pathogenetic evolution. Various factors like obesity, physical inactivity and poor lifestyle habits contribute to its development. The aim of this study was to verify if in young healthy sedentary male and female there is positive correlation between family history to type 2 diabetes and an increase in body weight and fat mass, or alterations in basal glycemia values. Totally183 male and 237 female healthy sedentary subjects were analysed in 2012, in Italy. They were divided in three groups: FH+ with first degree family history, FH++with second degree family history and FH- with no family history. Anthropometrics, body composition and blood parameters were assessed. Male had the highest BMI values (P<0.01). FH+ and FH++ had increased waist and hip circumferences and body weight (P<0.005 for men, P<0.0001 for women), body mass index (P< 0.0001 in both sexes), waist-hip ratio (P< 0.05 for men and women) and triceps skinfold (P< 0.0005 for both sexes). Obesity incidence was higher in FH+ and FH++ compared to control groups. The study confirms family history to diabetes type 2 as a risk factor for the development of the illness, mainly in a case of first degree of FH. Preventive interventions are necessary to promote significant life-style changes, such as increased physical activity and controlled quantity and quality of food intake.

Prenatal lead exposure could not only affect various organ systems of the mother, but also provide a plumbeous environment for the fetus and newborns, and may affect the fetus in a number of detrimental ways. The aim of this study was to adequately determine the interaction between these factors and risky behaviors such as smoking. Data from Nanjing Maternity and Child Health Care Hospital survey during the years of 2006–2011 were used (n = 4400) to evaluate the effections of age, parity, body mass index (BMI), race/ethnicity, pregnancy, iron (Fe) storage status and smoking status on the consumption of the levels of blood cadmium (Cd) and lead (Pb) of females aged 16–35yr old. The blood samples were sent to determine blood lead / cadmium concentration by the Inductively Coupled Plasma Mass Spectrometry (ICP-MS). STATA 12.1 software (www. stata.com) was used to fit regression models for each of the two metals. For both of the two metals, age was positively while BMI was negatively associated with the levels of these metals in blood. Smokers showed statistically significantly higher levels of Cd and Pb (P=0.007), while irrespective of race/ethnicity and Fe storage status as compared to nonsmokers. Novel to this study, pregnancy was found to be associated with significantly lower levels of Cd and Pb, while irrespective of race/ethnicity and Fe storage status as compared to non-pregnant females. It is conceivable that pregnancy could thus accelerate clearance of these metals in the blood.

We conducted a study to evaluate efficacy and safety of dimeticone 4%, a lotion with no conventional insecticide activity, to cure lice infection and to prevent spread of infestation/reinfestation by prophylaxis of classmates. The study is carried out between April 2008 and June 2008 in Petranova International Institute in Rome. A total of 131 children, aged 3 to 13 years (median age: 7 years) were included in the study. All participants received treatment with dimeticone 4% that was applied both to children with the infestation, to cure it, and to all classmates, to prevent the spreading of the infestation. They have been controlled after 7 and 30 days from the application of dimeticone. At baseline we found a positivity of lice infestation in 23/131 children (17.6%), whereas 108/131 (82.4%) children were free from lice. After 7 days of treatment with dimeticone 4%, 7/23 (30.4%) positive children still had lice infestation, with a cure rate of 69.6% (16/23). At 30 days 26/131 children (19.9%) were infested: 15 children were lice free at baseline whereas 11 had lice at both evaluations; the cure rate amounted to 52.2% (12/23). The reinfestation rate (percentage of positive children that showed negativity at baseline) was 5.3% (7/131) at 7 days and 11.5% (15/131) at 30 days. The lower reinfestation rate showed in our trial suggests that this approach could be effective in reducing spreading of head lice in small communities. More studies are needed to confirm our findings.

Cholera epidemics have a recorded history in eastern Congo dating to 1971. A study was conducted to find out the linkage between climate variability/change and cholera outbreak and to assess the related economic cost in the management of cholera in Congo. This study integrates historical data (20 years) on temperature and rainfall with the burden of disease from cholera in South-Kivu province, eastern Congo. Analyses of precipitation and temperatures characteristics in South-Kivu provinces showed that cholera epidemics are closely associated with climatic factors variability. Peaks in Cholera new cases were in synchrony with peaks in rainfalls. Cholera infection cases declined significantly (P<0.05) with the rise in the average temperature. The monthly number of new Cholera cases oscillated between 5 and 450. For every rise of the average temperature by 0.35 °C to 0.75 ºC degree Celsius, and for every change in the rainfall variability by 10-19%, it is likely cholera infection risks will increase by 17 to 25%. The medical cost of treatment of Cholera case infection was found to be of US$50 to 250 per capita. The total costs of Cholera attributable to climate change were found to fall in the range of 4 to 8% of the per capita in annual income in Bukavu town. It is likely that high rainfall favor multiplication of the bacteria and contamination of water sources by the bacteria (Vibrio cholerae).The consumption of polluted water, promiscuity, population density and lack of hygiene are determinants favoring spread and infection of the bacteria among human beings living in over-crowded environments.

Medical education & medical profession are among the most challenging and most stressful ones. Anxiety and depression represents an escalating public health problem among medical students. The objective of the study was to determine the prevalence & predictors of anxiety and depression among female medical students in King Abdulaziz University, Jeddah, Saudi Arabia. A cross- sectional study was carried out during 2010-2011. A stratified random sample method was used to select 450 medical students. A confidential, anonymous & self administered questionnaire included Standardized Hospital Anxiety & Depression Scale was used. The mean scores for anxiety and depression were 9.32 ± 3.77 & 6.59 ± 3.62, respectively. There is a positive correlation between anxiety & depression scores (r= 0.52, P< 0.001). Prevalence of morbid anxiety and depression were 34.9% and 14.7%, respectively. Logistic regression analysis revealed that the first predictor of morbid anxiety was depression (adjusted Odds Ratio (aOR) = 3.28; 95% Confidence Interval (CI): 1.85-5.82, P < 0.001). Students complained from condensed academic course, had academic and emotional failures during the 6 months preceded the study were about 2 times more prone to anxiety. Predictors of depression were having anxiety, nationality (being non-Saudi) & having emotional failure. Medical students encountered high rates of anxiety & depression compared to others. Academic problems and major life events were the main predictors. Enhancing faculty preventive & curative mental health services is recommended. Initiation of stress management courses & enhancing academic advising services are required since the start of medical education.

We aimed to verify the issue of the ethics audit and its use in the system of accreditation of hospitals. It presents the results of a survey conducted among hospital managers from Romania. Our article highlights the results of the second part of a research carried out in 2012 on the pertinence and the structure of the ethics audit integrated within the accreditation process of hospitals, according the opinion of the 47 executives and managers involved in the quality management of Romania hospitals. The data have been gathered with the aid of the online questionnaire. An ethics audit integrated within the accreditation process of hospitals should include primarily the respect of the patients’ rights, the good relations of the institutions with its patients and the respect of the moral rights of the employees. The usefulness of this study is due to the fact that it consults precisely those who should really contribute to the creation, application and monitoring of ethical policies and instruments necessary in every hospital which are permanently under the scrutiny of public opinion and confront themselves with the obligation to give a thorough account of their results and spending of the public resources. This study gain consistency as the relevant aspects that could form the structure of a hospital ethics audit are identified with the direct help of the managers responsible for implementing it.

The objectives of this work were to study the association of maternal smoking habits with stillbirths, abortions, neonatal deaths, birth weights, placental weights and the outcomes on the 28th day of life. A questionnaire was developed and completed with the hospitals'' recorded data collected over a period of 5 years from 47,000 babies born in several hospitals in Ontario, Canada. The mothers were classified into four categories: non-smokers, light smokers (less than 10 cigarettes per day), moderate smokers (between 10 and 19 cigarettes per day) and heavy smokers (20 or more cigarettes per day). The population surveyed was of mixed ethnicity from both rural and urban areas. Statistical analysis was performed using the SPSS statistical package. Even the light smoking habit has an effect on the birth weight and the placental weight but for other characteristics, stillbirth, abortion, and the outcomes on the 28th day of life, no significant difference observed between light smokers and non-smokers. While quit smoking must be the ultimate goal for any smoker, the present study concludes that moderate and heavy smokers, if they will not be able to quit, they should reduce their number of cigarettes per day to at least the level of light smokers to achieve the same results for non-smokers. All characteristics show significant difference between non-smokers and moderate and heavy smokers.

Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran.Methodos: This paper is a study of comparative type which has been written in three stages: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country.

Diabetes is a major health problem worldwide. Type II diabetic patients are reported to have higher ferritin and lower vitamin C concentrations. Considering the role of ascorbic acid in carnitine biosynthesis and the limited information on free carnitine correlations with ferritin and vitamin C levels in diabetic patients without microvascular complications, this case-control study was conducted to determine ferritin and vitamin C levels in hyperlipidemic-diabetic men comparing to healthy controls; the correlation of free carnitine with ferritin and vitamin C levels were also studied in these patients. Thirty-five hyperlipidemic-diabetic and seventy healthy men, were included in the study by the convenience sampling method. Body Mass Index, blood pressure, fasting blood glucose, lipid profile, ferritin and vitamin C levels were assessed in both case and control groups; moreover, serum free carnitine was measured in both groups. Dietary assessments were performed using 24 hour recall and food frequency questionnaires. Blood pressure, fasting blood glucose, cholesterol, triglyceride, LDL, and HDL concentrations were significantly higher in the case group. Mean serum ferritin concentrations were higher in diabetics comparing to controls (93.22±0.27 vs. 44.66±4.23 µg/l); whereas, mean plasma vitamin C in these patients were lower than the healthy subjects (0.68±0.07 vs. 0.89±0.05). Positive correlations were observed between free carnitine and vitamin C levels. According to the results, it could be suggested that vitamin C supplementation in diabetic patients with hyperlipidemia might be useful. In addition, inclusion of serum ferritin assay in routine evaluation of diabetic patients could be beneficial.

The CD1 family is less variable transmembrane antigen presenting molecules related to the MHC molecules. CD1a and CD1e genes are the most polymorphic ones associated with autoimmune diseases. The aim was to better clarify the map of CD1 genes in Southwest Iranian normal population for implications in vaccine design. In this study we investigated the polymorphism of CD1a, CD1d and CD1e in 311 healthy individuals from Fars Province in Southwest of Iran by PCR-SSP method. Six of individuals had homozygote CD1a 01/01 genotype and 248 had homozygote CD1a 02/02 genotype. CD1d was found to be monomorphic with all tested individuals showing CD1d 01/01 genotype. Hundred and eleven individuals had homozygote CD1e 01/01 genotype and 48 had homozygote CD1e 02/02 genotype. The frequencies of CD1a 01 and CD1a 02 alleles were 11% and 89% while the frequencies of CD1e 01 and CD1e 02 alleles were 60.1% and 39.9%, respectively. Consistent with previous reports on other genes, a high degree of similarity in CD1a and CD1e allelic distribution was observed between Southwest Iranians and other Indo-European populations. However, the allelic frequency of the CD1a and CD1e alleles showed a significant difference from those of Chinese Han and She populations. These data are notable in the light of relatively recent genetic admixture along the Silk Road. Considering the significance of CD1 alleles in some autoimmune and infectious diseases and with the admixed nature of Iranian population, mapping the distribution of CD1e alleles in different regions of Iran can be useful in future designing of preventive and therapeutic vaccines.Keywords: