Iranian Journal of Public Health
Volume:42 Issue: 11, Oct 2013

Adolescence is an important stage of human life span, which crucial developmental processes occur. Since peers play a critical role in the psychosocial development of most adolescents, peer education is currently considered as a health promotion strategy in adolescents. Peer education is defined as a system of delivering knowledge that improves social learning and provides psychosocial support. As identifying the outcomes of different educational approaches will be beneficial in choosing the most effective programs for training adolescents, the present article reviewed the impact of the peer education approach on adolescents. In this review, databases such as PubMed, EMBASE, ISI, and Iranian databases, from 1999 to 2013, were searched using a number of keywords. Peer education is an effective tool for promoting healthy behaviors among adolescents. The development of this social process depends on the settings, context, and the values and expectations of the participants. Therefore, designing such programs requires proper preparation, training, supervision, and evaluation.

In this cohort study, we investigated the background factors promoting and inhibiting a return to work after long-term absence from work due to sickness among psychiatric outpatients. We surveyed 73 psychiatric outpatients who were absent from work for a long time (POAWs), and 42 POAWs who were followed up until the 2-year time point. GHQ-30, NEO-FFI, MPS, RSS and questionnaires inquiring about background factors, including relationships with others, were used, and the data were compared those who had returned to the work by the 2-year time point with those who had not. Factors promoting a return to work were “extroversion (NEO-FFI)”, “organization (MPS)”, and “neuroticism (NEO-FFI)”, whereas “concern over mistakes (MPS)” was an inhibitory factor. Period of absence from work was markedly associated with psychological stress outside the workplace, while depression, anxiety, and even psychological stress inside the workplace were not. POAWs left from work by the result of psychiatric problems like depression, anxiety and so on. These were the result of their background factors, their characteristics, and psychological stress in/outside the workplace. After two-year psychiatric treatment, their psychological stress outside the workplace remained as an essential matter. These were inescapable because they were set in private place, while stress at the workplace could be left at the workplace.

To determine the normal ranges of serum age-related prostate-specific antigen (PSA) level in men from Beijing area without cancer. In this cross sectional study, form April 2010 to October 2011, 1611 healthy men undergoing a routine health check-up in our hospital and all men received three examinations including serum PSA test, digital rectal examination and transrectal ultrasound. Men with any two abnormal results of the three examinations were undergone a prostate biopsy. Men with any two normal results of the three examinations or with negative biopsy were defined as men without cancer. Men with a prior history of prostate cancer/surgery or with urinary tract infection/obstruction were excluded. 1572 men without cancer were recruited into the study finally and were stratified into 10-year age groups: 40 to 49, 50 to 59, 60 to 69, 70 to 79, and older than 80. The median PSA value (95th percentile range) was 0.506（1.565）, 1.04（2.920）, 1.16（4.113), 1.34（5.561)and 2.975 (7.285) for each age group respectively, and the 25th percentile to 75 percentile was 0.343 to 0.923, 0.663 to 1.580, 0.693 to 2.203, 0.789 to 2.368 and 1.188 to 4.295 respectively. The serum PSA value is directly correlated with age (r=0.314, P＜0.001). Use the age-related range for PSA increases the sensitivity in younger men and decreases the biopsy rate in older patients.

The current study aims to measure the efficiency of primary health care units completed in health sector of rural Azad Jammu and Kashmir (AJK) and to compare it across developed and deprived regions. Operational efficiency and beneficiary efficiency of a total of 32 Basic Health Units (BHUs) were measured through Data Envelopment Analysis (DEA) by using different input and output variables. Independent sample T-test was applied to compare these efficiencies across developed and deprived regions. The study could find no significant difference of operational efficiency across developed and deprived regions, however a significant difference was found across regions from beneficiary perspective (P= 0.044). The study concludes that BHUs of deprived region are more efficient from beneficiary perspective, however there is no significant difference of operational efficiency across the regions.

Data regarding the effects of dietary protein on modifying serum lipid and lipoprotein levels are controversial. In this study we have investigated the hypothesis whether dietary protein and protein to carbohydrate ratio could be related to subsequent changes in lipid profile in adults. This 3-yaers follow-up longitudinal study was conducted on a sample of participants (845 men and 1043 women, aged 19-70 years) of the Tehran Lipid and Glucose Study. Dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire. Anthropometric and serum lipid and lipoprotein levels were measured both at baseline (2006-2008) and after 3 years. After adjustment for potential confounding variables and dietary factors, the highest quartile energy intakes from protein was inversely associated with changes in total cholesterol (β= -6.5; 95% CI= -11.5, -1.5) and HDL-C levels (β= -6.7; 95% CI= -12.2, -1.4) in men during the follow-up. Increased proportion of energy intake from protein, compared to that of carbohydrate also had favorable effect on 3-years changes in triglycerides (β= -18.2; 95% CI= -36.7, -0.1) and total cholesterol (β= -8.4; 95% CI= -15.1, -1.8) in men. Higher dietary P/C ratio (median ≥ 0.23) was associated with a significant decrease in serum total cholesterol at 3-years follow-up in men with the higher intake of protein (median ≥ 13.4 % of energy). Higher intakes of dietary protein and more importantly, higher proportion of energy intakes from protein, compared to carbohydrate, had favorable effects on modifying lipid levels during a 3-year follow-up.

TGIFLX, a Homoproteins cluster member located on the X chromosome, has a critical role in male reproduction and prostate development. Previous studies have shown the erratic expression of TGIFLX gene in a large proportion of prostate tumors. However TGIFLX function in prostate development remains unknown. The purpose of this study was to evaluate the consequences of TGIFLX expression on prostate cancer cell lines (LNCaP). Inducible Tet-On gene expression system was used with a regulatory capability by doxycycline induction. In this system, stable LNCaP cells with TGIFLX tet-on plasmid were able to induce TGIFLX expression by doxycycline treatment. TGIFLX gene expression was confirmed by RT-PCR. Induction of gene expression caused cell proliferation decrement and apoptosis increment in LNCaP TGIFLX cells compared with control cells (P<0.01). Also, by using PEGFPN1 plasmid protein in this study localization was shown in nucleus. The gene was cloned in the plasmid and transfected to LNcap cells with plasmid PEGFPN1 TGIFLX and the plasmid was PEGFPN1. The TGIFLX expression was confirmed by RT-PCR and fluorescent microscopy. TGIFLX expression demonstrated a tumor suppressor characterization in a prostatic cancer cell line with low grade of tumorigenicity (LNCaP). More cell lines with different level of tumorogenicity need to be investigated for further clarification of the TGIFLX gene function.

Late-onset Alzheimer''s disease (AD), a genetically heterogeneous neurodegenerative disorder, is the most common form of dementia in people over 65 years old. The role of vitamin D in neuropsychiatric and neurodegenerative disorders such as AD has been supported by epidemiologic investigations and animal models, as well. We examined the association of the vitamin D receptor (VDR) gene polymorphisms and late-onset AD in an Iranian population. This study was performed in Tehran, Iran from 2007 to 2008. Totally, 145 AD patients and 162 age-matched unrelated healthy controls were included. The genotype and allele frequencies for the VDR polymorphisms, ApaI (G>T; rs7975232) and TaqI (C>T; rs731236), were determined in the case and control subjects PCR-RFLP analysis. Logistic regression analysis was performed to assess the effect of mutant genotype or allele in the study groups. The statistical analyses showed significant differences neither in genotype nor in allele frequencies of the ApaI and TaqI polymorphisms between the case and control groups. It seems that the ApaI and TaqI polymorphisms are not associated with the risk of late-onset AD in Iranian population.

Awareness of hyperdontia pattern/prevalence can be useful in early diagnosis and prevention by general practitioners, pediatric dentists, and orthodontists. Since the previous results regarding the pattern of hyperdontia (supernumerary teeth) are controversial, this study aimed to assess this subject among Iranian orthodontic patients. All approved panoramic radiographs of 3374 orthodontic patients (aged 10 to 20 years old) who had visited orthodontic departments of all Tehran dentistry universities and 10 private clinics during the years 1999-2009 were investigated to establish the prevalence/pattern of hyperdontia in permanent dentition (excluding third molars). The data were analyzed using a chi-square, a chi-square goodness-of-fit, and a Fisher exact test (α = 0.05). Of the patients, 2012 were female and 1362 were male. The prevalence of hyperdontia was 0.72% (14 females [0.69% of females], 10 males [0.73% of males], female-to-male ratio = 1:1.055). The difference between the genders was not significant (P = 0.896). No double or multiple supernumeraries were found. The most common accessory teeth were mesiodens (58.3%), maxillary laterals (25%), and maxillary premolars (16.7%). Hyperdontia was significantly more common (P = 0.000) in maxilla (there was only one mandibular accessory tooth). It was more frequent in the anterior segment (P = 0.000). However the occurrence was not significantly different between bimaxillary right and left quadrants (P = 0.6). Hyperdontia was more common in premaxilla, and the most common accessory tooth was mesiodens. Unlike earlier studies, no bilateral accessory teeth were found. Also no gender dimorphism was discerned.

Depression disorders are associated with serious dysfunction and depressive symptoms. Cognitive slowing is a clear symptom observed in all depressed people. PVSAT is a measure of cognitive function that specifically assesses visual information processing speed and flexibility, as well as calculation ability. The aim of the present study was to determine whether the Paced Visual Serial Addition Test (PVSAT) might constitute a useful procedure for assessing cognitive functions in depressive disorder. Twenty – eight depressed patients, together with fourteen healthy control (HC) subjects participated in the study. All participants performed the PVSAT and a set of clinical tasks assessing information processing speed, working memory and executive functions. Compared with the HCs, the depressed patients were significantly impaired in their performance of the PVSAT. Significant impairment (compared with controls) was also evidenced by only one of the clinical tasks – the symbol coding task, which assesses information processing speed. Our results demonstrate the high sensitivity of the PVSAT to cognitive impairment. However, correlation analyses showed that the main factor explaining the depressed patients PVSAT impairment was cognitive slowing.

The centralization of human activities is associated with different pollutants which enter into environment easily and cause the urban environment more vulnerable. Regarding the importance of air pollution issue for Tehran metropolis, many plans and regulations have been developed. However, most of them failed to decline the pollution. The purpose of this study was to pathologically analyze air-pollution control plans to offer effective solutions for Tehran metropolis. A Qualitative content analysis in addition to a semi-structured interview with 14 practicing professional were used to identify 1) key sources of Tehran’s air pollution, 2) recognize challenges towards effective performance of pertinent plans and 3), offer effective solutions. Related challenges to air-pollution control plans can be divided into two major categories including lack of integrated and organized stewardship and PEST challenges. For controlling the air pollution of Tehran effectively, various controlling alternatives were identified as systematization of plan preparation process, standardization and utilization of new technologies & experts, infrastructural development, realization of social justice, developing coordination mechanisms, improving citizens'' participatory capacity and focusing on effective management of fuel and energy.Controlling air pollution in Tehran needs a serious attention of policymakers to make enforcements through applying a systemic cycle of preparation comprehensive plans. Further, implement the enforcements and evaluate the environmental impact of the plans through involving all stakeholders.

Childhood obesity and overweight are a general public health concern in a transition society. Thus, the objective of the study was to determine the prevalence of overweight, obesity and their correlates with socio-demographic and life style related factors. This cross-sectional study was conducted on 760 representative samples of preschool children aged 2 to 5 years in urban area of Babol, northern Iran. The weight and height were measured with standard method and the socio-demographic and life style data were collected by interviewing their parents. The diagnosis of overweight and obesity was based on CDC criteria. The prevalence rate of overweight and obesity were 11.8%, 15% respectively. There was no significant difference observed between sexes. The odds of overweight/obesity was elevated more than double in age 4-5 years compared with 2-3 years(OR=2.53, 95%CI:1.71-3.73). By parental education at university level, the odds ratio significant decreased compared with primary level (OR=0.34, 95%CI: 0.31-0.90 and OR=0.49, 95%CI: 0.34-0.98 for mothers and fathers respectively). Parental obesity is positively associated with overweight/obesity risk OR=2.67(95%CI: 1.75, 4.07) and 1.61(95% CI: 1.04-2.150) for mothers and fathers respectively). While spending ≥2 hours per day for Tv watching and ≥1 hours for playing with computer games tended to elevate the risk but not significant. The findings indicate that overweight and obesity are high in preschool children in Babol. Increasing child age, parental obesity, spending more times on TV and playing with computer games are positively associated with overweight/obesity while parental education at university level is inversely associated.

Since establishing a safety culture in an organization is considered as the first step in patient safety improvement, there is always a need for updated field evaluation to better plan future decisions. We performed a cross-sectional, analytic-descriptive study in 25 hospitals related to Mashhad University of Medical Sciences (MUMS) during a 3-month period from April to June 2012. A questionnaire, designed by previous patient safety culture studies with confirmed validity and reliability, was used and distributed among a sample of 922 staff, chosen randomly from the mentioned hospitals. Data were analyzed by SPSS software version 16. “Organizational learning - continuous improvement” and “teamwork within unit” had the highest percentage of positive results as 79.85 ± 12.03% and 71.92 ± 17.08%, respectively; whereas “non-punitive response” to errors (21.57 ± 6.42) and “staffing” (26.36 ± 16.84) came out as the least important factors. There were no meaningful statistical relation between general features of the understudy hospitals including the number of beds, educational level or proficiency status with the general safety culture score. Most of the safety culture aspects were reported as low to moderate in terms of importance. If something needs to be modified interventionally in this respect, “the approach to confront errors” would be a wise choice. This could be achieved by establishing an atmosphere of open communication and continuous learning through elimination of the fear for reporting errors and installing a more acceptable approach in hospitals.

Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution. This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators. The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again. Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists’ distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.

Intervention in early childhood development as one of the social determinants of health, is important for reducing social gap and inequity. In spite of increasingly developing intensive neonatal care wards and decreasing neonatal mortality rate, there is no follow up program in Iran. This study was carreid out to design high risk infants follow up care program with the practical aim of creating an model action for whole country, in 2012. This qualitative study has been done by the Neonatal Department of the Deputy of Public Health in cooperation with Pediatrics Health Research Center of Tabriz University of Medical Sciences, Iran. After study of international documents, consensus agreement about adapted program for Iran has been accomplished by focus group discussion and attended Delphi agreement technique. After compiling primary draft included evidence based guidelines and executive plan, 14 sessions including expert panels were hold to finalize the program. After finalizing the program, high risk infants follow up care service package has been designed in 3 chapters: Evidence based clinical guidelines; eighteen main clinical guidelines and thirteen subsidiaries clinical guidelines, executive plan; 6 general, 6 following up and 5 backup processes. Education program including general and especial courses for care givers and follow up team, and family education processes. We designed and finalized high risk infants follow up care service package. It seems to open a way to extend it to whole country.

Autism is a complex neuropsychiatric disorder that manifests in early childhood. Although the etiology is unknown yet but, new hypothesis focused on identifying the key genes related to autism may elucidate its etiology. The main objective of the present study was to verify the value of karyotyping in autistic children and identifying association between chromosome abnormalities and autism. We examined the peripheral blood lymphocytes cell culture for cytogenetic alterations by GTG-banding technique. The investigation was carried out on 50 autistic patients referred by Pediatric neurologist to Cytogenetic Laboratory in Khorasan-e-razavi Province, Iran. Using GTG-banding technique, the chromosome analysis of patients identified an unbalanced male karyotype with a r (14) in all 50 metaphases were examined. Since structural abnormalities may have a critical role in the etiology of autism, according to the region where is affected and number of related genes, therefore an outcome with wide spectrum of clinical manifestations could be expected. Furthermore by considering of recent study, the results indicated that there is an association between chromosome 14 with brain development and neurological disorders, but, in conclusion, it could not be suggested that in order to postulate cytogenetic testing in idiopathic autism patients, specifically screening for chromosome 14 which might has diagnostic value.

A case of a 40-year-old female, in whom a 6-meter long worm (Taenia saginata) was found in stomach, is reported here. In this patient, T. saginata upward migration of the worm to the stomach, its rare phenomenon, worm mostly seen in the small intestine. This is mainly because of the high gastric acidity. In this patient, we believe proton pump inhibitor (PPI) use caused hypochlorhydria and coexistence H. pylori infection caused chronic atrophic gastritis, which resulted in the retrograde migration of the tapeworm to the stomach in our patient.