Iranian Journal of Public Health
Volume:43 Issue: 2, Feb 2014

Vascular endothelial growth factor (VEGF)-C, as a lymphangiogenic factor, plays important roles in the progression of several malignancies. However, its clinical prognostic value in breast cancer still remains controversial. We performed a meta-analysis of available studies to assess the association between VEGF-C expression and the outcomes of breast cancer patients We searched eligible studies in three English databases (MEDLINE, EMBASE, and Web of Science) and two Chinese databases (Wanfang and Chinese National Knowledge Infrastructure databases). Key words used in the research included “VEGF-C”, “breast cancer”, “immunohistochemistry”, “breast neoplasma(s)”, “breast carcinoma”, “metastasis”, and “prognosis”. Fourteen studies with a total of 1, 573 breast cancer cases were finally included into the meta-analysis. The pooled odds ratios (ORs) with the corresponding 95% confidence interval (95% CIs) for lymph node metastasis, overall survival, and disease-free survival were calculated by using fixed-effects or random-effects models. Heterogeneity and publication bias were also assessed. Meta-analysis of random-effects model showed VEGF-C expression was associated with lymph node metastasis in patients with breast cancer (random-effects, OR = 2.14; 95 % CI 1.21–3.77, P = 0.009). VEGF-C expression was associated with poorer overall survival (fixed-effects, OR = 2.46, 95% CI: 1.46–4.14, P < 0.001) and disease-free survival (fixed-effects, OR = 2.10, 95% CI: 1.32–3.35, P = 0.002) in patients with breast cancer. VEGF-C expression is positively associated with lymph node metastasis in breast cancer, and VEGF-C detection in breast cancer might be an effective and feasible means to predict outcome.

Self-medication with over the counter (OTC) and non OTC drugs may provoke serious consequences for users and societies. Recognition of its predictors therefore, is pivotal in plans to hinder the aggregating behavior. This study aimed to identify possibly all predictors of self-medication and the range of its prevalence among different populations. Medline, Amed, Scopus, Medlib, SID, Pub Med, Science Direct, and super searcher of Google Scholar were scrutinized using “self-medication”, “self-prescription” and “self-treatment” key words without a time limit with special focus on Iranian studies. Authors independently assessed the title, abstract and full text of identified articles for inclusion and any disagreement was resolved with consensus. The range of reported self-medication in the 70 included publications was 8.5-98.0%. Having a minor illness (15 studies), health care costs (9 studies), lack of adequate time to visit a physician (11 studies), prior experience (7 studies) in using a drug and long waiting time to visit a qualified practitioner (5 studies) were most frequently reported reasons of self-medication. The observed diversity in the reported prevalence and reasons of self-medication among different subgroups of populations (e.g. males vs. females) and between developed and developing countries highlights the importance of explanatory behavioral chain analysis of self-medication in different population groups and countries. Even within a single country, predictors of this harmful practice could be inconsistent. Lack of sufficient quality research to identify precipitating factors of self-medication in developing countries is paramount.

Fumonisins (a family of foodborne carcinogenic mycotoxins) cause health hazards to humans and animals in developing countries, and has also economic implications. Therefore, the efficacy of a novel environmental friendly nixtamalization procedure to make tortillas (the main staple food for the Mexican population) was investigated. Maize contaminated with 2136.67 ng/g total fumonisins was processed into tortillas, starting with maize grits mixed with water and calcium hydroxide that was cooked in a microwave field at 2.45 GHz during 3.75 min, and steeped 3.5 h at room temperature. The steeped maize grits (nixtamal) was stone-ground into masa (maize dough), which was then used to make tortillas. Total fumonisin content was determined using monoclonal antibody columns. Masa contained 1998.33 ng/g total fumonisins, which represents 6.5% toxin reduction. Nevertheless, fumonisin concentration was reduced significantly in tortillas (up to 985.33 ng/g) due to the cooking process, corresponding to a cumulative toxin degradation of 54%. Tortillas were below the maximum tolerated level, considering the European Union regulatory limit for fumonisins in maize (1000 ng/g). The physicochemical and technological properties of tortillas were also considered within the acceptable margins of quality. Microwave nixtamalization was not a feasible method to reduce fumonisin content in masa to acceptable levels; however, an effective extra-reduction occurred when masa was baking into tortillas.

Transfusion-transmissible infections such as hepatitis B and hepatitis C are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem. The aim of this study was to assess the epidemiological aspects of hepatitis B and C in Kazakhstani donor’s blood over the period 2000-2011. The data were obtained from the annual reports of the Republican Blood Center. The retrospective study was conducted from 2000 to 2011. Over the study period in the republic a growth of volumes of procured blood from 312.4 to 398.0 units was noted, in total equaled to 4,277.8 units. The proportion of blood wasted increased from 8.3% to 8.7%. In the dynamics the proportion of viral hepatitis among all causes of blood wasted decreased from 29% to 15.5% (HBV) and from 33.5% to 9.9% (HCV). The proportion of HBV and HCV in whole blood decreased considerably, in plasma and red cell concentrate the rates changed slightly. The average annual prevalence of HBV and HCV were 2.1% and 1.8%, respectively. Despite the reduction of viral hepatitis rates among blood donors in Kazakhstan the prevalence still remains high. The HBV prevalence is higher compared to HCV, which needs further investigations in the general population to address the issue.

‘Cercarial dermatitis’ also known as swimmers itch (Skin allergies) is caused by a trematode parasite, Schistosoma which has two hosts - an invertebrate (snail) and a vertebrate (livestock, human being). Although the availability of both vector snails and pathogens at the selected site the Doon Valley in northern India has already been confirmed but there was a hazy picture of the disease, whether it is due to entrance of cercariae or due to wild variety of grass (Parthenium hysterophorus).The present study is an attempt to provide a way forward towards the vector snails and snail borne diseases in the study area. Snail sampling and identification was done by applying standard methods / using Keys & Catalogues. Associated parasites and cercariometry in snails has been worked out by cercarial shedding. Human involvement at zoonotic level has been performed in collaboration with Health centers and socio- economic aspect of inhabitants of study area. The snail diversity encountered 19 species including the vector species such as Indoplanorbis exustus, Gyraulus convexiusculus, Melanoides tuberculata and Lymnaea acuminata. The cercarial diversity comprised Furcocercous, Monostome, Amphistome and liver fluke / Xiphidiocercaria. During the study (2009-2010), 0.173% was found with cercarial dermatitis among human population in the selected area. The symptoms of disease recorded were red spots and swellings on effected parts of skin. Frequent visits of livestock to the water body and presence of vector snails provides a clue in completing the life cycle of the parasite of the family Schistosomatidae. Cercarial dermatitis has been considered a potential risk at those places where warm blooded and snail’s hosts share a link with aquatic bodies with particular emphasis to temperature and time of year.

There are more than 350 wastewater treatment plants distributed across different parts of Oman. Some of them produce large quantities of domestic sewage sludge, particularly this study focused on characterizing domestic sludge of six treatment plants that may contain various pollutants, therefore the proper management of domestic sewage sludge is essential. Samples of domestic sewage sludge were collected for each month over a period of one year in 2010.Samples of retained/ recycled activated sludge (RAS) and waste activated sludge (WAS) were analyzed for electrical conductivity (EC), potential of hydrogen (pH), cations, anions and volatile content. All tests were conducted according to the Standard Method for the Examination of Water and Wastewater. Monitoring ofelectrical conductivity, nitrite and nitrate, the presence of chloride, sulfate and phosphate were higher than the other anions, the phosphate was found very high in all domestic STPs. The average obtained values of the cations in both domestic RAS and WAS samples were within the Omani Standards. The study showed the very high concentration of phosphate, it might be worth to further investigate on the sources of phosphate. Cations in both domestic RAS and WAS samples were low and suggest that the domestic sludge can be re used in agriculture. A regular maintenance should be performed to prevent any accumulation of some harmful substances which may affect the sludge quality and the sludge drying beds should be large enough to handle the produced sludge for better management.

We aimed to analyze the range of motion (ROM) and internal rotation (IR) and external rotation (ER) isokinetic strength according to humeral retroversion of the dominant shoulder. We included 40 elite baseball players in Korea (OBP group: n=20 players with careers spanning >10 years, age: 19.37±2.21 years, height: 181.00±5.41 cm, weight: 84.58±7.85 kg; BBP group: n=20 players with careers spanning <10 years, age: 16.55±1.36 years, height: 177.27±7.57 cm, weight: 77.27±8.14 kg). Radiography was performed to examine humeral retroversion, a goniometer was used to measure IROM and EROM, and a dynamometer was used to measure IR and ER isokinetic strength (speed set at 180°/s or 300°/s). The BBP and OBP groups had significantly different IR and ER isokinetic strength (180°/s and 300°/s) (P<0.001) and dominant shoulder retroversion (P=0.009). In the BBP group, retroversion had no correlation with ROM and with IR or ER isokinetic strength (180°/s and 300°/s). In the OBP group, retroversion had no correlation with ROM and with ER isokinetic strength at 180°/s, but had significant correlation with IR isokinetic strength at both 180°/s (r=0.483, P=0.007) and 300°/s (r=0.373, P=0.043) and ER isokinetic strength at 300°/s (r=0.366, P=0.046). Thus, youth players with careers spanning >10 years had significantly higher humeral retroversion, IROM, EROM, and IR and ER isokinetic strength of the dominant shoulder than youth players with careers spanning <10 years. Furthermore, humeral retroversion and ROM were not significantly related, but IR and ER isokinetic strength were significantly positively related with retroversion in both groups.

School is the first social institution which affects adolescents'' lives, and it determines their opportunities, life quality and behavior. Thus, the aim of this study was to determine the relationship between students’ bonds with their school and multiple health risk behaviors amongst high school students in Kerman City, Iran. In this cross-sectional study, high school students of all levels participated during November and December 2001 in Kerman.The research sample included 1024 students (588 females and 436 males) aged 15 to 19 years. A CTC (Communities That Care Youth Survey) questionnaire was designed based ona standard questionnaire in order to collect a profile of students’ risk behaviors. A multi-stage cluster sampling method was used to collect the data. In the final multivariate logistic regression, two variables including; age, (ORa=1.15, P=0.02) and male gender (ORa=2.14, P=0.001) had a significant positive association with multiple health risk behaviors (MHRB). School commitment (ORa=0.38, P=0.001) and school rewards for involvement (ORa=0.80, P=0.21), had a significant negative association with MHRB. Our results quantified the pivotal role of schools in shaping the risky behavior of students. It seems that school may minimize the risky behaviors by creating a strong link, and improving the effective communications with students.

Our aim was to evaluate the association of metabolic syndrome (MetS) and its components with body fat percentage (BFP) and anthropometric indicesin10 to 18year old adolescents. This was a cross-sectional study conducted on 134 Tehranian adolescents, aged 10 to 18 years (66 boys and 68 girls) in 2007.The MetS definition proposed by Cook et al. was used. Logistic regression was used to determine the relationship of MetS and its components with body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), and BFP. Using the areas under the receiver operating characteristic (ROC) curve, the discriminatory ability of anthropometric measurements and BFP was evaluated. The mean±SD forage of boys and girls was14.5±2.3and13.0±2.9 years, respectively (P=0.001); the prevalence of MetS in these groups was 32.3 and6.5%, respectively (P=0.001). After adjusting for sex and physical activity, the highest odds ratios (95% CI) for MetS and hypertriglyceridemia were found for WC, 6.27 (2.63-14.94; P<0.05)and 3.14 (1.87-5.27; P<0.05), respectively, and those for low HDL-C and hypertension were found for BMI, 2.91 (1.73-4.90; P<0.05)and 2.26 (1.27-4.02; P=0.05), respectively. After adjusting for sex and physical activity, the highest area under ROC curve for MetS and hypertriglyceridemia was seen for WC (P=0.001), for hypertension it was seen for BMI (P=0.001), and for low HDL-C it was observed for both WC and BMI (P=0.001). In adolescents, WC was the best predictor of MetS and hypertriglyceridemia, BMI was the best predictor of hypertension, and WC and BMI were the best predictors for low HDL-C.

This study aimed at identifying components of the household health costs. This study was a qualitative research conducted in two main phases. The first phase consisted of interviews with sample households selected in eight provinces of Iran. They were to identify components of the household health costs. In the second phase, components were determined as direct, indirect and intangible based on a content analysis. In the first phase of the study, 93 components of households’ health costs were identified. According to the content analysis, 44 components were categorized as direct costs, 10 components were indirect and 39 components were categorized as intangible. All components of households’ health costs including: direct, indirect and intangible costs, should be considered in the planning and policy-making in the health system.

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

Skilled labor force is very important in economic growth. Workers become skilled when they are healthy and able to be educated and work. In this study, we estimated the effects of health indicators on labor supply. We used labor force participation rate as the indicator of labor supply. We categorized this indicator into 2 indicators of female and male labor force participation rates and compared the results of each estimate with the other. This study was done in eastern Mediterranean countries between 1995 and 2011. We used a panel cointegration approach for estimating the models. We used Pesaran cross sectional dependency, Pesaran unit root test, and Westerlund panel cointegration for this issue. At the end, after confirmation of having random effect models, we estimated them with random effects. Increasing the fertility rate decreased the female labor supply, but increased the male labor supply. However, public health expenditures increased the female labor supply, but decreased the male labor supply because of substitution effects. Similar results were found regarding urbanization. Gross domestic product had a positive relationship with female labor supply, but not with male labor supply. Besides, out of pocket health expenditures had a negative relationship with male labor supply, but no significant relationships with female labor supply. The effects of the health variables were more severe in the female labor supply model compared to the male model. Countries must pay attention to women''s health more and more to change the labor supply.

Prison inmates are among the high risk population for dangerous infections such HIV, HBV, HCV and other contagious diseases. In spit of many data about the prevalence and risk factors for blood born diseases among prisoners in the world, such data are spares from Iran. The aim of this study was to determine the prevalence and associated risk factors for HIV, HBV, HCV and HDV infections among a large sample of prison inmates in Iran. In a cross-sectional study in 2009-2010, 881 inmates in three prisons of Southern Khorasan Province in Iran were selected based on a systematic, stratified random sampling method. Sera were analyzed for HBV, HDV, HCV and HIV infections by appropriate commercial ELISA kits. An anonymous questionnaire was used to collect the demographic data and information about risk factors. Overall, 881 prisoners (mean age: 34.7±11.4 years, range: 11-84 years, M/F ratio:4.5/1) were participated in this study. The prevalence of HBV and HCV infection was 6.9% and 7.7%, respectively. Among the HBsAg positive subjects, 6.6% (4/61) and 9.8% (6/61) had HDV and HCV super-infection, respectively. Only one case (0.1%) had HIV infection that was co-infection with HCV. Drug abuse and history of traditional phlebotomy were associated risk factors for HBV infection (P<0.05) and history of drug injection was associated with HCV infection (P<0.05). This study show fairly higher prevalence of blood borne infections among prisoners and indicate drug abuse and phlebotomy as the associated risk factor. Implementation of appropriate screening tests and preventive programs is suggested in prisons.

Medullary thyroid carcinoma (MTC) occurs in both sporadic (75%) and hereditary (25%) forms. The missense mutations of the REarranged during Transfection (RET) proto-oncogene in MTC development have been well demonstrated. The aim of this study was to investigate frequency of G691S/S904S haplotype in MTC patients and their relatives. In this research 293 participants were studied, including 181 patients (102 female, 79 male) and 112 their relatives (58 female, 54 male). Genomic DNA was extracted from peripheral blood leucocytes using the standard Salting Out/Proteinase K method. Nucleotide change detection was performed using PCR and direct DNA sequencing methods. According to DNA sequencing results, 159 individuals (104 patients, 55 relatives) had both G691S (rs1799939) missense mutation in exon11 and S904S (rs1800863) synonymous mutation in exon 15 of RET proto-oncogene. The allele frequency of G691S/S904S haplotype was 21.15% in patients and 10.75% in their relatives. The obtained data showed the frequency of G691S/S904S RET gene haplotype among Iranian MTC patients and their relatives. The G691S and S904S nucleotide changes were in complete linkage disequilibrium, so the results were grouped together and referred to as G691S/S904S haplotype. Further analysis is need to demonstrate the association between this haplotype and MTC development.

Human infection with avian influenza A H7N9 virus has emerged in China with high morbidity rates. Patients usually present with severe and rapidly progressive pneumonia. Therefore, radiological findings are important to diagnose and evaluate disease severity. The clinical characteristics of three new cases of H7N9 virus infection were analyzed, especially the radiological findings, and previously published studies regarding H7N9 virus infection were summarized. Ground-glass opacification and areas of consolidation were the most common image features. Although drug resistance has been found in some H7N9 viruses, oseltamivir administration is still recommended as soon as possible. Moreover, timely epidemiological surveillance is needed, and a new vaccine is expected for the management of avian influenza.