Iranian Journal of Public Health
Volume:47 Issue: 8, Aug 2018

Hand-foot-mouth disease (HFMD) is a widespread communicable disease and has caused large epidemics in many countries. This meta-analysis aimed to analyze and evaluate the epidemiological features of HFMD outbreaks in Chinese preschools.
Literature review was based on PubMed, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases from 2008 to 2015. The temporal, spatial and demographic parameters were summarized and analyzed.
Overall, 19 studies with a total of 11269 HFMD cases were selected for data synthesis and analysis. April, May, June and July were detected as the peak months of HFMD outbreaks, with the pooled rate of 21% (95% CI: 12%-34%), 23% (95% CI: 19%-27%), 20% (95% CI: 17%-24%) and 11% (95% CI: 7%-15%). Urban areas were at a higher risk of suffering from HFMD outbreaks than rural areas, with the pooled rate of 65% (95% CI: 48%-78%) and 35% (95% CI: 22%-52%) respectively. The constituent ratio of children aged 37-48 months is the highest, accounting for 46% (95% CI: 39%-53%) of the total cases during HFMD outbreaks. The pooled rate of male cases (60%) was higher than that of female cases (40%).
Month, residence, age, and gender may be early risk factors for potential HFMD outbreaks. Before the advent of peak months from Apr to Jul each year, measures should be taken to prevent the HFMD outbreaks among preschool children in China. Preschools located in urban areas should take priority over special prevention. HFMD surveillance should preferentially focus on children aged 37-48 months, especially boys in preschools.

We explored the effects of high-volume hemofiltration(HVHF) by different ultrasound directing on the plasma N-terminal pro-B-type natriuretic peptide(NT-Pro-BNP), extra vascular lung water index (EVLWI), liquid net balance quantity and prognosis in patients with septic shock.
Overall, 107 intensive patients with septic shock were enrolled by retrospective analysis from Department of Intensive Care Unit (ICU) of the Shandong Provincial Hospital affiliated to Shandong University from 2014-2017. According to HVHF by different ultrasound directing, all the patients were divided into two groups ((ultrasonic cardiac output monitor (USCOM), group A, n=51cases)) and ((critical bedside ultrasound (CBU), group B, n=56cases)).
The value of CI in group A had a significant positive correlation with the value of PCCI by the PiCCO2 monitoring (P＜0.05). The lung ultrasound water B lines in group B also had a significant positive correlation with the value of EVLWI by the PiCCO2 monitoring. The cumulative liquid net balance quantity in group B had a more significant elevation than group A after treatment 7th d. The level of EVLWI after treatment 48 h and 72 h, the level of plasma NT-Pro-BNP, the levels of P(A-a)DO2,OI and blood lactic after treatment 72 h, and the APACHEⅡ scores and SOFA scores after treatment 7thd were reduced more significantly in group B than group A (P It could decrease the level of NT-Pro-BNP, EVLWI, P(A-a)DO2,which then improves pulmonary oxygenation. Consequently, it decreased the APACHEⅡand SOFA scores and improved the 28th survival rate of patients.

In this study, we assessed the secular trends and socioeconomic differentials in menarcheal age among women aged 25-64 year.
Using the 5th Korea National Health and Nutrition Examination Survey (KNHANES, 2010-2012), bivariate analysis and one-way analysis of variance were used to test the statistical differences between age groups.
The mean age at menarche was 14.3 yr with a steep decrease in the younger cohort: from 15.9 yr in 1951-1955 to 13.1 yr in 1986-1990. Height as a proxy marker for early nutrition showed an inverse relationship with menarcheal age. The earlier menarcheal age patterns in women of higher socioeconomic position were observed according to one's education, monthly family income, occupation, region (urban vs. rural), and parental education.
This result suggests a fast and ongoing trend in age at menarche and the socioeconomic discrepancy among Korean women in the last four decades.

We aimed to evaluate the risk factors of the daily mortality associated with air pollution causing acute lower respiratory tract infections.
We applied a short time series analysis to the air pollution record, meteorological data and 133 non-accidental death data in Shengyang, China, in 2013-2015. After controlling the seasonality, day of week and weather conditions, the group employed an over-dispersed Possion generalized addictive model to discuss the associations among different variables, then performed the stratified analysis according to age, gender, and season.
Mean concentrations of particulate matter with aerodynamic diameters of These findings clarified the burden of air pollution on the morbidity of acute lower respiratory tract infections and emphasized the urgency of the control and prevention of air pollution and respiratory diseases in China.

To examine whether polymorphisms of SIRT1 and dietary product intake can be implicated in type 2 diabetes mellitus (T2DM).
In this community-based, case-control study, 568 subjects (284 patients and 284 controls) were enrolled in a community located in northern Guangzhou, China. The four polymorphisms of SIRT1 (rs4746720, rs10509291, rs2236319, rs10823116) were examined using TaqMan nuclease technology. The dietary data were collected by an inquiring officer through face-to-face method.
The rs4746720 CC genotype had higher risk compared with CT genotype to develop T2DM [odds ratio (OR) =1.42, 95% confidence interval (CI) = 1.02-1.97]. The subjects with rs4746720 CC genotype and eat sugar food over 30g per day increased the risk of T2DM to 2.22(1.21-4.06) times. The subjects with rs4746720 CC genotype and smoking increased the risk of T2DM to 1.65 (1.10-2.47) times. The unhealthy eating habits such as red meat, salty food, use animal fat yielded higher risks of T2DM, the OR of risk of T2DM was 2.89 (1.38-6.01), 2.73 (1.61-4.64) and 27.91(9.24-84.32) respectively. However, the milk, soy, white meat, vegetables and low-salt diet decreased the risk of T2DM, the OR of risk of T2DM was 0.51 (0.29-0.88), 0.43 (0.26-0.74), 0.51(0.32-0.83), 0.21(0.10-0.44), 0.28(0.12-0.65), 0.35(0.21-0.51) respectively.
Variants in SIRT1 with rs4746720 CC genotype increased the risk of T2DM, especially with the unhealthy eating habits.

Remote sensing have been intensively used across many disciplines, however, such information was limited in spatial epidemiology.
Two years (2009 & 2010) Landsat TM satellite data was used to develop vegetation, water bodies, air temperature and humidity criterion maps to model malaria risk and its spatiotemporal seasonal variation. The criterion maps were used in weighted overlay analysis to generate final categorized malaria risk map.
Overall, 25%, 68%, 18% and 16% of the total area of Rawalpindi region was categorized as danger zone for Jun 2009, Oct 2009, Jan 2010 and Jun 2010, respectively. The malaria risk reached at its peak during the monsoon season whereas air temperature and relative humidity were the main contributing factors in seasonal variation.
Malaria risk maps could be used for prioritizing areas for malaria control measures.

We aimed to investigate the trends of interested and extra time spending activities in order to find potential correlation between computer-based activities (CBA) and healthy lifestyle (HLA).
Information was adapted from the South Korea governmental open source database which gathered from official measurement statistical results. Various types of the interested and extra time spending activities were categorized into eight main activities based on the library research and expert comments. Moreover, two main categories of sports and outdoor activity (S&OA) were found to be attributed to HLA. Descriptive and analytical statistics analyses, besides correlation analysis were conducted; through Kolmogorov-Smirnov test for normalizing data and Fisher's exact test for making the comparison.
Among demographic variables, watching and listening as well as social activities, were the most interesting activities for almost all citizens, furthermore computer games and social network system (CG&SNS) were found to have a negative association with HLA.
Newly emerged computer-based activities, such as game behavior, would be among the main determinates of the HLA. The associated implications are provided to assist the authorities and governments in making the policy and planning.

we aimed to determine the existing state analysis of children on the street and also attending to a school. The children’s ages were between 13-18 yr, attending grades between 7-12th grade.
The sample group was 54,928 students in Sanliurfa, Turkey. The data were analyzed using Chi-square test (P 82.8% of working children were male. 92.5% were elder than 12 yr old and 85.8 % had more than 4 siblings. 52.7% of the families’ income was less than 1,000 TL per month. 79.9% of the children had worked in different places before. The distribution of working places was 66.4% in an establishment, 9.5% in the fields, 7.5% in the bazaar and in the streets, 2.8% in bus terminal, 2.9% in industry, 2.5% in parks. The 46.3% of the children stated that they are working willingly. 50.7% were working 6 to 10 h a day. 64.4% were giving the money they earned to their families. 82.1% of the children stated that they liked to attend the school but 62.8% sometimes did not go to school. 20.6% went to work instead of school in those days. The 62.2% of the children answered the question; “According to you, should the children work?” with;”No”.
The children started working at very early ages and they faced unfavorable situations. To avoid the children work in very early ages, it is suggested to make educational programs and to compose policies to resolve the problems that force the children to go to work.

Quality of life is a key measure in estimating the burden of disease, especially of chronic diseases. This study investigated the impact of a variety of chronic diseases on quality of life (QoL) in primary health care patients in three Southeast Asian countries (Cambodia, Myanmar, and Vietnam).
This cross-sectional survey was conducted on 4803 adult chronic disease patients (mean age 49.3 yr; SD=16.5) recruited systematically from primary health care centers in rural and urban areas in Cambodia, Myanmar and Vietnam in 2015.
In ANCOVA analysis, adjusted for age, sex, marital status, geo locality, education, income and country, the poorest summative QoL was found among patients with cancer (49.8 mean score), followed by Parkinson’s disease (50.7), mental disorder (53.2), epilepsy (53.3), asthma (54.3), kidney disease (54.3), chronic obstructive pulmonary disease (COPD) (54.5) and cardiovascular diseases (CVD) (55.1). Patients having three or more chronic conditions had a significantly lower summative QoL than patients with two chronic conditions (56.4) and one chronic condition (58.0). In multivariable linear regression analysis, younger age, being married or cohabitating, better education, living in an urban area, having only one chronic condition, not experiencing chronic disease stigma and good medication adherence was associated with better QoL in two or three of the study countries.
Major chronic diseases were found to have poor QoL. The determined QoL of chronic disease patients in this study provides information to improve the management of chronic diseases.

The Migrated Agricultural Population (MAP) of China continues to increase with the continuous development of urbanization. As MAP is a socially disadvantaged group, their mental health issues require urgent attention.
An ordinary least squares regression model was established by using the newest survey data from the 2016 Chinese General Social Survey. Moreover, the effects of income and psychological identification on the mental health status of China’s MAP were also examined using the Stata 12.0 software. The differences in the examination results under the influence of gender, educational level, and marital factors were compared.
The mental health level of China’s MAP is affected by both income and psychological identification. Specifically, income has a more significant influence on men's mental health, whereas psychological identification is more significant for women. The mental health of MAP with spouses or those who received secondary education also reflects the overall characteristics of the sample. By contrast, those without spouses or those who did not receive other forms of education are mainly affected by psychological identification. Additionally, the mental health of the unmarried group is mainly affected by the family’s actual income and subjective well-being based on the psychological identification.
The influence of income and psychological identification on the mental health of China’s MAP shows population differences. Therefore, different emphasis should be placed on the interventions of mental health in various groups of MAP. This study can provide decision-making references for the mental health management and psychological pressure counseling of MAP.

High-fat diets have been considered a risk factor for sporadic colorectal cancer (CRC) in Western countries. However, data for this phenomenon are lacking in China. The purpose of this study was to comprehensively evaluate the association between diet and the risk for sporadic CRC in Shandong Province, China.
In this case-control study, 317 patients with sporadic CRC and 317 controls were collected in Shandong Province, China. All the samples were collected on the basis of rigorous screening criteria. The data were analyzed using a χ2 test, univariate or multivariate conditional logistic regression, and stratified analysis.
Multivariate logistic regression showed that the following are risk factors for sporadic CRC (all P Dietary factors are related to sporadic CRC in Shandong Province. Future interventions should focus on reducing the related risk factors while advocating for practice of the protective factors.

Due to high cost and burden of osteoporosis, it is reasonable to focus on the reduction of fractures as the main goal of treatment. We compared the efficacy and safety of a new biosimilar recombinant human parathyroid hormone (CinnoPar®, CinnaGen, Iran) to the reference product (Forteo®, Eli Lilly, USA) in a randomized double-blind clinical trial (RCT).
Overall, 104 osteoporotic postmenopausal women aged 45-75 yr were randomized to receive 20 µg daily subcutaneous injections of either Forteo® or CinnoPar® for 6-months from 2011-2012. Bone biomarkers were measured at baseline, and during first, third, and sixth month's follow-up along with lumbar spine, total hip, and femoral neck bone mineral density (BMD) assessment at the baseline and six months after that. The study was registered in Iranian registry of clinical trials under the registration number of IRCT138810121414N5. The endpoints were to compare bone biomarkers, BMD and drug safety between groups. Data analysis was performed using SPSS 11.
Age range of ninety-four patients who completed the study was 42-81 yr. Participants were divided into Forteo (45 subjects) and CinnoPar (49 subjects) groups. No significant difference in terms of bone biomarkers or BMD scores was shown between groups (P≥0.05). The most prevalent side effects were hypercalcemia and hypercalciuria without any significant statistical differences between groups.
CinnoPar® can be considered as a good alternative therapy for Forteo® in postmenopausal osteoporotic women due to its comparable efficacy and safety properties.

Topiramate facilitates gamma aminobutyric acid (GABA) transference and an ideal candidate for reducing cocaine use in methadone patients. The present study evaluated topiramate in Dual dependence on opiate and cocaine.
This placebo-controlled study (Clinical Trial Registration Code: TCTR20170201001) conducted during the period 2013–2014, Cocaine-dependent individuals maintained on methadone (n=50) were randomized to receive topiramate or identical placebo capsules. Participant's dosage ranged between 25-300 mg/day (12 wk) in escalating doses. Methadone Doses started at 30 mg/day (median 100 mg/day; range 20 –140 mg/day). In addition, all subjects received brief behavioral compliance enhancement treatment (BBCET). The data were analyzed by Chi-square Test, generalized estimating equations (GEE) models, linear mixed effects (LME) model and Analysis of covariance (ANCOVA). Primary outcome measures included twelve weekly urine drug screens (cocaine abstinence, detection of benzoylecgonine) and treatment retention. Secondary outcome measures included correlation between cocaine craving with cocaine urine samples and Side effects of depression.
Topiramate was not better than placebo in reducing cocaine use. The secondary outcome showed that Topiramate was better than placebo in reducing cocaine craving. The mean [99% confidence interval (CI)] scores of cocaine craving were 24.31 (18.61–30.01) in experimental group and 21.84 (16.86–26.81) in control group (all P > 0.01). Retention and correlation between cocaine craving and cocaine urine samples were not significantly different between the groups. Topiramate usage was not associated with increase in depression symptoms as a side effect (P>0.05).
The efficacy of topiramate in cocaine treatment is limited and needs the similar controlled clinical trials and can be used as a complementary intervention.

To investigate the determinants of smoking behavior among Iranian adolescents applying the Prototype/Willingness (P/W) Model.
In this cross-sectional study, a self-administered P/W model-based questionnaire was completed between 760 randomly selected adolescents (high school students and dropouts) in Hamadan, Iran, in 2015. Generalized structural equation modeling (GSEM) was applied to analyze data.
Significant associations were found between subjective norms and positive attitudes toward smoking (P When social reaction and reasoned processes are modeled together, both may predict the smoking behavior. The high-risk perception and the high-risk image toward smoking behavior among the adolescents may originate from socio-cultural factors underlying the behavior. Further research is recommended to investigate the socio-cultural biases of the issue.

Helicobacter pylori are the main cause of chronic inflammation and peptic ulcer. We aimed to determine if IL-1B� and IL-1RN polymorphisms are associated with the risk of chronic gastritis and peptic ulcer in Iranian population.
In this case-control study, from 198 individuals enrolled by Mohammadi Hospital, Bandar Abbas, southern Iran from 2012 to 2014 and who showed the symptoms of chronic gastritis and 84 with peptic ulcer participated in the case group, two biopsies were taken from the body, antrum, or ulcer edge of each patient. Individuals without chronic gastritis or peptic ulcer were selected as the control group and we also confirmed the presence of anti-H. pylori serum IgG in 321 control subjects. IL-1B�砋 polymorphism was analyzed through PCR-RFLP, while the IL-1RN polymorphism was analyzed via PCR-based VNTR.
IL-1B� TT was associated with a high risk of gastritis and peptic ulcer [Odds Ratio (OR)]=2.63, 95% Confidence Interval (CI)= (1.47-4.70) (OR=3.40, CI=1.72-6.71) respectively and the IL-1B� T allele was associated with chronic gastritis (OR=1.64, 95% CI=1.13-2.36). Moreover, patient carrying IL-1RN L/2 and allele 2 showed an increased risk of peptic ulcer (OR=2.97, CI=1.72-5.11, OR=1.64, CI=1.13-2.36), respectively.
IL-1B and IL-1RNare associated with an increased risk for chronic gastritis and peptic ulcer disease.

Drowsiness is one of the underlying causes of driving accidents, which contribute, to many road fatalities annually. Although numerous methods have been developed to detect the level of drowsiness, techniques based on image processing are quicker and more accurate in comparison with the other methods. The aim of this study was to use image-processing techniques to detect the levels of drowsiness in a driving simulator.
This study was conducted on five suburban drivers using a driving simulator based on virtual reality laboratory of Khaje-Nasir Toosi University of Technology in 2015 Tehran, Iran. The facial expressions, as well as location of the eyes, were detected by Violla-Jones algorithm. Criteria for detecting drivers’ levels of drowsiness by eyes tracking included eye blink duration blink frequency and PERCLOS that was used to confirm the results.
Eye closure duration and blink frequency have a direct ratio of drivers’ levels of drowsiness. The mean of squares of errors for data trained by the network and data into the network for testing, were 0.0623 and 0.0700, respectively. Meanwhile, the percentage of accuracy of detecting system was 93.
The results showed several dynamic changes of the eyes during the periods of drowsiness. The present study proposes a fast and accurate method for detecting the levels of drivers’ drowsiness by considering the dynamic changes of the eyes.

We aimed to measure changes in socioeconomic inequality in child mortality in Iran.
A secondary data analysis of two Demographic and Health Surveys (DHS 2000 and 2010) was undertaken. Neonatal, infant and under-5 mortality rates were estimated directly from complete birth history. Economic quintiles were constructed using principal component analysis. Changes in inequality were measured using odds ratios, mortality rates, and concentration curves and indices.
Based on the compared measures, inequalities in neonatal, infant, and under-5 mortality declined between the two surveys. The poorest-to-richest neonatal, infant and under-5 mortality odds ratios in 2000 were 1.69 (95% CI= 1.3-2.07), 2.85 (95% CI= 1.96-4.1) and 1.98 (95% CI= 1.64-2.3), respectively. Whereas these mortality odds ratios in 2010 had fallen to 1.65 (95% CI= 0.95-2.9), 1.47 (95% CI=0.5-4) and 1.85 (95% CI=1.13-3), respectively. Moreover, mortality rates in all economic quintiles experienced a decreasing trend. Neonatal, infant, and under-5 mortality concentration indices in 2000 were -0.15, -0.26, and -0.17 respectively. Whereas concentration indices in 2010 had dropped to -0.13, -0.11, and -0.14, respectively. Concentration curves dominance test revealed that there was a statistically significant reduction in inequality in infant and under-5 mortalities.
Despite substantial reduction in child mortality rates and narrowing of the gap between poor and rich people, socioeconomic inequality in child mortalities disfavoring worse-off groups still exists. Combination of child health-related efforts that aim to reach to those children born in poor households alongside with pro-equity programs in other sectors of society may further reduce infant, under-5, and particularly neonatal mortality across economic quintiles in Iran.

Due to the importance of prenatal maternal stress as environmental factor on autism, the influence of prenatal maternal psychological agitations was assessed in relation with the risk of autism.
In this case-control study, some mothers of autistic children in Isfahan, central Iran, in 2014, were retrospectively compared with control mothers in terms of quantity, quality, andschedule of exposure to 45 stressful events in a 15-month period. In addition, dividing the stressors into two groups of genome-dependent/independent events, their prevalence was separately scrutinized and compared among patient and control families.
Although the child’s risk of autism increases significantly with the increase of maternal stress during months 4-7 of pregnancy, the increased stress during months 2-3 of pregnancy can lead to a significant increase in the severity of autism affliction as well as a slight but significant increase in the possibility of LFA in afflicted children (P Although the present study consistent with recent findings in the fields of epigenetics and gene-environment interactions can confirm the role of severe and scheduled prenatal stresses in causing autism, it does not deny the necessity of a perspective and wider study in Isfahan and Iran.

The Lifestyle Promotion Project (LPP) is a long-term community-based project for prevention and control of non-communicable diseases (NCDs). In this project, the healthy lifestyle promotion plan will be implemented by the health policy agenda of East Azerbaijan Province, Iran.
The study design included two phases: phase I was a cross-sectional prevalence study of NCDs and the associ­ated risk factors implemented from Feb 2014 to Apr 2014. Phase II is a prospective follow-up study currently ongoing. The healthy lifestyle promotion intervention consists of five core strategic plans. These programs was implemented by the health policy agenda of East Azerbaijan Province. Overall, 3000 participants aged 15-65 yr were enrolled to evaluate the impact of healthy lifestyle interventions in phase II of project.
The experience of the LPP in Iran may support the idea that a well-organized, fully evidence-based, and well-developed community-based program could be affordable to prevent non-communicable disorders in developing countries.
The results of this survey will be presented as research articles and reports for policy makers.

Intertrigo is an erythematous inflammatory condition with multiple etiologies including fungi and bacteria. Intertrigo manifests in different clinical forms with various complaints. This study was conducted to evaluate the causative agents of intertriginous infections with emphasize on clinical presentations.
This descriptive cross-sectional study was carried out in 2015-2016, on 188 patients with clinical suspicion of superficial and cutaneous intertriginous infections in Tehran, Iran. Demographic and additional related data were obtained by questionnaire from all participants. Specimens were collected by gentle scraping of the affected areas. Direct examination and culture were performed for all specimens and grown colonies were identified based on the macroscopic and microscopic features. Supplementary tests were done whenever needed. Data were analyzed in SPSS.
Overall, 80 (42.5%) cases with the mean age of 43.5 yr were confirmed for intertrigo. Dermatophytosis was the predominant cause in this study with 36 (45%) cases followed by erythrasma (28 cases, 35%), tinea versicolor (10 cases, 12.5%) and candidiasis (6 cases, 7.5%). Intertrigo lesions with dermatophytic agents significantly were observed in groin in comparison to different infections among body sites (P Different clinical manifestations may be observed in infectious intertrigo. Regarding the significant association observed in this study, some clinical features can be used for presumptive diagnosis of diseases but further studies are required to make it clear.

Actinomycosis is a rare bacterial infection, caused by a group of Gram-positive bacteria which form the normal flora of oral cavity, gastrointestinal tract, and female genital tract. We present a rare case met in 2016 at Legal Medicine Bihor County Service, Romania of a 14 yr old boy in infection with Actinomyces israelii was able to produce sudden death. Infection with A. israelii was diagnosed with the help of histological exam, after medico-legal autopsy. Most probably, A. israelii was aspirated from the level of the oropharynx, it arrived into the lungs, and using the haematological way it spread into the heart, causing sudden death.

Myiasis is caused by invasion of larvae stage of dipterans fly in living tissue of vertebrate host including human and animals. The most important family is Calliphoridae and included Calliphora, Lucilia, Chrysomyia and Cochliomyia genus. A 35-yr-old man with gastric cancer history referred to Golestan Hospital in Ahvaz Southwest of Iran in 2015. He was infected by nasal myiasis from Lucilia spp. in ICU. The genus of third larvae stage was identified by microscopic examination and culture of pupa. The population of flies inducing myiasis should be controlled in hospitals.