Iranian Journal of Public Health
Volume:37 Issue: 1, Spring 2008

Abstract: Iran, a low- to middle-income country, has experienced considerable socioeconomic changes in 20th century, which their impacts on the adult heights has not been assessed deeply by now. This article aims to quantify the temporal varia­tions of height (with respect to shrinkage of height due to aging) and its deterministic factors in Iranian population born be­tween 1940 and 1984. We analyzed the data of a large-scale national population- based survey that recruited 89,532 healthy subjects aged from 15 to 64 in 2005. Having used the Baltimore Longitudinal Study of Aging formulae, the shrinkage of height due to aging was adjusted. We modeled the estimated maximum height using multivariate regression analysis based on year of birth, sex, residing area and literacy. Moreover, we generated series of country maps showing the average of height classi­fied by decades and provinces. On average, the height of Iranian population has increased around 1.28 cm per decade (1.17cm in females; 1.53cm in males). The most prominent jumps of male and female heights are observed in 1970s. However, the jump of height in women has occurred around 3.5-10 years later than in men. We found a very sharp and clear increasing trend in height among those who were born between 1940 and 1984. Our findings support the fact that the socio-economical variations have had considerable impact on the maximum height of people; this can prove the population height measure as a good historical determinant for socio-economical de­velop­ment trend.

Abstract: Previous studies indicate a high incidence of digestive cancers along southern parts of Caspian Sea including Ma­zandaran Province. The present study was conducted to further investigate time to occurrence, age distribution and pos­sible risks associated with the incidence time of digestive cancers in the above regions. For this purpose the data of digestive cancer incidence of 3723 cases during a five-year period of 2001 to 2005 col­lected from Babol Cancer Registry Center in Iran. Almost all cancer cases residence of Mazandaran Province is included in this study and so the results could be considered a population-based conclusion. In order to modify the mortality due to other causes before digestive cancers, and to adjust the effect of digestive cancers correlations, a competing risks model was used. The Cox regression model was used for study of risk factors on cancer incidence. Although incidence of colorectal cancer was relatively low, however, unfortunately the age of onset was at the age cate­gory of 15-19, much sooner than occurrence of stomach cancer which was at 20-24 yr (P< 0.0001), and esophageal can­cer at age category of 30-34 yr (P< 0.0001). Life tables of all digestive cancer, esophageal cancer, stomach and colorectal cancers were presented in this pa­per. Risks related to these cancers are significantly higher in men and residences of urban areas than their baseline coun­terparts. (P< 0.0001) More studies needed to identify risk factors and high risk cases for screening and prevention programs.

Abstract: Recent advances in organ transplantation have promised certain benefits to humankind. Consequently, it is neces sary to take into consideration all aspects of these new approaches and provide specific ethical guidelines for re search in this field. Con sidering the ever-increasing advancements of transplantation in Iran and noting the necessity of scientific researches in this field, and to observe ethical principles in such researches, compilation of the "Na tional Ethical Guidelines for Transplanta tion Researches", as one topic of the "Specific National Ethical Guidelines for Biomedical Research" were considered in our coun try. We stated some points of this guideline in this article.

Abstract: Air pollution in Tehran, capital of Iran is responsible for several diverse negative effects. It has been estab­lished that air pollution can affect human health. These health effects include increased hospital admissions due to the ex­acerba­tion of cardiac and respiratory diseases, as well as symptoms such as headache, cough, eye irritation, nausea, sputum and even death in the most vulnerable individuals. In evaluating any policy that would reduce air pollution, it is useful to com­pare the policy''s costs to its benefits expressed in monetary units. Since there is no market available that places value on the benefits of improved air quality, we must undertake non market valuation methods. In this paper we used direct medical cost (DMC), contingent valuation (CV) and value of sta­tisti­cal life (VOSL) approaches and household production model of health. According to this study marginal health dam­age costs for the following type of pollutants impacts: sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM10) and carbon monoxide (CO) are quantified using exposure response functions(ERF) which relate pollutant con­centra­tion to the resulting impact on a receptor(health). ERFs for health impacts are derived from epidemiological studies. Health damage costs has been estimated at 16224 US$ per each unit increase of PM10, 28816 US$ per each unit in­crease of CO, 1927 US$ per each unit increase of NO2 and 7739 US$ per each unit increase of SO2. Substituting economic incentives for command and control approach to regulating air quality.

Abstract: Point mutations in the genes, Pfcrt and Pfdhfr, have been identified elsewhere as strongly associated with re­sistance to chloroquine (CQ) and pyrimethamine, respectively. Using a restriction digestion method, we report the frequency of two important mutations, T76 and Asn108, re­spon­sible for conferring resistance to chloroquine and pyrimethamine, respectively, in patients residing in malarious areas of southeastern Iran. Ninety eight and 84% of the patients were found to harbor chloroquine resistant (theronine-76) and pyrimethamine resis­tant (aspargin-108) mutants, respectively. Despite the high frequency of T76 and Asn 108 mutations in Iranian patients, combination of CQ and pyrimethamine-sulfadoxine (SP) was shown to be quite successful with 100% adequate clinical and parasitological re­sponses.

Abstract: Adiponectin is an anti-inflammatory and antiatherogenic protein that has a protective effect against athero­sclero­sis and diabetes. It is exclusively secreted by adipose tissue. Serum adiponectin levels are inversely associated with pa­rame­ters of overall adiposity including body mass index (BMI), fat mass, and percentage of body fat. In a cross-sectional study of 76 women we sought to evaluate if adiponectin is associated primarily with central adi­pos­ity rather than overall adiposity. We also assessed adiponectin changes after weight loss in a subgroup of 42 obese sub­jects. Waist to hip ratio (WHR), an index of central obesity, was the only variable independently associated to adi­ponectin (Beta= 0.25, P< 0.05). A mean increase of 8.2±24.2% in adiponectin concentration was observed in response to the dietary restriction and weight loss (P= 0.03). Our findings provide evidence for association of serum adiponectin level with visceral fat, represented by waist to hip ratio index. Moderate weight loss result in significant improvements in adiponectin concentration and provide another bio­logi­cal explanation for the beneficial effect of body weight loss on reducing cardiovascular and diabetes risks in obese pa­tients.

Abstract: Enterobacteriaceae are a large group of bacteria widely distributed in nature. Escherichia coli is the most com­mon cause of urinary tract infection. Two amino acid substitutions, in GyrA, are commonly responsible for quinolone re­sistance in E. coli. The aim of this study was molecular survey of nalidixic acid resistance E.coli isolated from patients in the codones of 83 and 87 gyrA genes. During 5 months (January to June 2005) of Molecular Survey of Nalidixic Acid Resistance, one hundred and twenty-one E. coli isolates from urine samples of patients referred to clinical laboratory of Baqiyatallah Hospital were cul­tured. Differential tests were done for diagnosis of E.coli. An economical and time-efficient mismatch amplification muta­tion assay (MAMA) PCR was developed to detect mutations in the chromosomal gyrA gene causing these substitutions. In nalidixic acid antibiogram test, 55 cases (45.5%) were sensitive, 63 cases (52%) were resistant and 3 cases (2.5%) were intermediate. Results of PCR and MIC were similar to antibiogram. There was not any mutation in the sensi­tive samples but there were performed five mutations on the 85, 81, 107, 97 and 87 codones of resistance samples. The codone number 87s mutation is one of the main mutations of nalidixic acid resistance. Depending on results of this study and comparison with other studies, trend of resistance of E.coli is increas­ing. Therefore, we recommend control of antibiotic misusage and application of MIC and PCR tests (if possible) prior to treat­ment for suitable selection of antibiotic and prevention of microbial resistance.

Abstract: Primary prevention status and goals in 2010 are promoting healthy weight and eating habits and dietary ma­nipula­tion considered in all reports to be the cornerstone of prevention and management of chronic diseases. Since in de­velop­ing countries physicians are in the front line of responding patients'' questions regarding their diet, we decided to evalu­ate their necessary nutritional knowledge for accomplishing this mission and to identify consideration for improving the paucity of nutrition education and the nutrition literacy in medical training program, we did the same education in medi­cal students. Applied nutritional knowledge of 150 general, specialist and sub specialist physicians and 202 medical students was evaluated by structured self administrative questionnaire. Eighteen questions which could be self completed in less than 5 minutes were filled by each subject. The percentage of physicians who gave dietary recommendations to their patients was 73% but the mean correct re­sponds to questions were 3.73±2.15 and 5.87±2.14 out of 14 questions in physicians and medical students respectively. Our data show deficient applied nutritional knowledge of physicians is one of the main problems of hospital mal­nu­trition. As the same results were shown in medical students, this can not be due to forgetting what was learned but can be related to the quality of nutrition training.

Abstract: Direct identification of Leishmania species in Giemsa-stained slides without parasite culturing in the areas where multiple species exist, is very helpful. This study was designed to isolate Leishmani spp. from Giemsa-stained smears and to characterize them by PCR technique. A total of 48 Giemsa-Stained slides from confirmed cases of leishmaniasis were examined under a light micro­scope at×1000 and classified based on grading of Leishmania parasites. DNA from each slide was extracted separately and sub­jected to PCR. The ribosomal internal transcribed spacer 1 (ITS1) was amplified with specific primers and the PCR prod­ucts were digested with a restriction enzyme (HaeIII). Of the 48 microscopy-positive slides, 43(89.6%) were positive by PCR-RFLP and Leishmania species were identi­fied. A statistically significant difference was observed between the both methods (P< 0.05) and also a concordance was found between microscopy and PCR-RFLP (k= 0.55). PCR-RFLP seems to be an effective method to identify Leishmania species from Giemsa-stained smears which have been collected from both infected humans and animal reservoir hosts in Iran.

Abstract: The aim was to investigate the distribution of blood pressure (BP) and evaluate some of the risk factors con­nected to hypertension. This study was deemed important and relevant due to the increasing importance of hypertension and car­diovascular diseases. This cross-sectional survey was conducted on 4,446 women aged 40 and over who had presented themselves with any number and form of health reasons to any of the 19 primary health care (PHC) centers in a district of western Tur­key between February 1st and March 31st, 2006. The Seventh Report of the Joint National Committee (JNC 7) was used for BP measurements and classifications. We performed Chi Square (x2) test, variance (ANOVA) and Logistic Regression Analy­sis with the statistical importance of P≤ 0.05. The respondents'' BPs showed an increase with age (P< 0.001, for each one). 56.7% of the study group had high BP. An advanced age (P< 0.001), obesity (P< 0.001), family history (P< 0.01), smoking (P< 0.01), hypercholesterolemia (P< 0.01), and not having health insurance (P< 0.01) were all deemed important risk factors for hypertension (P< 0.001). 6.6% of women had not had their BP previously measured. 24.5% of whose BP was high were not aware of their high BPs. The number of the respondents at risk to hypertension was high and many people reported that they were un­aware of hypertension and its risk factors. This shortfall in information and knowledge needs to be addressed by health edu­cation programs such as BP screening studies and periodical examinations targeting those at higher risk.

Abstract: Although cockroaches are mechanical vector of many pathogens, still biological transmission of pathogens via these insects is controversial. More covenant immune defense in the hemolymph of cockroaches may take this ad­vantage to block any adaptation of pathogens regarding to biological transmission. Lectin molecules in hemolymph of in­sects play as mediators of nonself recognition, in the innate immune response. Initially, lectin-carbohydrate interactions in hemolymph of American cockroach, Periplaneta, americana, have been investigated and then as a model, non pathogenic soil bacterium, Streptomyces griseus was used to specify the cock­roach hemolymph reaction. The results showed that the hemolymph lectin activities were inhibited with GlcNAc, galactose, mannose, arabi­nose, and fucose but not with fructose, lactose and glucose. Also, S. griseus cells were agglutinated with the cockroach hemo­lymph while in the presence of fructose, mannose and galactose, the agglutinin activities were inhibited. Introducing the soil bacterium, S. griseus, into the hemolymph increased both the lectin activities as well as the number of hemocytes from an average 101 to 2688 cells per milliliter hemolymph 6 days after injection. At the same time, the number of pro­hemocytes in the hemolymph declined while the granular cell numbers rapidly increased. Generally injecting S. griseus into the cockroach body resulted in a positive correlation between an increase in hemo­lymph titers and enhancement of hemocyte numbers. The results tentatively support the idea that soluble and/or cell-asso­ciated lectins may be involved in immuno-recognition in insects and block biological transmission of pathogens.

Abstract: The study aims at clarifying prevalence of work-related musculoskeletal disorders (WMSDs) among steel mak­ing workers and employees as well as associated lost work days. A detailed questionnaire based on Nordic ergonomic questionnaire describing work history, ergonomic condi­tions at work, sign and symptoms of musculoskeletal system with in previous12 months was applied to the investigation among1030 male workers and employees in a steel making plant in Isfahan, Iran, 2004. The prevalence of low back pain ranked top, regardless of job titles followed by knee pain. The age groups (24-35) and (34-45) manifested the most frequent number of (MSDs) and MSDs related lost workdays. This is almost in harmony with the prevalence of MSDs among general population and statistics presented by Bu­reau of Labor Statistics, the U.S Department of Labor.

Abstract: Fatigue identified as the most prevalent, disturbing and disabling symptom that has profound impact on quality of life in patients with breast cancer receiving chemotherapy. In these patients, unnecessary bed rest and prolonged sedentariness can potentially contribute significantly to the development of fatigue, so this study was carried out to investigate and determine the effect of designed exercise program on fatigue in women with breast cancer receiving chemotherapy. This research was a quasi-experimental study with control and experimental groups carried out in cancer institute center of Tehran Imam Khomeini Hospital in 2006. The Piper Fatigue Scale used in order to measure subjective fatigue in behavioral, affective, sensory and cognitive dimensions before and after intervention. The intervention consisted of a designed exercise program at home 20 to 30 minutes every day, 3 to 5 days per week for 9 weeks (3 chemotherapy cycles). The control group during the study did not use any intervention except routine procedures. Data analysis showed that the posttest mean of fatigue in four dimensions (Behavioral, Affective, Sensory, and Cognitive) in the experimental group was lower than the control group. According to the results, the designed exercise program was effective in reducing fatigue in women with breast cancer receiving chemotherapy. Therefore, it can be used as an effective approach for reducing fatigue in cancer patients, and improving the patient''s quality of life.

Abstract: Backround: Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibi­otic treatment, but sporadic cases can occur. The purpose of this study was to investigate five tissue culture monolayers sen­sitivity in detection of C. difficile-toxin. A total of 402 stool samples from patients with nosocomial diarrhea hospitalized in three hospitals of Tehran Uni­versity of Medical Sciences (TUMS) were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA) and incubated in anaerobic conditions, at 37 °C for 4 days. Isolates were characterized to species level by con­ventional biochemical tests. Bacterial cytotoxicity was assayed on five tissue culture monolayers. Our findings show that of the total patients, 24 toxigenic C. difficile (6%) were isolated. All 24 C. difficile toxins showed cytotoxic effect at ³ 1:10 dilution on Hela, Hep2, Vero, McCoy and Mdck cells after 16, 20, 24, 24 and 30 hours, re­spectively. C. difficile toxin showed cytotoxic effect at ³ 1:100 dilutions only on Hela cell monolayer after 48 hours. Hela cell monolayer may be a satisfactory substitute for the detection of C. difficile toxin in clinical specimens.

Abstract: Enterococci are members of the normal gut flora and released into the environment via sewage outlets, where they can survive for long times. Infections with high-level gentamicin resistant (HLGR) enterococci are emerg­ing worldwide. HLGR enterococci have developed a resistance to most antibiotics commonly used for enterococcal in­fec­tions therefore; treatment of infections caused by HLGR enterococci is difficult. The present study investigated the dis­tribution and antibiotic resistance of HLGR Enterococcus faecium and E. faecalis isolates from raw wastewater sam­ples in Tehran. Raw wastewater samples were collected during the period from November 2006 to May 2007 at 3 sewage treat­ment plants located in different parts of Tehran. All 90 HLGR enterococcal isolates were identified to the species level by biochemical and PCR assays and subjected to antibiotic susceptibility testing. Sixty four percent (58 of 90) of isolates were E. faecium and 29%(26 of 90) of them were E. faecalis. The high­est level of antibiotic resistance was observed with erythromycin (63%), co-trimoxazole (69%) and tetracycline (92%) for E.faecalis and with erythromycin (97%), ciprofloxacin (47%), co-trimoxazole (45.5%) and tetracycline (47%) for E. faecium. Multiresistance against 3 to 4 antimicrobial was present in 27.5% and 15.5% of the isolates, re­spectively. HLGR E. faecium were more commonly found than E. faecalis. Species identification of HLGR entero­cocci enables us to assess species-specific antibiotic susceptibility patterns in our area. The present study reviled that HLGR E. faecalis remained more susceptible than E. faecium against the usual first-line and alternative treatments.

Abstract: Paraoxonase-1(PON1), a high-density lipoprotein (HDL) associated enzyme, is believed to contribute in the patho­genesis of coronary artery disease (CAD). The aim of this study was to evaluate the association of PON1 promoter C (-107)T polymorphism with the extent of coronary artery stenosis in Iranian patients. The RFLP analysis for determination of the C(-107)T genotype distribution and measurement of serum PON1 ac­tivities (Paraoxonase and Arylesterase) were performed in 99 patients. They were undergone coronary angiography to deter­mine the number of stenotic vessels and classified into three groups: single vessel disease (SVD), two vessels disease (2VD) and three vessels disease (3VD). The C(-107)T polymorphism was significantly associated with serum arylesterase activity but not with paraoxonase activity. The CC and TT genotypes distributed inversely in SVD as compared with 3VD group. Moreover, the CC high activity genotype frequency decreased with increase of stenotic vessels in patients. The reduced arylesterase activity as a function from the weak promoter activity increases the stenosis severity, so that, we assume it is one of the progressive factors of atherosclerotic process in stenotic vessels.

Abstract: Malaria is a serious global health challenge. Mangalore, Karnataka, India is an endemic area for malaria and there has not been much research on this area. Thus it has been felt that this study will provide an insight into efficacy of the cur­rent malaria control programs and identifying targets for future educational campaigns and provide guidance for existing pro­grams. The study was community based descriptive study and the data were collected by interviewing the subjects who had malaria infections in the last 12 months. The study duration was 24 months. Two hundred and five individuals >= 15 years of age and who had at least 1 episode of malaria in the past 12 months were interviewed. Within the study population, 80.5% of the subjects correctly identified mosquitoes as the source of malaria. Seventy one percent of the interviewed subject completed the full course of medicine prescribed to them. Eighty one percent of the respondent said that no health education was given to them regarding prevention of malaria majority of the respondents spent between $10 to $30 for treatment of malaria. The malaria awareness campaign should be intensified as not all the people are aware to the cause of malaria and compliance to the treatment has to be increased by sensitizing the patients.