Iranian Journal of Public Health
Volume:39 Issue: 2, Summer 2010

Alzheimer''s disease as a neurodegenerative disorder is the commonest type of dementia. A growing number of genes have been reported as the risk factors, which increase the susceptibility to Alzheimer''s disease. Apolipoprotein E (APOE), which its ε4 allele has been reported as a risk factor in late onset Alzheimer''s disease (AD), is the main cholesterol carrier in the brain. The main goal of this study was to assess the role of APOE genotypes and alleles in AD in Iranian population. This study was performed in Tehran, Iran from 2007 to 2008. Totally, 154 AD cases and 162 control subjects from Iranian population were genotyped for APOE using PCR method. Genotype and alleles frequencies for APOE were calculated and compared between AD case and control subjects by χ2 or Fisher''s exact test. Type one error assumed less than 0.05. The frequency of ε2ε3 genotype was significantly higher in control subjects than AD patients was (13.5% versus 5.2%, P< 0.05) and ε3ε4 genotype frequency was significantly higher in AD cases compared with control subjects. APOE -ε2 allele frequency in cases was lower than that of control subjects but this difference was not significant (4.2% versus 7.7%). It seems that individuals carrying ε4 allele, develop AD 6.5 times more than non-carriers do (OR= 6.566, 95% CI= 2.89-14.92). It has been reported that ε4 allele acts in dose- age-dependent manner but we have shown that the risk of developing AD in male APOE -ε4 allele carriers is higher than that of female ε4 carriers.

A new biological domestic wastewater treatment process, which has been presented these days in activated sludge modification, is Upflow Sludge Blanket Filtration (USBF). This process is aerobic and acts by using a sludge blanket in the separator of sedimentation tank. All biological flocs and suspended solids, which are presented in the aeration basin, pas through this blanket. The performance of a single stage USBF process for treatment of domestic wastewater was studied in laboratory scale. The pilot of USBF has been made from fiberglass and the main electromechanical equipments consisted of an air com pressor, a mixing device and two pumps for sludge return and wastewater injection. The wastewater samples used for the experiments were prepared synthetically to have qualitative characteristics similar to a typical domestic wastewater (COD= 277 mg/l, BOD5= 250 mg/l and TSS= 1 mg/l). On the average, the treatment system was capable to remove 82.2% of the BOD5 and 85.7% of COD in 6 h hydraulic re tention time (HRT). At 2 h HRT BOD and COD removal efficiencies dramatically reduced to 50% and 46.5%, respectively. Even by increasing the concentrations of pollutants to as high as 50%, the removal rates of all pollutants were re mained similar to the HRT of 6 h.

Screening of students´ health problems could lead to timely prevention and control of many health disorders. This study aimed to determine the nationwide prevalence of common disorders through school health screening program in Iran This cross-sectional national screening program was conducted in 2007-2008 among first- and third-grade- stu dents in primary schools, first- grade-students of middle and high schools of all provinces in Iran. Data were obtained from 3,124,021 (81.9%) students reported from the whole country classified into 33 geographi cal zones. Of total students studied, 12.48% had weight abnormalities, 4.77% had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Among students studied, 0.4%, 0.7%, 0.4% and0.8% had endo crine, psychological, neurological and genitourinary disorders, respectively. In addition, 2.1%, 1.9%, 1.8%, 0.8%0.5%, 0.3% and 0.3% of students had ear, nose & pharynx disorder, anemia, skin & hair, cardiac, abdominal, vertebral and lung prob lems, respectively. In elementary schools, 57.6% of first-grade- students with at least one disorder were managed in outpa tient settings and 6% of them were hospitalized for more investigation. Among third- grade- students of elementary schools, these values corresponded to 13.2% and 1.1%, respectively. Among first grade students of middle and high schools, this prevalence was 58.5% and 44.6% and 1.2% and 0.3% of students were hospitalized for more investigation. This integrated school screening program revealed a considerably high prevalence of health disorders among school students. These results might help health policy makers to design future health promoting programs.

More than 8% of Iran''s populations are elderly. The greatest challenge in this generation is improvement of health and quality of life. So we decided to perform an interventional study with the aim of promoting the health of the eld erly. This study was a community interventional in Ekbatan Complex. Subjects were elderly. At first, need assessment was done with the participation of 200 elderly by questionnaire. Based on the need assessment, we designed the educational inter ventions in different fields such as nutrition, mental health, and exercise and then, we compared the results. 0ne hundred elderly participated as interventional group. There were 86% women and 24% of men. Almost 59% were in the 60-69 age group. More than ¼ of the subjects were univer sity graduates. Pre and post interventional groups were matched in age, education and gender. Regarding nutrition, second priority food in women aged 60-69 was rice and after the intervention, it was changed to vegeta bles (P= 0.05) but in other age groups and in the men''s groups no difference were noted.Aerobic exercises in women has increased after the intervention (P= 0.01). With regards to mental health, life satisfaction among women under study has increased from 68% to 90% after the intervention (P= 0.01). Feeling happy most of the time has increased from 53% to 83% in women aged 60-69 (P= 0.01) and in men from 64% to 83% (P= 0.05) respectively. Policymakers should design long-term educational programs to promote the elderly lifestyles.

Aflatoxins cause health hazards to human and animals and has also economical problems. Therefore, the de toxification effect of citric acid was investigated in rice as the main food of Iranian people. Initially 275 samples of rice were examined for aflatoxins by HPLC. The aflatoxins contaminated samples were later treated by aqueous citric acid and detoxification of aflatoxins were quantified using HPLC. Among the 275 samples analyzed, aflatoxin B1 and aflatoxin B2 were detected in 211(76.72% of total) samples. Afla toxin B1 was detected in 203(73.82% of total) samples with a mean and standard deviation of 2.3±10.21ppb. Aflatoxin B2 together with aflatoxin B1 were detected in only 8(2.91% of total) samples with a mean and standard deviation of 1.38±2.7ppb of aflatoxin B2 and 2.99±1.56 of aflatoxin B1 respectively. Aflatoxin B1 level in 5 samples (1.82%) was above the maximum tolerated level of aflatoxin B1 in Iran (5ppb). However considering the Iranian maximum tolerated level for aflatox ins in rice (30ppb), only 3(1.09%) samples were above the 30ppb and also in regard to the European maximum toler ated level for aflatoxins in rice (4ppb), only 9(3.27%) samples were considered as higher than 4ppb. The HPLC assay showed that although aflatoxins with a concentration of <30 and <4 ppb in the rice samples were completely degraded, but 97.22% degradation occurred in rice contaminated with ³30 and ³4ppb when treated with 1N citric acid. These results revealed the efficacy of 1N citric acid in reducing aflatoxins levels in rice.

Availability of antiretroviral therapies has transformed AIDS into a manageable chronic condition and im proved well-being among people living with HIV/AIDS (PHA) in developed countries. In developing countries however, such transformations are yet to occur due to socio-economic, systemic and environmental constraint. This study examined the impact of social, economic, psychological and environmental factors on health and wellbeing among PHA living in south west Nigeria. Using qualitative participatory methodology, 50 HIV positive people, 8 health personnel and 32 care providers were interviewed to explore how care and social support affect wellbeing among PHA in view of constraints to accessing antiretro viral drugs. Analysis of data used the grounded theory (GT) approach to identify themes, which are considered cru cial to the wellbeing of PHA. The findings highlight several factors, apart from antiretroviral drugs, that impact the wellbeing of PHA in south west Nigeria. These include concerns about deteriorating physical health, family and children''s welfare, pervasive stigma, finan cial pressures and systemic failures relating to care among others. We describe how psychosocial and social support struc tures can considerably contribute to improving health outcomes among them because of how they affect the function ing of immune system, self-care activities and other illness behaviours. We recommend that interventions should address the psychosocial, socio-economic and other systemic issues that negatively influence the wellbeing of PHA and governments need to strengthen the policy environment that empowers PHA support groups.

Successful treatment to eliminate HCV RNA depends on the identified genotype. In the present study, we com pared the frequency of different HCV genotypes, during four years study (2004 till 2008). Sera specimens were received from 16 provinces of Iran. We used High Pure Viral Nucleic Acid Purification kit for extraction and samples were tested with improved form of RT-PCR technique. HCV genotypes were determined using Am plisense PCR kit and Amplicor HCV Monitoring Version 2 test utilized a reverse transcription (RT)-PCR approach to quan titative HCV RNA. Two hundreds six HCV positive specimens were entered to the study out of 389 tested samples. Type 3a was the most frequent type (46.6%), followed by type 1 (including 1a and 1b with 25.73% and 17.47% for each respectively) with 43.2%. Looking through collected results of the four years study confirmed the rate of HCV infec tion in those single genotypes 1b, 3a were slightly increased from 12.22% and 38.88% in the first year to 18.66 and 46.51% in the fourth year of the study period. The analyzed data proved that some patients were infected with two different types. High viral load was also more correlated to genotype 1 than other types.

The aim of the study was to determine the incidence of non-bacterial acute gastroenteritis associated with diar rheal diseases in Mazandaran Province, northern Iran. A total of 400 symptomatic cases from patients with acute gastroenteritis from Mazandaran Province in Iran were screened using EIA method for the presence of rotavirus, adenovirus and astrovirus during 2005-2006. Chi-square tests were used for testing relationships between different variables. Rotavirus, adenovirus and astrovirus were detected in 62%, 2.3%, and 3% of samples, respectively. The maximum rate of rotaviruses was detected in the <1-year-old age group, while minimum rate was found in the 10 years and older age group. Astrovirus and adenovirus were detected predominantly in the 2-5-year-old age group of children, with a prevalence of 8.3% and 3.5% respectively. All studied viral gastroenteritis peaked in the winter, and minimum rate were found in summer. Our statistical analyzes indicated that viral gastroenteritis, especially Rota-viral, had the highest number of occurrences in colder seasons notably in winter and more frequently were observed among younger children.

The need to provide high quality prenatal care services, which take account of women''s views and specifi cally address their need for information, support and communication, has been advocated and group prenatal care, had been sug gested as one of the ways to achieve this objective. The purpose of this study was to examine the impact of group versus in dividual prenatal care on satisfaction and prenatal care use. This was a cluster-randomized controlled trial with the health center as the randomization unit that conducted in 2007. Satisfaction was measured through a standardized questionnaire, and the Kotelchuck Adequacy of Prenatal Care Utili zation Index was used to measure prenatal care utilization. We recruited 678 women (group prenatal care, (N= 344) and individal prenatal care, (N=334) in the study. Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evalu ated, including information, communication, co-ordination and quality of care. Group care women were significantly more likely to have adequate prenatal care than individual care women were (OR=1.35 95% CI=1.26-1.44). Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utili zation. This model of care has implications for the planning and provision of prenatal services within public health sys tem, which is moving toward a better quality health care, and increasing use of services

Acinetobacter spp. is characterized as an important nosocomial pathogen and increasing antimicrobial resis tance. Our aim was to evaluate antimicrobial susceptibility and aminoglycosides resistance genes of Acinetobacter spp. iso lated from hospitalized patients. Sixty isolates were identified as Acinetobacter species. The isolates were tested for antibiotic resistance by disc diffu sion method for 12 antimicrobials. The presence of aphA6, aacC1 aadA1, and aadB genes were detected using PCR. From the isolated Acinetobacter spp. the highest resistance rate showed against amikacin, tobramycin, and cef tazidim, respectively; while isolated bacteria were more sensitive to ampicillic/subactam. More than 66% of the isolates were resistant to at least three classes of antibiotics, and 27.5% of MDR strains were resistant to all seven tested classes of antim icrobials. The higher MDR rate presented in bacteria isolated from the ICU and blood samples. More than 60% of the MDR bacteria were resistance to amikacin, ceftazidim, ciprofloxacin, piperacillin/tazobactam, doxycycline, tobramycin and levofloxacin. Also, more than 60% of the isolates contained phosphotransferase aphA6, and acetyltransferase genes aacC1, but adenylyltransferase genes aadA1 (41.7%), and aadB (3.3%) were less prominent. 21.7% of the strains contain three aminogly coside resistance genes (aphA6, aacC1 and aadA1). The rising trend of resistance to aminoglycosides poses an alarming threat to treatment of such infections. The find ings showed that clinical isolates of Acinetobacter spp. in our hospital carrying various kinds of aminoglycoside resis tance genes.

Mutations in β-globin gene may result in β-thalassemia major, which is one of the most common genetic dis or ders in Iran and some other countries. Knowing the beta-globin mutation spectrum improves the efficiency of prenatal diagno sis in the affected fetuses (major β-thalassemia) of heterozygote couples. Couples with high hemoglobin A2 and low mean corpuscular volume were studied as suspicious of β-thalassemia carri ers in Genetic Laboratory of Afzalipour Hospital, Kerman, Iran. We used amplification refractory mutation system, re verse hybridization, and DNA sequencing to determine the spectrum of β-globin gene mutation in the people who involved with β-thalassemia minor in this province. Among the 266 subjects, 17 different types of mutation in β-globin gene were identified. Three of the mutations ac count for 77.1% of the studied cases. IVSI-5(G> C) was the most frequent mutation (66.2%) followed by IVSII-I (G> A) (6%) and Fr 8-9 (+G) (4.9%). The less frequent mutations include: IVSI-6(T> C), codon 15 (G>A), codon 44 (-C), codon 39 (C>T), codon 8 (-AA), codon30 (G> C), IVSI-110 (G > A), codon 36-37 (-T), 619bp deletion, codon 5 (-CT), IVSI-25bp del, codon 41-42(-TTCT), IVSI-I (G> A), and βnt30 (T>A) were accounted for 19.5%. Unknown alleles comprised 3.4% of the mutations. However, the frequencies of different mutations reported here are significantly different from those found in other part of the world and even other Iranian provinces. Reporting a number of these mutations in the neighboring coun tries such as Pakistan can be explained by gene flow phenomenon.

The aim of the study was to compare the effects of ''face-to-face education'' and ''educational movies'' on ''knowledge'' and ''practice'' of women of child-bearing-age, in terms of health-care during pregnancy and during infancy in a suburban region near Tehran City, Iran. In this quasi-experimental study, the sample included 873 married women. Questionnaires for knowledge and practice assessment were designed. The women were assigned to three groups: control (group I), face-to-face education (group II), and educational movie (group III). Knowledge questionnaires were completed before and immediately after in tervention. Practice questionnaires were completed before and three months after intervention. Both questionnaires con sisted of two types of questions: type A (concerning infant care issues) and type B (concerning prenatal health care). There was a significant differenc in post-test knowledge between groups I and II and between groups I and III, but not between groups II and III. In terms of post-test practice, the changes were determined for every individual question, and significantly, better results were seen in group II, especially concerning type B questions. Face to face education lead to better practice than educational movies. In addition, significantly better practice occurred regarding child health care issues rather than prenatal issues in both groups. Realistic and tangible issues, those easy to practice, and with little or no economical burden imposed on the family, progressed from the knowledge state to the practice state more successfully in both groups.

The WHOQOL-BREF is one of the best-known instruments that have been developed for cross-cultural compari sons of quality of life and currently it is available in more than 40 languages. Current study was done to provide: (1) the psychometrics properties of the Iranian version of WHOQOL-BREF and (2) the norm scores for satisfaction with life over all and satisfaction with specific Life domains of Iranian students. A sample of 1000 Iranian undergraduate students, (Males= 490 and Females= 510) were pooled using multi-stage random method and asked to complete the Iranian version of the WHOQOL-BREF. The results of current study indicated that a good internal consistency () for WHOQOL-BREF (26 items) as well as four domain ratings. Our findings also showed no floor or ceiling effect for the 4 domains as well overall QOL and general health facets. Moreover, General norms for the satisfaction with life overall, general health and satisfac tion with spe cific life domains (physical health, psychological well-being, social relationships, and environmental support) were ob tained using WHOQOL-BREF. The Iranian version of WHOQOL-BREF was deemed reliable in assessing the quality of life of a student popula tion in Iran. Our results of calculating and presenting norm scores for satisfaction ratings can be used as preliminary Ira nian stu dents'' norms for those researchers who are interested in measuring and interpreting satisfaction ratings using WHO QOL-BREF

All over the world motorcycle accident are one of the major causes of road death and injury. This study aimed to determine the pattern of Motorcycle Fatal Accidents in Mashhad-Iran. This descriptive cross-sectional study was carried out in 2006 to analyze the epidemiological pattern of the mo tor cycle accident in Mashhad, North-Eastern Iran. Three hundred fifty cases of motorcycle accidents were included. Data gath ering tool was a standard questionnaire. The compiled data were analyzed using SPSS11 and χ 2 test. The significance level was considered 0.05 in all statistical tests. In the time span of the study, 350 cases of motorcycle accident occurred, most of which happened at 8pm to 12pm. In 119 cases, the motorcyclist was the blameful rider. Generally, 84.2% of the motorcycle riders did not have safety hel mets. About two third of blameful motorcycle riders (63.1%) were less than 25 years old. The major cause of the accidents (55.1%) was due to neglecting the Yield Right of Way. Motorcycle riders endanger pedestrian, other drivers, passengers and their own life. Paying attention to cultural and instructional issues of correct motorcycle riding and performing appropriate monitor ing in traffic and transportation system such as honoring our and others safety and setting limitations on using this vehi cle by the youth is of great importance.

Heterogeneity is usually a major concern in meta-analysis. Although there are some statistical approaches for as sessing variability across studies, here we present a new approach to heterogeneity using "MetaPlot" that investigate the influ ence of a single study on the overall heterogeneity. MetaPlot is a two-way (x, y) graph, which can be considered as a complementary graphical approach for testing hetero geneity. This method shows graphically as well as numerically the results of an influence analysis, in which Higgins'' I2 statistic with 95% (Confidence interval) CI are computed omitting one study in each turn and then are plotted against recipro cal of standard error (1/SE) or "precision". In this graph, "1/SE" lies on x axis and "I2 results" lies on y axe. Having a first glance at MetaPlot, one can predict to what extent omission of a single study may influence the over all heterogeneity. The precision on x-axis enables us to distinguish the size of each trial. The graph describes I2 statistic with 95% CI graphically as well as numerically in one view for prompt comparison. It is possible to implement MetaPlot for meta-analysis of different types of outcome data and summary measures. This method presents a simple graphical approach to identify an outlier and its effect on overall heterogeneity at a glance. We wish to suggest MetaPlot to Stata experts to prepare its module for the software.

The importance of accurate diagnosis of all of major diseases cannot be underestimated and efficient labora tory testing is vital to identifying and treating life-threatening illnesses including malaria. In this study, we compared the poten tial of one of merozoite surface protein genes, PvMSP-3ß, for detection of Plasmodium vivax in blood samples by PCR with routinely used marker, ssrRNA gene. One hundred P. vivax microscopy-positive blood samples were simultaneously tested with two genetic markers, includ ing PvMSP-3ß gene and ssrRNA gene by PCR and nestedPCR method, respectively, and their sensitivity and specific ity in detection of P. vivax was compared. An important difference was seen in sensitivity between the 2 genetic markers, 100% in case of ssrRNA gene vs. 95% of PvMSP-3ß gene. The specificity of the two markers was same (100%). Microscopic diagnoses of thick and thin blood smears was used as "golden standard" method. Due to critical importance of accurate detection of the parasite in malarious area, the PvMSP-3ß gene cannot be a suitable marker for detection of P. vivax in blood sample by PCR. More investigations are needed to find other valid markers.

Recent analyses of hospital outbreaks have documented the spread of resistance to imipenem, which is cur rently a major problem among gram positive and gram-negative bacteria. The aim of this study was to describe the rate of gram- positive and gram-negative isolates resistance to imipenem as an antibiotic. Recorded files of 242 hospitalized patients with at least one sample of positive culture specimens in one of the two general hospitals of Shahid Beheshti and Naghavi in Kashan, Iran in 2005 were randomly selected and reviewed. All strains were tested for antibiotic susceptibility by Disk Diffusion and were designated for imipenem. Escherichia coli (21.9%), Kelebsiella (19.8%) and coagulase-negative Staphylococci (17.8%) were the most com mon isolated organisms. Imipenem had coverage against 96.2% of Escherichia coli, 58.4% of Kelebsiella, 79.1% of coagu lase-negative Staphylococci, 81.8% of Pseudomonas aeruginosa, and 85.7% of Entrococci isolates. Proteus and Salmonella iso lates susceptibility to imipenem was 100%. Susceptibility of Escherichia coli, Salmonella and Proteus to imipenem is satisfactory; however, the susceptibility of Pseudomonas aeruginosa to this antibiotic was dramatically lower in our region. Because of the major health problems caused by imipenem resistance, attempts have been made to organize a national surveillance program in our country.