International Journal of Preventive Medicine
Volume:3 Issue: 4, Apr 2012

Cardiovascular disease (CVD) is the driving force behind the discrepancy in life expectancy between indigenous and nonindigenous groups in many countries. Preceding CVD many indigenous groups exhibit a cluster of cardiometabolic risk factors, including overweight-obesity, diabetes, high cholesterol, and high blood pressure. In turn, modifiable lifestyle risk factors contribute to the development of this cluster of cardiometabolic conditions. Modifiable lifestyle risk factors include, but are not limited to, physical inactivity, poor nutrition, excessive alcohol consumption, and cigarette smoking. Notably, these metabolic and lifestyle risk factors are relatively simple to monitor and track. The current review will look at modifiable cardiometabolic (overweight-obesity, diabetes mellitus, high cholesterol, and high blood pressure) and lifestyle (physical inactivity, poor nutrition, risky alcohol behavior, and cigarette smoking) risk factors among indigenous populations from Australia (Aboriginal Australians and Torres Strait Islanders), New Zealand (Māori) and the United States (Native Americans). Discussion will focus on the causal relationship between modifiable lifestyle risk factors and cardiometabolic outcomes, as well as, simple measurements for tracking these risk factors.

The students’ vulnerability to different problems can have an impact on their mental health. Regarding the lack of evidence on the effectiveness of interventional programs based on health education planning models in this area in developing countries, an educational-participatory program based on the PRECEDE model was used, to promote the medical science students’ self-esteem and mental health status, in Iran. In this experimental study, 154 students from the universities of medical sciences in the north east of Iran were selected by stratified random sampling method. Then, they were randomly assigned to two groups of case and control. The questionnaires, including the enabling, reinforcing, and predisposing factors, the Rosenberg self-esteem scale, and the GHQ-28 were used for data collection. Then, an intervention plan, including focus group discussions and training of selected life skills, based on the PRECEDE model, was conducted for the case group. The predisposing, reinforcing, and enabling factors,and the self-esteem and mental health of the students showed a significant difference between the case and control groups. The Pearson correlation coefficient showed that there was a correlation between mental health and knowledge (P =0.008), between self-esteem and knowledge (P =0.02), self-esteem and attitude (P =0.01), and mental health and attitude (P = 0.03). Health promotion planning by using life skills training based on the PRECEDE model can result in participation and empowerment, in order to promote the self-esteem and mental health of the students.

Dietary Guidelines are considered as a useful tool for the promotion of healthy dietary behaviors. In Iran, despite the development of the latest National Food‑Based Dietary Guidelines, in 2006, it has not been introduced at the community level yet. The present study aims to evaluate the effectiveness of an intervention program to promote Iran’s Food‑Based Dietary Guidelines (IFBDGs) in urban adult women. A sample of 435 healthy women, aged 26 to 54 years,was randomly assigned to the intervention or control groups.The intervention group was designed based on the Health Belief Model (HBM). Each subject in the intervention group received three sessions of group education on IFBDGs and the food guide pyramid and participated in a healthy cooking class. Dietary intake, cognitive outcomes related to the constructs of the HBM, physical activity, and the BMI were measured in both groups before, immediately, and one month after the intervention. The outcome measures were compared with the analysis of covariance (ANCOVA), by adjusting for baseline values. The intervention group had a significantly lower total daily energy intake than the control group after the intervention (P=.000). The adjusted differences in the changes of body mass index from the baseline were significant in both post intervention measurements in the intervention group compared to the controls. The intervention designed based on the Health Belief Model was effective in improving the adherence to FBDGs and could serve as a basic model for the promotion of healthy nutrition behavior among women in the primary health care setting.

This study was performed to find out whether transcutaneous bilirubinometry could be a valid screening method for hyperbilirubinemia in preterm infants, especially for those who needed mechanical ventilation. We evaluated 63 preterm Iranian newborns who were managed in the neonatal intensive care unit of Shahidbeheshti University Hospital, Isfahan, Iran from April 2009 to April 2010.Transcutaneous bilirubin (TCB) measurements were obtained using BiliCheck™ shortly before or 10 minutes after taking blood for determination of the plasma bilirubin level in premature newborns, who did not receive phototherapy. We assessed the correlation between the transcutaneous bilirubin and plasmabilirubin level by linear regression analysis. We also analyzed the gestational age, birth weight, postnatal age, sex, and hematocrit, for determination of their effect on transcutaneous bilirubin accuracy. The overall bilirubin concentration ranged from 5.4 to 17 mg/dL and from 4.8 to 17.3 mg/dl for total serum bilirubin (TSB) and transcutaneous bilirubin, respectively. The mean values obtained by transcutaneous bilirubinometry were slightly higher than the total TSB values. The correlation coefficient between TSB and TCB was r=0.82, P<0.001, and this was not influenced by gestational age, postnatal age or hematocrit, which were previously considered to be important. The correlation coefficient between TSB and TCB in mechanically ventilated preterm infants was r=0.75, P<0.001. Plasma bilirubin level can be accurately measured by BiliCheck™ in premature newborns, even in newborns who need mechanical ventilation.

Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran (Guilan) during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its’ occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an “epidemic investigation” and a cross sectional descriptive one. Clinical data and para‑clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah (western Iran). The mean age was 21.65, (SD=12.44). Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1‑2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% (SD=26). The patients’ Enzyme Linked Immunosorbent Assay (ELISA) and Counter Current Immuno‑electrophoresis (CCIE) serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten‑year clinical and laboratory follow‑up revealed no evidence of abnormality in treated patients. It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks.

Iron deficiency anemia (IDA) is one of the well recognized presentations of celiac disease (CD). According to the lack of data from our population in this regard, we determined the prevalence of CD in patients presenting with IDA to see if it is worthwhile to do a precise screening for CD in such patients. This cross-sectional study was conducted on patients referred with IDA to Poursina Hakim Gastroenterology Clinic, Isfahan (IRAN). All included patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Also, patients were evaluated for IgA anti-tissue transglutaminase (t-TG) antibody with enzyme-linked immunosorbent assay (ELISA) technique. CD was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten free diet (GFD). During the study, 130 patients with the mean age of 35.5±13.7 (67.7% female [20.4% post-menopausal]) were undergone seropathological studies. According to histopathological study and a clinical response to GFD, 13 patients (10%) were ultimately diagnosed with CD. Nine patients (6.9%) were seropositive, from which, five patients (3.8%) were ultimately diagnosed as CD cases. IgA anti-tTG became negative in all of these patients after six months of GFD. CD should be considered in any adult patient presenting with unexplained IDA, even if not accompanied with gastrointestinal symptoms. Routine duodenal biopsy performed during diagnostic upper gastrointestinal endoscopy is worthwhile in order to investigate for CD as an underlying cause of IDA in adult patients.

Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo. We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country. The results show that there are variations in the use of antenatal care and delivery care. Individual‑level characteristics, such as women’s occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility‑based delivery has been seen to be dependent on the household wealth status, women’s education, and partner’s education. The effect of the neighborhoods’ socioeconomic disadvantage on the use of antenatal care and facility‑based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake. Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.

Vitamin B12 (Cobalamin) deficiency can result in some clinical and paraclinical characteristics similar to what is seen in multiple sclerosis (MS) patients. This study aimed to evaluate the controversial association between vitamin B12 deficiency and MS. We measured serum vitamin B12 in 60 patients with MS and 38 healthy controls. Clinical disability was evaluated according to the Extended Disability Status Scale (EDSS). Serum B12 concentration was measured with Radioimmunoassay Dual Isotope method. The cutoff value for low serum vitamin B12 concentrations was 75 pg/mL. Patients were in remission at the time of blood draw. There were 13 (21.6%) MS patients and 10 (26.3%) controls with low serum B12 concentration with no significant difference between the groups; P>0.05. The mean serum vitamin B12 concentration in MS patients (108.9±45.3 pg/mL) was not significantly different compared with controls (98.9±44.4 pg/mL); P=0.284. Likewise, there was no correlation between the concentration of serum vitamin B12 and disease’ age of onset,duration, subtypes, or disability status. In contrast to some previous reports, our findings did not support any association between B12 deficiency and MS.

Behavioral science experts believe that all entities capable of stimulating a person can be addictive; and whenever a habit changes into an obligation, it can be considered as an addiction. Researchers also believe that there are a number of similarities as well as some differences between drug addiction and behavioral addiction diagnostic symptoms. The purpose of this study is to consider different approaches in this field. This is a descriptive research using content analysis method. First, differences and similarities of various perspectives on addiction and addiction behavior in different substances were obtained, thereafter, the data was coded and categorized, subjects were discussed and major issues were extracted. Behavioral addiction such as internet addiction is similar to drug addiction except that in the former, the individual is not addicted to a substance but the behavior or the feeling brought about by the relevant action. In addition, the physical signs of drug addiction, are absent in behavioral addiction. Others have stated that behaviorally addicted individuals have certain symptoms and will undergo the same consequences brought about by addiction to alcohol and drugs as well as other obsessive behaviors. Similar to substance abuse prevention, programs aimed at addicted individuals and specialized training can educate adolescents about the warning signs of online addiction, in order to assist the early detection of this disorder. For prevention of behavioral addiction (such as internet addiction) authorities, cultural institutions and parents should monitor the use of internet and teach to the adolescent and children, the useful and appropriate methods of internet use.

We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery – the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase.To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

I read the recent publication on children contacting with smear positive tuberculosis patients with great interest.[1] Aminzadeh et al. concluded that the ‘Strategy of six months of supervised isonicotinylhydrazine (INH) chemoprophylaxis is successful, particularly in children who are at high risk to progress to the disease, following exposure.[1] I agree with the usefulness and effectiveness of such a practice. However, I am concerned about the possible side effects of chemoprophylaxis on the children. A further cost-benefit weighting study is warranted.