International Journal of Preventive Medicine
Volume:3 Issue: 10, Oct 2012

Review of Iran’s experiences regarding health following Islamic Revolution suggests that two major events influenced on health system structure; establishment of Primary Health Care (PHC)[1] and integration of medical education in former ministry of health and formation of Ministry of Health and Medical Education (MOHME).[2] Both of these important developments began in the first decade after the revolution resulting from immediate needs of the country and spirit of social justice that dominated the country. In fact, these two major events occurred for development of health services to disadvantages parts of the country, especially rural and remote areas, as well as provision of human resources for delivering necessary health services. Outcome of development, in various social and economical aspects, and interventions in the health system had sharp improvements in important health indicators such as maternal mortality,[3] life expectancy,[4] control of infectious diseases[5] and provision of manpower.[6]

Originally، public health actions turned to the living conditions that prevented the development of countries in the process of increasing urbanization، especially protecting their workers and tackling economic losses. The actions were primarily directed to infectious diseases. Today، the process of urbanization in most countries of the world is consolidated، and new health problems that affect communities’ quality of life should be addressed، with special attention to non-communicable-diseases (NCDs) (Beaglehole et al.، 2011). [1] Among NCDs، mental disorders are highly prevalent and the gap between this fact and the low proportion of individuals that receive proper care، mainly in low- and middle income countries، has been pointed by World Health Organization (WHO) (WHO، 2010). [2] In this October، 10th day is being commemorated the 20th anniversary of World Mental Health Day [3] and it is timely discuss effective and practical solutions to take care of that gap.

Service-learning is a type of experiential teaching and learning strategy combining classroom instruction and meaningful community service and guided activities for reflection. This educational approach has been used frequently in higher education settings, including an array of disciplines such as medicine, theology, public health, physical education, nutrition, psychology, anthropology, and sociology. The purpose of the present review paper was to provide guidance on the use of service-learning within higher education, relevant to the preventive medicine and public health topics of healthful eating, physical activity, and obesity prevention. In service-learning, coursework is structured to address community needs, and to benefit students through the real-world application of knowledge. The benefits for students include positive impacts on social skills, empathy, awareness, understanding, and concern regarding community issues, plus greater confidence and skills to work with diverse populations, increased awareness of community resources, improved motivation, and enhanced knowledge. Educational institutions may also benefit through improved “town and gown” relations, as strong ties, partnerships, and mutually beneficial activities take place. The present literature review describes several servicelearning applications such as nutrition education for kids, dietary improvement for seniors, foodservice recipe modification on a college campus, an intergenerational physical activity program for nursing home residents, motor skill development in kindergarteners, organized elementary school recess physical activities, health education, and obesity prevention in children. From this review, service-learning appears to have great potential as a flexible component of academic coursework in the areas of preventive medicine and public health.

Body mass index (BMI) before pregnancy and weight gaining during pregnancy affect infant birth weight and are associated with unfavorable pregnancy outcomes. The aim of this study was to describe the weight gain pattern of Iranian pregnant women according to the BMI status at the beginning of pregnancy. This was a longitudinal cross sectional study. A total of 500 pregnant women in 6th-10th weeks of pregnancy were enrolled and followed up through delivery. Body mass index categories based on first visit weight and total weight gain were calculated. The multiple analysis of variance (MANOVA) was used to compare the mean values of gestational weight gain. At the first care, those with underweight, normal, overweight and obese accounted for 10.7%, 46%, 35.9% and 7.4% of all participating women, respectively. Most of the subjects were in normal range of BMI (46%) at the beginning of the study. As BMI was more at the first visit, the recommended amount of weight gain was less achievable (70% versus 27%). Although the average weight gain in obese women was less than other groups (9±7.9), about 55% of them were over the recommended standards of weight gain. In conclusion, in spite of frequent visits during pregnancy, only half of pregnant women had normal weight gain and most of them had normal BMI at the first visit. This study highlights the importance of considering women with abnormal pre pregnancy BMI and gestational weight gain at an increased risk and providing appropriate care for them to prevent future adverse outcomes.

Thalassaemia is one of the most common Mendelian disorders in Mediterranean area. Iran has about 26,000 Thalassaemic patients, so it is one of the most affected countries. The aim of this study was to evaluate the screening program and cost analysis of Thalassaemia prevention program in West-Azerbaijan province of Iran. This study evaluated the efficacy of Health system’s Thalassaemia prevention program with a sensitivity analysis for its costs. The second five years of the program was evaluated. The economic burden of Thalassaemia is determined by the birth prevalence of the affected infants and the cost that is accrued to treat the infected individuals and was compared with the total cost of screening the couples for thalassemia trait. The average incidence rate of major Thalassaemia was 19.8 per 100,000 live births and mean coverage rate of program was 74%. The rate of canceling the marriage among carrier couples was 53%. Cost analysis showed that the cost of screening and prenatal diagnosis program was much lower than the cost of treatment in potential thalassaemic patients. The prevention program of Thalassaemia including a premarital and pre-natal screening in west Azerbaijan province is demonstrated to be cost-effective. Taking some actions in order to increase the coverage of pre-marital screening, providing prenatal diagnosis in private and public sector, complete insurance coverage for the high-risk couples to perform the investigations more easily, were recommended.

Knee joint osteoarthritis (OA) is one of the most incapacitating diseases affecting older population, which is associated with pain and functional limitation. Various kinds of conservative treatment have been used to decrease knee pain and to improve the quality of life of the subjects suffering from this disease. There are discrepancies in the clinical effects reported for the use of lateral wedge insole in spite of being used as one of the first conservative mechanical treatments for patients with medial compartments of knee OA. A total of 36 subjects with medial knee compartment OA were recruited in this research project. Subjects were randomized into two groups to receive 3- and 7-mm lateral wedge insoles based on the date of birth of the participants. Some parameters such as severity of knee pain, Tibiofemoral angle (TFA), severity of OA, and quality of life were selected in this research project. The use of both 3-mm and 7-mm lateral wedge insole improves the quality of life and decreases knee joint pain. However, the effect of 7 mm lateral wedge insole was more than that of 3 mm. Using lateral wedge insole is a simple, inexpensive therapy for decreasing pain and improving quality of life; however, most research must be carried out to find the effects of lateral wedge on severity of knee joint OA and aligning TFA.

Little experience exists on valid and reliable tools for assessment of the determinants of underweight and overweight in children and adolescents living in the Middle-East and North Africa (MENA). This study aimed to develop a valid and wide-ranging questionnaire for assessment of these parameters in a nationwide sample of Iranian children and adolescents. This national study was conducted in 31 provinces in Iran. The first phase consisted of focus group discussion with 275 children and adolescents and their parents. After a qualitative content analysis, the initial items were extracted. In the next step, the face validity was assessed by expert panelists using the quantitative method of the Impact Score. To assess the content validity, the content validity rate (CVR) and the content validity index (CVI) were determined. The internal consistency was examined by Cronbach alpha, and its test-retest reliability was determined. The socio-demographic variables, perinatal factors, lifestyle factors, family history, knowledge and attitude were assessed. Dietary intakes were assessed using a validated 168-item semi-quantitative food frequency questionnaire. A validated questionnaire for quality of life was filled in anonymously. A team of expert researchers conducted the data analysis of 576 interviews by using qualitative content analysis method. The analysis process began by determining the semantic units associated with the understanding of participants about the concepts studied. The initial questionnaire was developed in four domains by including Likert scale questions. In the face validity step, all questions of the primary questionnaire obtained a score of more than 1.5. In the phase of CVR assessment, 6 questions obtained a score of less than 0.62, and were omitted. The rest of questions were assessed for CVI, and got a score of more than 0.75. Cronbach’s alpha coefficient of the whole questionnaire was 0.97, and the Pearson correlation coefficient of the test–retest phase was 0.94. The developed questionnaire is a valid and reliable tool for assessment of the determinants of weight disorders in a nationally representative sample of children and adolescents in the MENA.

This study was performed to compare the effect of different doses of intrathecal meperidine on the incidence and intensity of shivering and other side-effects after spinal anesthesia for cesarean delivery. One hundred and fi fty-six parturient women scheduled for elective cesarean delivery were enrolled in four groups. Spinal anesthesia consisted of heavy bupivacaine 0.5% (10 mg) in the standard group (Group I), heavy bupivacaine 0.5% (10 mg) plus meperidine (0.2 mg per kg) in Group II, heavy bupivacaine 0.5% (10 mg) plus meperidine (0.3 mg per kg) in Group III, heavy bupivacaine 0.5% (10 mg) plus meperidine (0.4 mg per kg) in Group IV. The signs and symptoms were recorded by an observer unaware of the study groups. The systolic blood pressure, amount of bleeding, Pulse Rate, O2 saturation, neonatal apgar scores, core temperatures and sensory level revealed no difference between groups (P>0.05). The incidence (47.5%, 37.5%, 27.5% and 15.0%, respectively) and intensity of shivering decreased as the dose of meperidine increased (P=0.002) but the incidence of nausea and vomiting (8.0%, 15.4%, 25.9% and 35.8%, respectively) (P=0.000) and pruritis (25.64, 28.21, 38.46, and 48.72 respectively) increased as the dose of meperidine increased (P=0.000). The high dose of intrathecal meperidine is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery but the high incidence of nausea and vomiting is unpleasant for the patient and can be a major problem with a high dose of meperdine.

To measure clients’ satisfaction with primary health care in the capital of Oman, Muscat, and also to identify the factors affecting their satisfaction. Through a cross-sectional study in health centers, 400 participants during the period from November 2009 to February 2010 were interviewed about their satisfaction degree with the primary health care services and setting. Four urban primary health care clinics from Muscat were selected randomly. Six domains of satisfaction including accessibility to services, continuity of care, humaneness of staff, comprehensiveness of care, provision of health education, and effectiveness of services were calculatedfrom selected variables. The mean score of each area were calculated and then divided by the number of items in each area. Finally satisfaction areas were ranked based on recent criteria. Mean age was 29.5 years (SD = 9.37) for male and 26.01 years (SD = 7.12) for female participants. All the areas were suitable and only continuity of care had negative score. The ranked areas of satisfaction were as humanness of staff, effectiveness of services, access to services, provision of health educational materials, comprehensiveness of care, continuity of care. Primary health care were accepted as a suitable strategy for providing health care among clients of urban health centers of Muscat. It can be recommended to other countries to use this as a choice for health care provision.

Silicon hydrogel bandage contact lenses are used to enhance epithelial healing, control surface-generated pain, and prevent epithelial erosions after refractive surgery. Considering the importance of faster reepithelialization in preventing complications of photorefractive keratectomy (PRK) and the fact that the features and specifications of these commercially-available lenses are different and their performance as a postoperative bandage lenses would be different also, the aim of this study was comparison the efficacy of senofilcon A and lotrafilcon A after PRK. In this prospective study, 44 patients with PRK in both eyes randomly received a silicon hydrogel contact lens of senofilcon A in one eye and lotrafilcon A in other eye. Then the epithelial defect size, visual acuity and subjective level of pain and discomfort were measured for both eyes and compared on day 1, 3 and 5 postoperatively. There was no statistical difference in rate of reepithelialization between senofilcon A and lotrafilcon A (P > 0.05). The mean pain and discomfort index was significantly lower in eyes with senofilcon A (P < 0.05). The mean subjective visual scores were similar with both bandage contact lenses (BCLs) (P > 0.05). Silicon hydrogel BCLs are safe and effective for corneal reepithelialization and have great therapeutic outcome on visual outcomes after PRK. But, senofilcon A had better effect on postoperative pain and discomfort which made it superior than lotrafilcon A. However for more conclusive results, it is recommended to study larger sample size with evaluation the possible factors responsible for the obtained findings regarding postoperative pain and discomfort.

In this study, we aimed to assess the association between air pollution and cerebrovascular complications in Tehran, one of the most air-polluted cities in the world, among different subgroups of patients with stroke in 2004. In this ecologic study, we calculated the daily average levels of different air pollutants including CO, NOX, SO2, O3, and PM10 and also humidity and temperature on the day of stroke and 48 hours prior to stroke in 1 491 patients admitted with the diagnosis of stroke in eight referral hospitals in different areas of Tehran. Then, we evaluated the association between the rate of stroke admissions and the level of the selected pollutants, humidity, and temperature on the day of stroke and 48 hours prior to stroke among different subgroups of patients. There was no significant association between the sameday level of the pollutants and the rate of stroke admissions, but an association was seen for their level 48 hours before stroke. These associations differed among different subgroups of age, sex, history of underlying diseases, and type of stroke. Same-day temperature had a reverse association in patients with hemorrhagic stroke and in patients without a history of heart disease or previous stroke. A direct significant association was seen for humidity level 48 hours before stroke in patients with a history of heart disease. It is inferred that air pollution has a direct association with the incidence of stroke and these association differs among different subgroups of patients. The results of this study are not time-dependant and can be generalized to different times and regions. Moreover, these results may be useful for environmental health policy makers.

Global disease burden estimates often lack real data on morbidities, especially from patients treated in Outpatient Department (OPD). In Sri Lanka, around 40 million visits are made annually to the OPDs in government hospitals and we conducted a preliminary study to assess the morbidity profile of these OPD patients. Patients attending the OPD, in teaching hospital Peradeniya, Sri Lanka, was recruited into the study using systematic random sampling procedure. A self-administered, structured questionnaire was used to collect data. Investigators explained the study to patients and data collection was completed before seeing the physician. Self-reported presenting complain was used to analyze the morbidity profile of the patients. The study sample consisted of 1 439 patients (male - 515, female - 924). The mean age of the study sample was 40 years (SD = 19 years). The mean age of the females were statistically significantly higher than that of the males (t = 4.03, P<0.001). Housewives constituted the major occupational group (52%) followed by students (15.9%). The most common presenting complains reported were body aches and pains (15.6%), cough and cold (10.5%), and abdominal pain (8.5%). Leading cause of hospital visit among different demographic categories showed statistically significant variations. The morbidity pattern observed in this patient population was not previously reported. OPD surveillance should be established to understand the changing pattern of minor ailments which might have a huge impact on health of the public.

A 35 year female born and residing in Esfahan presents to the physician due to fatigue and sense of weakness. The patient refers that she has been having bilateral low back pain accompanied bythrobbing bone pain in the lower extremities since 5 months ago.In past history menses is regular and 3 pregnancy followed by lactating the newborns. The patient denies use of any medication, except regular use of sunscreen. She also denies history of DM.

Most oral and oropharyngeal squamous cell carcinomas (OOSCCs) are in advanced stages at diagnosis, and treatment does not improve survival rates. Early recognition and diagnosis of OOSCCs might improve patient survival and reduce treatment-related morbidity. The purpose of this article is to create awareness among the general practitioners to recognize the premalignant and early malignant lesions and to review the different diagnostic aids for the detection of cancer.