International Journal of Preventive Medicine
Volume:4 Issue: 3, Mar 2013

A growing body of evidence supports an association between oral health and cardiovascular diseases and diabetes in adults. This study aimed to investigate the relationship between tooth brushing frequency and cardiometabolic risk factors in adolescents. This nationwide population‑based study was conducted among 5258 Iranian students, aged 10-18 years, living in urban and rural areas of 27 provinces in Iran. The association of tooth brushing frequency was assessed with anthropometric indexes and cardiometabolic risk factors after adjustment for potential confounders. Higher frequency of tooth brushing was associated with lower mean levels of low‑density lipoprotein cholesterol (LDL‑C) in both genders (P < 0.0001) and lower frequency of elevated LDL‑C in girls (P = 0.03). The frequency of elevated blood pressure decreased with higher tooth brushing frequency in boys (P = 0.03). After adjustment for many potential cofounders such as age, gender, anthropometric indexes, screen time, socioeconomic status, and family history of non‑communicable diseases, participants who washed their teeth at least once a day had lower risk of high LDL‑C and low high‑density lipoprotein cholesterol (HDL‑C) levels in comparison to those who reported lower frequency of tooth brushing; some different associations were observed among girls and boys. Our findings suggest an independent and protective role of teeth brushing frequency for some cardiometabolic risk factors in adolescents. Increasing both the general health awareness and improving oral health should be considered in primordial and primary prevention of non‑communicable diseases.

Studies have shown that a large proportion of traffic accidents around the world are related to inadequate or disordered sleep. Recent surveys have linked driver fatigue to 16% to 20% of serious highway accidents in the UK, Australia, and Brazil. Fatigue as a result of sleep disorders (especially obstructive sleep apnea), excessive workload and lack of physical and mental rest, have been shown to be major contributing factors in motor vehicle accidents. A number of behavioral, physiological, and psychometric tests are being used increasingly to evaluate the impact of fatigue on driver performance. These include the oculography, polysomnography, actigraphy, the maintenance of wakefulness test, and others. Various strategies have been proposed for preventing or reducing the impact of fatigue on motor vehicle accidents. These have included: Educational programs emphasizing the importance of restorative sleep and the need for drivers to recognize the presence of fatigue symptoms, and to determine when to stop to sleep; The use of exercise to increase alertness and to promote restorative sleep; The use of substances or drugs to promote sleep or alertness (i.e. caffeine, modafinil, melatonin and others), as well as specific sleep disorders treatment; The use of CPAP therapy for reducing excessive sleepiness among drivers who have been diagnosed with obstructive sleep apnea. The evidence cited in this review justifies the call for all efforts to be undertaken that may increase awareness of inadequate sleep as a cause of traffic accidents. It is strongly recommended that, for the purpose of promoting highway safety and saving lives, all disorders that cause excessive sleepiness should be investigated and monitored.

Gentamicin (GM) nephrotoxicity has been related to oxidative stress. Garlic and metformin (MF) have anti‑oxadant activity and therefore, this study was aimed to evaluate the preventive and curative effects of garlic, MF and their combination on GM indeced tubular toxicity in Wistar rats. In a pre‑clinical study, 70 male Wistar rats were randomly designated into 7 groups of 10 and treated as follows: Group 1: Received saline for 20 days. Group 2: Were injected 100 mg/kg/d of GM intraperitoneally (ip), for 10 days and saline for 10 more days. Group 3: Received GM for 10 days then 20 mg/kg garlic ip for the next 10 days. Group 4: Received GM for 10 days and MF (100 mg/kg) orally for the next 10 days. Group 5: Received GM for 10 days and a combination of MF and garlic for the next 10 days (100 and 20 mg/kg, respectively). Group 6: The same as group 5but with half‑doses of MF and Garlic. Group 7: Received GM for 10 days together with a combination ofMF and garlic. On 20th day of the experiment the serum blood urea nitrogen (BUN) and creatinine (Cr) were measured and compared in different groups. GM injection significantly increased the serum BUN and Cr (P < 0.05). Administration of MF, garlic or their combination with or after injection of GM (high doses) could atenuate BUN and Cr. The results indicate that MF and garlic or their combination have curative and protective activity against GM nephrotoxicity.

To determine inequality in mortality in 1‑59 months children across Iranian provinces focusing on referring system and determinants of death. After designing and examining a national questionnaire for mortality data collection of children 1‑59 months, 40 medical universities have been asked to fill in the questionnaires and return to the main researcher in the health ministry in 2009. Mortality in 1-59 months children was unequally distributed across provinces (universities). The recommended refer was 3466 but only 1620 patients were referred. The first five important determinants of death were congenital (671 children or 20.9%), accident (547 children or 17.1%), pulmonary diseases (370 children or 11.5%), cardiovascular (266 children or less than 8.3%), central nervous system (263 children or 8.2%), and infectious and parasitic diseases (245 children or 7.6%), respectively. Our results suggest that inequality in 1‑59 months mortality based on the hospital records, and specially referring system, needs more attention in Iran. In addition, it is advisable to conduct provincially representative surveys to provide recent estimates of hospital access inequalities and to allow monitoring over time.

To investigate the respective contribution of various biologic and psychosocial factors, especially Health Related Quality of Life (HRQOL) as a main outcome, in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL. In a prospective cohort study For 24 weeks, 150 patients were assessed at an outpatient clinic in Korea consulting for low back and confirmed disc herniation duration at inclusion and treated with treatment package comprised of herbal medicines, acupuncture, bee venom acupuncture, and a Korean version of spinal manipulation (Chuna). Study participants were evaluated at baseline and every 4 weeks for 24 weeks. Low back intensity levels were measured on a visual analog scale (0‑10), back function was evaluated with the Oswestry Disability Index (0‑100), disability assessed by HRQOL assessed by the short form 36 health survey (0‑100 in 8 different sub‑categories). Out of 150 patients, 128 completed the 24 weeks of traditional therapy. Patients reported improvements SF‑36 outcome measures. At the completion of the study, low back pain scores improved by a mean of 3.3 (95% CI = 2.8 to 3.8). According to the results of our modeling, low back intensity level, back function and BMI measures had significant effects on quality of life during study. Interpreting the coefficients of modeling, the impact of the decreasing acute LBP episode on HRQOL by VAS and ODI outcomes, was high and important. This study highlights the large contribution of integrative package therapy as an effective preventive method for improving LBP patient’s HRQOL.

Kidney iron deposition (KID) is caused by iron overload that is observed in kidney diseases and anemia. The protective effects of deferoxamine (DF) and silymarin (SM) were studied against iron overload‑induced KID in rat model. Rats received iron dextran (200 mg/kg) for a period of 4 weeks every other day, but at the beginning of week 3, they also were subjected to a 2‑week (every other day) treatment with vehicle (group 2, positive control), SM (200 mg/kg; group 3), DF (50 mg/kg; group 4), SM (400 mg/kg; group 5), and combination of SM and DF (200 and 50 mg/kg, respectively; group 6). Group 1, as the negative control, received saline alone during the study. The levels of serum creatinine (Cr), blood urea nitrogen (BUN), iron, ferritin, and nitrite were determined, and the kidney was removed for histopathological investigations. Before treatment, the serum levels of iron and ferritin in all iron dextran receiver groups were significantly higher than those of the negative control group (P < 0.05). However, the serum levels of BUN, Cr, and nitrite were not different between the groups. No statistical differences were detected in kidney weight and the serum levels of BUN, Cr, iron, ferritin, and nitrite after 2 weeks of treatment with SM, DF, or combination of both. The SM and DF treatments reduced the intensity of the KID, but only in the SM (200 mg/kg) group, a significant reduction in KID was observed (P < 0.05). It seems that SM is a nephroprotectant agent against KID in acute iron overload animal models.

We examined perceived health status and physical and psychological well‑being of 3,271 undergraduate students attending eleven faculties in a university in Egypt. During 2009-2010, participants completed a self‑administered questionnaire that gathered socio‑demographic, physical and psychological health data. Body mass index (BMI) was calculated from students’ measured height and weight. Differences across these variables were computed by gender and participating faculties. Whilst more females watched and rated their health favorably, they were more likely to feel psychosomatic/physical health problems, to have seen a medical practitioner or been ill that they had to stay in bed. Females were consistently more likely to feel burdened overall, and across several aspects apart from financial problems. Less females had ‘normal’ BMI, were satisfied with current weight, perceived their body image as ‘just right’, or were not worried about their shape. More males rated their quality of life favorably. About 25% of males and 32% of females were either overweight/obese. Exams, presentations, and the lack of time for studies were the frequently‑reported burdens. Comparisons of health/well‑being indicators across the participating faculties suggested some evidence of ‘clustering’: Favorable indicators would cluster at some faculties; and conversely, less favorable variables would cluster at other faculties. Generally, the levels of some health complaints and psychological problems/burdens are higher than in other countries. Increased vigilance of university administrators and leaders to monitoring the health and well‑being of their students, as well as their health needs is required if policy makers are to operate from a valid evidence base platform. Given cultural factors prevalent in the Eastern Mediterranean region generally, female students might require particular attention. The clustering effects suggest the need for local (faculty‑specific) health and well‑being profiles as basis and guidance for relevant health promotion programs in faculty/university settings.

The angiotensin II (Ang II) receptor 2 (AT2R) and angiotensin 1‑7 receptor (masR) expression in the kidney are gender‑related. We attempted to compare the response of nitric oxide (NO) production to Ang II administration, with and without AT2R and masR blockades, using A‑779 and PD123319 in male and female rats. Anesthetized and catheterized male and female Wistar rats were subjected to one‑hour continuous infusion of Ang II (~20 μg/kg/hour), with and without masR and AT2R blockades. The level of the NO metabolite (nitrite) was measured before and after the experiment in rat serum and in the homogenized kidney tissue. The basal data indicated that no sex difference in the serum level of nitrite could be detected before Ang II infusion. However, administration of Ang II in male and female rats caused a gender difference in the nitrite level, which resulted in the serum level of the nitrite significantly increasing in males (P < 0.05) when compared with the females. In addition, masR blockade or co‑blockade of masR and AT2R in male rats abolished the gender difference related to the effect of Ang II on nitrite production. In the presence of masR and AT2R, or when masR alone was blocked, the level of nitrite in the kidney, in response to the Ang II infusion was not significantly different between the two sexes. On the contrary, masR and AT2R co‑blockades significantly decreased the kidney nitrite concentration response to Ang II administration in both male and female rats (P < 0.05), but no sex difference was detected. The renal vasculature of male rats may provide more response to Ang II administration‑induced NO, which is dependent on masR and AT2R. During dual masR + AT2R blockades, the kidney NO formation wasreduced in a non‑gender related manner.

Gentamicin (GM) is a commonly used aminoglycoside, however, renal toxicity has limited its usage. This study was designed to evaluate the curative and protective effects of Zingiber officinale (ginger) against gentamicin tubular toxicity in rats. The phenolic and flavonoid components and antioxidant activity of ginger were also evaluated. In a preclinical study, 50 male Wistar rats were designated into 5 groups of 10 and treated as follows: Group I: vehicle. Group II: 200 mg/kg/d of ginger for 3 days then, GM (80 mg/kg) for 7 days. Group III: 200 mg/kg ginger orally for 3 days, then ginger plus GM for 7 days. Group IV: GM for 7 days. Group V: GM for 10 days. Group VI: GM for 7 days, then 200 mg/kg ginger orally for 10 days. At the end of the study, the animals were sacrificed and their kidneys were histologically evaluated. Ginger could prevent degeneration of the renal cells and reduce the severity of tubular damage caused by gentamicin. However, it could not regenerate the GM degeneration. The results indicate that ginger is effective as a prophylaxis agent, but has not curative effect.

Preeclampsia is an important cause of maternal morbidity and mortality with unclear cause. It is believed that inflammation plays an important role in the pathogenesis of preeclampsia. Periodontal disease is a chronic inflammatory infectious condition which commonly involves humans. Recently, chronic infection was linked to atherosclerosis. Atherosclerosis shares some histopathologic features with uteroplacental atherosis of preeclamptic women. This study was aimed to investigate the presence of periopathogenic bacteria in the placental tissue of preeclamptic women, and compare it with women with normal pregnancy. Samples were obtained from 23 placentas of preeclamptic women and from 23 age‑matched healthy pregnant women. Qualitative polymerase chain reaction was performed to detect the presence of five periopathogenic bacteria. There was no significant difference between the two groups regarding the relative frequency of women with different types of periopathogenic bacterial infection of the placenta. In addition, there was no significant difference in the number of women with any type of infection of the placenta (regardless of the type of periopathogenic bacteria) [14 (61%) mothers with placental infection in the case group vs. 18 (78%) mothers in the control group, P value = 0.16]. This study did not show any significant difference between preeclamptic women and healthy women with normal pregnancy regarding the periopathogenic bacterial profile of the placenta.

Few studies have been done on the use of metformin in pregnancy and their results were not similar, therefore this research is performed to compare neonatal outcomes of metformin and insulin in the treatment of gestational diabetes. In this prospective randomized trial, 200 pregnant women within their 24th to 34th weeks of gestation with gestational diabetes, single fetus pregnancy, and in need of hyperglycemia treatment were entered and grouped as either metformin or insulin. Data related to maternal and neonatal outcomes were recorded and analyzed. Considering data recorded of HbA1c at the beginning of pregnancy, pregnancy induced hypertension, preeclampsia, birth weight, dystocia, first and 5th min APGAR, neonatal sepsis, rout of delivery, liver function tests of neonate, hypoglycemia, anomaly, and still birth, there were no significant statistical differences between groups. The end pregnancy HbA1c, maternal weight gain during pregnancy, preterm labor, neonatal jaundice, respiratory distress and hospitalization of infants were higher in insulin group. Considering data from this study, metformin is efficient to control hyperglycemia in pregnancy. It is suggested performing more studies to evaluate long term side effects of metformin in pregnancy with higher sample size and longer follow‑up of newborns.

Obstructive sleep apnea (OSA) is a common but usually under‑diagnosed sleep disorder. Objective diagnosis is based on polysomnography, which is an expensive test. We assessed the reliability and diagnostic accuracy of the Berlin questionnaire (BQ) in diagnosis of OSA in Iranian sleep clinic patients. A cross‑sectional linguistic validation study was conducted on consecutive Iranian patients with Persian language attending one sleep clinic in Isfahan (Iran) were studied. Patients completed the Persian BQ (contains 10 questions in 3 categories), developed by forward‑backward translation method. The patients underwent an overnight polysomnographic study at the clinic. Apneas/hypopnea index of >5/Hour was considered for diagnosis of OSA. One hundred and fifty seven patients (55.4% male, mean age = 52.3 ± 13.6 years) were evaluated. Sleep study confirmed OSA diagnosis in 91.7% of the studied patients. The reliability analysis of the BQ categories showed alpha Cronbach’s as 0.70 and 0.50 for category 1 and category 2, respectively. BQ categories 1‑3 were positive respectively in 88.5%, 67.5%, and 66.9% of the patients. The BQ and sleep study were in agreement for 82.1% of the cases. The sensitivity, specificity, positive and negative predictive values, and positive, and negative likelihood ratio of the BQ were calculated as 84.0%, 61.5%, 96.0%, 25.8%, 2.18%, and 0.26% respectively. BQ is useful as a screening test for diagnosing OSA in Iranian patients with sleep complaints; however, the test cannot be used for rolling out the OSA. Further studies on editing, modifying, and applying the BQ in a larger sample of patients are warranted in our society.

Knowledge products such as clinical practice guidelines (CPG) are vitally required for evidence-based medicine (EBM). Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran. Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach. Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation (CPG) and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context. The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed.

Clinical guidelines have increasingly been used as tools for applying new knowledge and research findings. Although, efforts have been made to produce clinical guidelines in Iran, it is not clear whether they have been used by physicians and what factors are associated with them?. Four hundred and forty three practicing physicians in Tehran were selected from private clinics through weighted random sampling. The data collection tool was a questionnaire on familiarity and attitude toward clinical guidelines. The descriptive and analytical findings were analyzed with t‑tests, Chi2, logistic and linear multivariate regression by SPSS, version 16. 31.8% of physicians were familiar with clinical guidelines. Based on the logistic regression model physicians’ familiarity with clinical guidelines was positively and significantly associated with ‘working experience in a health service delivery point’ OR = 2.13 (95% CI, 1.17‑3.90), ‘familiarity with therapeutic protocols’ OR = 2.09 (95% CI, 1.22‑3.57) and ‘holding a specialty degree’ OR = 2.51 (95% CI, 1.24‑5.07). The mean overall attitude scores in the ‘usefulness’, ‘reliability’, and ‘problems and barriers’ domains were, respectively, 78.9 (SD = 16.5), 78.9 (SD = 19.7) and 50.4 (SD = 15.9) out of a total of 100 scores in each domain. No significant association was observed between attitude domains and other independent variables using multivariate linear regression. Little familiarity with clinical guidelines may represent weakness in of production and distribution of domestic evidence. Although, physicians considered guidelines as useful and reliable tools, but problems such as difficult access to guidelines and lack of facilities to apply them were stated as well.

Treatment of childhood obesity is difficult, and successful management may differ in various areas with different cultural backgrounds. The present study was conducted to assess the effect of lifestyle modification family‑based intervention in young Iranian children. This field trial study was conducted in 2011 among 156 obese children in Tehran, Iran. They were randomly assigned to intervention and control groups. At baseline, anthropometric measurements and biochemical analysis were performed. The second and third phases consisted of training sessions for parents of the intervention group. At the fourth phase, there was no training program. In all four phases, questionnaires on demographic characteristics, lifestyle and food frequency were completed by interviewing with mothers, and biochemical analysis was repeated at the end of the study. During the second and third phases of the study, weight and height increased significantly in both groups, although weight increased more slowly, and waist and hip circumferences was decreased in the intervention group. Serum triglycerides and cholesterol decreased significantly in the intervention group (P < 0.05). Analysis of food group consumption showed that in the intervention group, not only consumption of milk, dairy and nuts group increased significantly but also the corresponding figure decreased for bread and cereals, sugar and confectionery ingredients; moreover, the family’s oil and fat consumption decreased significantly (P < 0.05). Watching TV and playing on the computer decreased significantly in the intervention group; however, walking time increased significantly in both groups (P < 0.05). The family‑based lifestyle program had limited but desirable effects on anthropometric and metabolic outcomes of the obese children. We suggest that a longer period of intervention may have more favorable results.

Nosocomial infections (NIs) are one of the most important health issues, particularly in developing countries, because these infections cause high mortality and morbidity, and economic and human resource loss as a consequence. To date, most surveillance studies have been conducted in developed countries, and only a few have been performed in Iran. All of the few Iranian studies have been performed using paper-based collection forms, and none was conducted with the aid of an electronic patient data retrieving and collecting tool. The aim of this study is to determine the incidence of NIs in a big university hospital of Shiraz, with the help of specifically programmed surveillance software merging electronically the available patient data and the infection results input manually. The study was conducted prospectively through 6 months from 21st March up to 22nd September 2006, in a 374-bedded educational hospital. All patients admitted during this period were included in the study and examined everyday for detecting four types of NIs: surgical site infection (SSI), urinary tract infection (UTI), pneumonia (PNEU), and blood stream infection (BSI). Centres for Disease Control and Prevention National Nosocomial Infection Surveillance system criteria were applied. 4013 patients were admitted in the hospital. The overall infection rate was 4.14, and UTI, SSI, BSI, and PNEU rates were 1.82, 1.22, 0.5, and 0.5, respectively, per 1000 patient days of admission. The results of this study showed that the frequency of NI in the investigated hospital was not higher than in many other reported surveillance results from other countries. This, however, might be a bias as the administration of antibiotics was very high in this study and the quality of microbiological investigation might have influenced significantly, resulting in more false-negative results than expected. Overall, the use of the Iranian National Nosocomial Infection Surveillance System Software proved to be useful and allowed both rapid data collection and detailed data analysis.