فهرست مطالب

  • Volume:42 Issue:4, 2013
  • تاریخ انتشار: 1392/03/25
  • تعداد عناوین: 16
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  • Arash Rashidian, Eshagh Barfar, Hamed Hosseini, Shirin Nosratnejad, Esmat Barooti Pages 347-357
    Background
    Breast cancer is the leading cause of malignancy among women. Screening using mammography is proposed as an effective intervention for reducing early deaths due to breast cancer. We conducted a systematic review to assess the cost-effectiveness of such screening programs. We searched Medline, Scopus and Google Scholar and complemented it by other searches using sensitive search terms from 1993-2010. We screened the titles and abstracts, assessed the full texts of the remaining studies, and extracted data to a pre-designed data extraction sheet. Studies were categorized according to the age groups of the target population. We used narrative synthesis approaches for analyzing the data. Twenty-eight articles met the minimum inclusion criteria, mostly from high income settings. All studies used secondary data, and a variety of modeling techniques, age groups, screening intervals and outcome measures. Cost per life year gained, ranging from $1,634 (once at the age of 50 in India) to $65,000 (extending the lower age limit of screening to 40 Australian study), was the most commonly used outcome measure. Biennial screening test for those aged 50-70 years seems to be the most cost-effective option ($2685). Biennial screening for aged 50-70 years is the most cost-effective option among alternative scenarios. Screening those aged less than 50 is not recommended. Further studies in low-income and middle-income countries, and cost effectiveness studies along with randomized trials are required. To improve the comparability of the findings, future studies should include biennial screening in 50-70 age groups as an alternative strategy.
    Keywords: Cost effectiveness, Breast cancer, Screening, Systematic review
  • Yaojun Zhao, Zhenang Huo, Jian Wu, Shuangbao Xie, Liang Zhang, Zhanchun Feng Pages 358-367
    Background
    This paper focus on the impact on the performance of health workers at village and township levels in the provision of a government stipulated package of basic public health service, which adopted the performance-related contracts mode.
    Methods
    The concept of balanced scorecard was adopted and developed to gather the 11 evaluation indicators distributed in four quadrants. These were implemented using on-site questionnaire and interview design. Four thousand and twenty-one respondents at 30 administrative villages including 2674 respondents at 20 pilot villages and 1347 at 10 control villages were investigated. Meanwhile, 62 administration officials from three counties and nine townships were interviewed.
    Results
    Eight of 11 evaluation indicators were obviously better in pilot counties than in Control County, The remaining three indicators respectively represented that equal, inferior to control county, and could not clear judge.
    Conclusion
    The performance of health workers at village and township levels in the provision of basic public health service in pilot counties, which adopted the performance-related contracts mode, is better than before and control county.
    Keywords: Public health, Performance, related contracts, Balanced scorecard
  • Pietro Ferrara, Lorenza Romani, Giorgia Bottaro, Francesca Ianniello, Giovanna Carmela Fabrizio, Antonio Chiaretti, Francesco Alvaro Pages 368-373
    Background
    To evaluate physical and mental health in children in foster care and comparison with general population.
    Methods
    The study is carried out between September 2011 and April 2012 into nine group homes in Rome. It involved 112 children ranging in age 2-17 years, living in temporary care facilities or institutes. All data came out of clinical history and physical exams, validated by a pediatrician. Such data were being then compared with samples of general population.
    Results
    Significant themes were high percentage of children with psychiatric disorders in foster care (22.3%); high percentage of psychiatric disorders diagnosed immediately while arriving at the foster care (56%); no significant differences in weight, height and BMI between children in foster care and general population; significant differences (P<0.05) for allergy, gastrointestinal diseases and caries between children in foster care and general population.
    Conclusion
    The results suggest that the physical health of children in group homes is no worse than that of children living care in their own homes and that the foster care provides necessary conditions to support the growth of the children and their physical, mental and social needs.
    Keywords: Foster care, Institutes, Health, Psychology, Italy
  • The Peculiarities of Different Types of Chronic Rhinitis in Child¬ren and Adolescents in Kazakhstan
    Saule Zhumambayeva, Rafail Rozenson, Marina Morenko, Mazhit Shaida¬Rov, Vera Zatonskikh, Asem Kazangapova, Zaure Zhumadi¬Lova, Roza Zhumambayeva Pages 374-379
    Background
    The aim was to study the peculiarities of differential diagnosis, prevention and treatment of different forms of rhinitis in Kazakhstan children and adolescents.
    Methods
    124 children and adolescents aged 1-17 years were randomly enrolled in our hospital based study in 2010 and 2011. Skin prick tests and total serum IgE level were assessed in all allergic patients. Subcutaneous specific immunotherapy was performed in 57 (70.3%) allergic patients. For the treatment of the developed rhinitis, we used intranasal glucocorticosteroids in all 47 (37.9%) patients with rhinitis medicamentosa.
    Results
    Allergic rhinitis was diagnosed in 81 (65.3%), infectious rhinitis in 43 (34.7%) and rhinitis medicamentosa in 47 (37.9%) cases. High mono sensitization was mainly to Artemisia Absinthium 55 (67.9%) and Sunflower 20 (24.7%) species, whereas multiple sensitization was caused by the mix of weeds in 55 (67.9%) and the mix of meadow grass in 31 (38.3%). The mean IgE level was 323.2±264.9SD. Only 5 (17.2%) patients with specific immunotherapy developed rhinitis medicamentosa. 35 (74.5%) patients treated by nasal glucocorticosteroids stopped taking the decongestants.
    Conclusions
    The incidence of rhinitis medicamentosa depends on duration of decongestants use. Specific immunotherapy is recommended for the prevention of rhinitis medicamentosa in patients suffering from allergic rhinitis, whereas intranasal glucocorticosteroids are the most appropriate for the treatment regardless initial cause of rhinitis development.
  • Fatemeh Mohammadi, Nasrin Omidvar, Gail G. Harrison, Ghazi Mahmood, Tabatabaei, Morteza Abdollahi, Anahita Houshiar, Rad, Yadol¬Lah Mehrabi, Ahmad Reza Dorosty Pages 380-390
    Background
    Despite reports on association between overweight/obesity among women and household food insecurity (FI) in developed countries, such association is not evident in developing countries. This study aimed to assess the association between household FI and weight status in adult females in Tehran, Iran.
    Methods
    In this cross-sectional study, 418 households were selected through systematic cluster sampling from 6 districts of Tehran. Height and weight were measured and body mass index (BMI) was calculated. Socio-economic status of the household was assessed by a questionnaire. Three consecutive 24-hour diet recalls were completed. FI was measured using adapted Household Food Insecurity Access Scale. Logistic regression was used to test the effects of SES and food security on weight status, simultaneously. Using Structural Equation Modeling (SEM) potential causal relationships between FI and weight status was explored.
    Results
    Only 1.0% of women were underweight, while 40.3% were overweight and 33% were obese, respectively. Severe, moderate, and mild food insecurity was observed in 11.5, 14.7, and 17.8%, respectively. Among women in moderately food insecure households, the possibility of overweight was lower than those of food secure households (OR 0.41; CI95%:0.17-0.99), while in severely food insecure households, the risk of abdominal obesity for women was 2.82 times higher than food secures (CI95%:1.12-7.08) (P<0.05). SEM detected no causal relationship between FI and weight status.
    Conclusion
    Association of severe food insecurity with abdominal obesity in adult females of households may indicate their vulnerability and the need for tailoring programs to prevent further health problems in this group.
    Keywords: Overweight, Abdominal obesity, Women, Food security, Household, Iran
  • Majid Majid Asgari, Mehdi Mehdi Mohebali, Eshrat Eshrat Beigom Kia, Ali Ali Farahnak, Moj¬Gan Moj¬Gan Aryaeipour, Samieh Samieh Asadian, Mohammad Bagher Mohammad Bagher Rokni Pages 391-396
    Background
    On the continuation of sorting the puzzle of the situation of hydatid disease in Iran and considering that so far no survey was conducted in this context in Arak City, Markazi Province central Iran, the present study was conducted to determine the seroprevalence of human hydatidosis using AgB-ELISA test.
    Methods
    Totally 578 serum samples randomly were collected from patients referred to hospitals and different health centers in the city and 3 nearby villages of Arak. All sera were examined by ELISA tests using AgB. Before sampling, a questionnaire was filled out for each case. Data were analyzed using Chi-square test and multivariate logistic regression for risk factors analysis. P<0.05 was considered significant.
    Results
    Cut-off value was calculated 0.32. Twenty cases (3.46%) were seropositive for hydatidosis in the region. This rate for females was 3.99% and for males 2.26%, respectively. There was no significant difference as regards all factors studied except location (P<0.001). As for job, farmers and ranchmen had the highest rate of infection as 6.67%. The seropositivity rate infection was 4.8% in illiterate people, which showed the highest rate. As regards residency, rural life showed significant difference with urban life (1.5% vs. 7 %). Age group of 40-49 yr old (6.25%) had the highest rate of positivity.
    Conclusion
    The rate of prevalence in this region shows more or less the same range with other cities of Iran. Obtained result might assist the policy makers to take sanitary measures to control the disease.
    Keywords: Seroepidemiology, Human hydatidosis, ELISA, Iran
  • Laleh Sharifi, Akram Karimi, Shokouhi Raheleh Shoormasti, Sara Miri, Hassan Heydar Nazhad, Saied Bokaie, Mohammad Reza Fazlollahi, Kho¬Sro Sadeghniiat Haghighi, Zahra Pourpak, Mostafa Moin Pages 397-401
    Background
    Toluene diisocyanate (TDI) is an imperative chemical substance used in the production of polyurethane foams, elastomers, paints and coatings that cause a variety of health problems in workers who are exposed in work places. This study aimed to determine the asthma symptoms and serum specific IgE levels in TDI exposed workers and comparing the results with healthy control group.
    Methods
    All the plants that use TDI in the manufacturing of paint and glue in the west of Tehran Province entered to the study and all the workers (550) completed modified initial questionnaire of the NIOSH, the questions were consisted of asthma symptoms. For each symptomatic exposed worker one healthy, sex and age matched control selected. Total IgE and Specific TDI IgE tests were done for each case and control groups.
    Results
    Among 550 TDI exposed workers, 26(4.7%) had asthma symptoms. Nine (34.6%) of symptomatic workers who were exposed to TDI were active cigarette consumer versus 3(11.5%) unexposed workers, P=0.049(CI= 0.953-17.29) OR=4.059. Nine (34.6%) workers had positive family history of atopy versus 1(3.8%) unexposed workers, P=0.0138 (CI= 1.45-305.41) OR=13.24. TDI specific IgE was found in 2 TDI exposed workers and 1 unexposed worker (P=0.5). Mean of total IgE was 339.05 in exposed workers (P=0.201).
    Conclusion
    This study provides clinical and paraclinical data of workers exposed to TDI and points to a relation between atopy and smoking habit with asthma symptoms that offer preventing recommendations for TDI exposed workers and their heath administrators.
    Keywords: Toluene diisocyanate (TDI), Asthma symptoms, IgE, Iran
  • Sahar Manavi, Saharnaz Nedjat, Parvin Pasalar, Reza Majdzadeh Pages 402-409
    Background
    Nearly three decades ago, the Master of Public Health (MPH) academic degree was introduced to Tehran University of Medical Sciences'' School of Public Health, Tehran, Iran. A new program for simultaneous education of medical, pharmaceutical and dental students was initiated in 2006. Talented students had the opportunity to study MPH simultaneously. There were some concerns about this kind of admission; as to whether these students who were not familiar with the health system had the appropriate attitude and background for this field of education. And with the present rate of brain drain, is this just a step towards their immigration without the fulfillment of public health?
    Methods
    This qualitative study was conducted in 2012 where 26 students took part in focused group discussions and individual interviews. The students were questioned about their motivation and the program''s impact on their future career. The participants'' statements were analyzed using thematic analysis.
    Results
    The primary motivations of students who entered this program were: learning health knowledge related issues, gaining a perspective beyond clinical practice, obtaining a degree to strengthen their academic résumé, immigration, learning academic research methods and preparing for the management of health systems in the future.
    Conclusion
    Apparently, there was no considerable difference between the motivation of students and the program planners. The students'' main motivation for studying MPH was a combination of various interests in research and health sciences issues. Therefore, considering the potential of this group of students, effective academic investment on MPH can have positive impact.
    Keywords: Curriculum, Graduate, Administration, Public health, Education, Iran
  • Fereshteh Farzianpour, Seyyed Mostafa Hosseini, Elham Movahed Kor, Shayan Hosseini, Mohammad Amerzadeh, Batul Ahmadi Pages 410-416
    Background
    Self-confidence is a glorious feature of an effective administrator. Their main goal is the organizational success. Therefore, we approached this idea by evaluating the self-confidence of nursing Administration in Tehran University of Medical Sciences (TUMS) Teaching Hospitals and its relation to vocational satisfaction of the staff.
    Methods
    In a cross-sectional study, we interviewed 200 nursing administrators and 200 staff in different departments of the TUMS Teaching Hospitals using a standardized questionnaire to assess the self-confidence among nursing administrators and staff satisfaction. Data were entered in SPSS (17.0) and analyzed using this software and STATA (11.0) using non-parametric tests and Spearman’s correlation of coefficient. The significant level was set as P<0.05.
    Results
    Of 200 nursing administrators 58 (29%) were male and 142 (71%) were female. Mean ± SD of the self-confidence score for the nursing administrators was 134.9 ± 19.8. Among the staff 68 (34%) were male and 132 (66%) were female. The mean ± SD of the vocational satisfaction for staff was 89.12 ± 18.3. After considering the effect of departments in a regression model, the correlation between nursing administration’s self-confidence and the staff’s vocational satisfaction was found not significant (P=0.055).
    Conclusion
    Gender and years of employment were the only factors affecting self-confidence and vocational satisfaction between the nursing administration and staff respectively, which not significantly correlated after adjustment.
    Keywords: Self, confidence, Vocational satisfaction, Staff workers, Hospitals
  • Maryam Noroozian, Zahra Poormand, Vali Allah Farzad, Gholamreza Had¬Jati, Anita Baghdasariyans Pages 417-421
    Background
    The purpose of this study was to design a valid questionnaire to the Iranian culture for dementia diagnosis and more specifically in its early stage.
    Methods
    A cross-sectional study was conducted in 2012 in Memory Clinic of Roozbeh Hospital and Iranian Alzheimer Association in Tehran in 2012. Among 235 subjects, there were 72 patients with Alzheimer''s disease (AD), 137 patients with other types of dementia, and 26 subjects with Mild Cognitive Impairment (MCI), which 107 of them were male. Moreover, 42 healthy subjects were selected as control group. We considered psychometric properties of the Cleveland Scale of Activity Daily Living (CSADL) questionnaire and used standard making operations according to exploratory factor analysis.
    Results
    Three factors were extracted: self-care (21 items), language skills (14 items), and planning (7 items). Convergent validity was 0.86 and cut off point for total, basic and instrumental scores respectively was 20, 3 and 20.
    Conclusion
    It can be claimed that Persian Version of CSADL psychometric questionnaire has appropriate indicators and can serve as a useful tool for research in dementia and in its early stage. It can also enable the implementation of scientific research in academic and medical centers on dementia in general and Alzheimer''s disease specifically in Iran.
    Keywords: Psychometric characteristics, Dementia, Alzheimer's disease, Iran
  • Issa Gholamour Azizi, Samaneh Rouhi Pages 422-427
    Background
    Fumonisins and aflatoxins are mycotoxins that are produced by Fusarium and Aspergillus genus respectively. Due to the toxicity of aflatoxin and fumonisin and its effects on human and animals’ health, the purpose of this study was analysis of total fumonisin and total aflatoxin contamination in biscuit and cookie samples in Babol City, Northern Iran.
    Methods
    Thirty biscuit (n=15) and cookie (n=15) samples were randomly collected at supermarkets in Babol City in winter 2011. Competitive ELISA was conducted for total fumonisin and total aflatoxin separately.
    Results
    Out of 30 biscuit and cookie samples, 28 (93.4%) samples were contaminated with <2ppm of total fumonisin and 2 (6.6%) showed infection with 2-4ppm of this toxin. The highest contamination rate of total fumonisin was 2.3 ppm in biscuit samples. In addition, none of the samples was infected by > 4ppm of total fumonisin. From 30 samples, 26 (86.7%) were contaminated with <4ppb of total aflatoxin and 4 (13.3%) were positive in total aflatoxin with ≥4ppb and highest contamination rate was found 7.9 ppb in biscuit samples. Contamination rate of samples by total aflatoxin was higher than total fumonisin.
    Conclusion
    Since biscuits and cookies are extensively used among all ages of humans, consumption of contaminated food causes different diseases in human. Therefore, determination, management, and prevention of mycotoxins according to the climatic conditions should be considered.
    Keywords: Total fumonisin, Total aflatoxin, Biscuit, Cookie, Iran
  • Seyed Mohammad Javad Mortazavi, Shahram Taeb, Naser Dehghan Pages 428-435
    Background
    Radar transmitters emit high-power radiofrequency radiation by creation of a high-voltage and high-frequency alternating electrical current.
    Methods
    Health effects of occupational exposure to military radar were investigated. Visual reaction time was recorded with a simple blind computer-assisted-visual reaction time test. To assess the short-term memory, modified Wechsler Memory Scale test was performed.
    Results
    The mean +/- SD reaction time in radar works (N=100) and the control group (N=57) were 238.58 +/- 23.47 milliseconds and 291.86 +/- 28.26 milliseconds (P<0.0001), respectively. The scores of forward digit span in radar works and the control group were 3.56 +/- 0.77 and 4.29 +/- 1.06 (P<0.0001), while the scores of backward digit span in radar works and the control group were 2.70 +/- 0.69 and 3.62 +/- 0.95 (P<0.0001). The scores of word recognition in radar works and the control group were 3.37 +/- 1.13 and 5.86 +/- 1.11 (P<0.0001). Finally, the scores of paired words in radar works and the control group were 13.56 +/- 1.78 and 15.21 +/- 2.20 (P<0.0001). It can be concluded that occupational exposures to radar radiations decreases reaction time, which may lead to a better response to different hazards.
    Conclusion
    To the best of our knowledge, this is the first study to show that occupational exposure to radar microwave radiation leads to decreased reaction time and the lower performance of short-term memory. Altogether, these results indicate that occupational exposure to radar microwave radiations may be linked to some non-detrimental and detrimental health effects.
    Keywords: Military radar, Occupational exposure, Radiofrequency, Microwave, Healt
  • Shahab Rezaeian, Nader Esmailnasab Pages 436-442
    Background
    There currently is lack of knowledge about HIV testing practices in Iran. The purpose of this pilot study was to evaluate the prevalence of self-reported HIV testing and its associated factors among women.
    Methods
    This cross-sectional study was conducted in Sanandaj City, located in the west of Iran, in 2012. Data were collected using self-administered questionnaire including demographics characteristics and the main outcome variable was self-reported HIV testing. The univariate and multivariate logistic regression models using STATA software was used for data analysis.
    Results
    A total of 1200 women were interviewed during the study (Response rate=87.5%). The mean age was 29.67 years (SD: 7.01 years), 49% were aged 28 years or younger, 39.2% were single, 16.9% were pregnant and 60% did not have academic education. The proportion of women that were HIV-tested was, 32.1% (CI 95%: 29.2%, 35.0%). HIV testing was associated with younger age, knowledge of HIV/AIDS, household wealth, pregnancy, academic education, occupation and duration time of occupation, rating of quality of health services and substance use history in her husband.
    Conclusion
    The self-reported HIV testing rate among our sample women is 32.1%, lower than the HIV testing rate in other studies. Therefore, interventions to expand HIV testing and increase awareness of HIV risk are urgently needed in Iran.
    Keywords: HIV testing, Women, Social determinants, Health, Iran
  • Fatemeh Heidary, Abolfazl Rahimi, Reza Gharebaghi Pages 445-446
  • Alireza Mokhtari, Bahareh Hosseini, Pourdad Panahi Pages 447-448