International Journal of Preventive Medicine
Volume:4 Issue: 8, Aug 2013

In the past five decades or so evidence has been accumulating about an environmental factor, which appears to be an influencing mortality, in particular, cardiovascular mortality, and this is the hardness of the drinking water. In addition, several epidemiological investigations have demonstrated the relation between risk for cardiovascular disease, growth retardation, reproductive failure, and other health problems and hardness of drinking water or its content of magnesium and calcium. In addition, the acidity of the water influences the reabsorption of calcium and magnesium in the renal tubule. Not only, calcium and magnesium, but other constituents also affect different health aspects. Thus, the present review attempts to explore the health effects of hard water and its constituents.

Approximately 2.2 billion (2200 million) of the world population are living in the area with Iodine deficiency (ID), most of them in the developing countries. In IRAN about 2 million are exposed to Iodine deficiency. Most of the complications of ID are not curable, especially brain damage. On the other hand, adding iodine to daily salt is a suitable program for decreasing iodine deficiency. This has been the main aim of IDD National committee since 1986. This study is a before‑after preventive trial, and was conducted to determine the effect of iodized salt in preventing the disorders of Iodine deficiency. This study was a preventive field trial in 2 stages before and after prevention. Since 1995, Iodized salt has been distributed in Tabas in Yazd province. Sample of 2,150 students aged 6‑18 years were chosen by stratified cluster random sampling method from 24 schools, 12 schools from rural and 12 from urban areas. Goiter frequency and educational status were determined using WHO criteria and mean scored, respectively. Prevalence of goiter has decreased from 34 to 25 percent after 10 years (P < 0.001). The prevalence in urban areas has decreased from 35.8 to 23.5 percent and in rural from 35.6 to 28.5 percent (P = 0.02). Prevalence of Goiter has changed from 32.8 to 20 percent and from 39.5 to 31.5 in boys and girls, respectively (P < 0.001). There was a statistically significant relation between educational status and goiter frequency before and after prevention (P = 0.01). There was also a statistically significant relation between educational status in 2 stages, before and after intervention (P < 0.001). Although, there are some confounding variables, such as: educational resources development, improved educational methods, and enhanced family emphasis on extracurricular education, increased frequency of students in higher education after intervention shows the iodine effects on mental function.

Prevalence of obesity and overweightness in different societies is increasing. Role of physical activity in weight loss and also prevention from some chronic diseases has been discussed previously. The objective of this study was to compare the effect of two different aerobic exercises (intermittent and continuous exercises) while prescribed with concurrent calorie-restrict diet on the weight loss and body fat of overweight and obese females. Fifteen individuals in intermittent group performed 40 min medium intensity exercise in 3 bouts per day for 5 days per week; the 15 participants of continuous group exercised a single 40 min bout per day, 5 days per week. Also, 15 participants were included in control group without exercise program. A self-monitoring calorie-restrict diet was recommended to all participants. The body fat percentage, waist circumference, and also skin fold thickness of all participants were assessed at baseline and 12th weeks. The reduction of weight and BMI of participants in intermittent group (-3.33 ± 1.80 and -1.34 ± 0.70, respectively) was significantly more than comparable changes in continuous group (-1.23 ± 1.60 and 0.49 ± 0.65, respectively) (P = 0.048 and 0.041, respectively). After the intervention, there was no significant difference between case and controls in terms of body fat percentage, waist circumference, and sum of skin fold thickness. It seems that medium intensity intermittent exercise for more than 150 min/ week is more efficient than continuous exercise in weight loss of obese and overweight women.

We aimed to determine the effects of Anethum graveolens (Dill) powder on postprandial lipid profile, markers of oxidation and endothelial activation when added to a fatty meal. In an experimental study, 32 rabbits were randomly designated into four diet groups: normal diet, high cholesterol diet (1%), high cholesterol diet plus 5% (w/w) dill powder and high cholesterol diet plus lovastatin (10 mg/kg, bw). The concentrations of glucose, total cholesterol (TC), low‑density lipoproteins‑cholesterol (LDL‑C), alanine aminotransferase (alt), aspartate aminotransferase (ast), fibrinogen, factor VII, apolipoprotein B (ApoB), nitrite and nitrate were measured in blood samples following 15 h of fasting and 3 h after feeding. Concurrent use of A. graveolens powder or lovastatin significantly decreased ALT, TC, glucose, fibrinogen and LDL‑C values in comparison with hypercholesterolemic diet group (P < 0.05). Consumption of A. graveolens or lovastatin did not change factor VII, ApoB, nitrite and nitrate levels significantly in comparison with hypercholesterolemic diet group. Intake of A. graveolens significantly decreased serum AST compared to hypercholesterolemic diet. A. graveolens might have some protective values against atherosclerosis and that it significantly affects some biochemical risk factors of this disease. Our findings also confirm the potential harmful effects of oxidized fats and the importance of dietary polyphenols in the meal.

Increased concentrations of tumor necrosis factor alpha (TNF‑α) in blood and amniotic fluid are observed in women with preterm delivery (PTD) and TNF‑α mutations at −308 position are associated with higher expression of this gene. Therefore, we compared the frequency of G308A transition in the promoter region of TNF‑α gene of women and neonates delivered preterm with the normal subjects. This cross‑sectional study was performed on 135 mothers who were referred for delivery. According to the gestational age, mothers and their neonates were allocated to the case (preterm, 64 subjects) and control (term, 71 subjects) groups. Using the polymerase chain reaction, restrictive fragment length polymorphism (RFLP), genotyping was performed on both maternal peripheral blood and cord blood samples to determine single nucleotide polymorphism in the promoter region of TNF‑α gene at –308. Two mothers in the case group, one mother in the control group and one neonate in the case group had genotyping assays (GA) mutation. All other subjects had normal GG genotype. Frequency of GA mutation was not significantly different between two groups (P = 0.47). There is no significant association between PTD and either maternal or fetal TNF‑α −308 polymorphism and frequency ofGAmutation is not significantly increased in mothers and neonates delivered preterm. It means that the presence of this mutation by itself does not modify the overall risk of PTD. Investigations on the combination of various polymorphisms indifferent genes are recommended to achieve more accurate results.

Chronic kidney disease (CKD) coexisting with type 2 diabetes mellitus (DM) leads to coronary artery disease. The present study compares clopidogrel and low‑dose aspirin as prophylactic therapy against coronary events in patients with CKD with diabetes. Total 80 patients of CKD with type 2 DM were randomized and allocated to clopidogrel and aspirin groups to receive the drug at a dose of 75 mg and 150 mg once daily respectively for 8 weeks as add‑on therapy. Main outcome was change in blood pressure, metabolic parameters, renal function, inflammatory biomarkers, platelet aggregability and UKPDS risk scoring. Significant decrease in blood pressure (P < 0.01), total cholesterol (P = 0.02), LDL (P < 0.01), triglyceride (P < 0.01) and a better glycemic control (P < 0.01) was found in clopidogrel group. Renal markers and electrolytes have been improved in clopidogrel group but in aspirin group there was deterioration (2.5%) of creatinine clearance. Clopidogrel group has shown a significant decrease in hsCRP (P < 0.01), UKPDS risk scoring (P < 0.01) and better anti‑aggregatory effect. Clopidogrel has prophylactic role in CKD with type 2 DM due to better control of metabolic parameters, renal function and inflammatory burden in comparison to aspirin.

There is conflicting evidence regarding the relationship between iron stores and cardiovascular disease (CVD). The present study aimed to investigate the association between body iron indices and some cardiovascular risk factors. In a case–control study conducted in the south of Shiraz, Iran, we determined ferritin, iron, total iron binding capacity (TIBC), metabolic risk factors, C‑reactive protein (CRP), and anthropometric measurements in 100 men aged 45 years and higher with newly diagnosed CVD and 100 adjusted controls without evidence for CVD. The mean of low density lipoprotein (LDL‑c), CRP, and ferritin concentrations were significantly higher in cases than controls, and high density lipoprotein (HDL‑c) was significantly lower in cases than controls. Pearson correlation coefficient between CRP and the other risk factors in case group showed that only ferritin, serum iron, waist circumference, and LDL‑c significantly correlated with CRP (r = 0.32 with P < 0.001, r = 0.29 with P < 0.05, r = 0.41 with P < 0.01, and r = 0.36 with P < 0.001, respectively). This study indicated an association between a positive balance of body iron and CVD. Hence, caution should be exercised in administration of iron supplements to patients with CVD and in consumption of food rich in iron by them.

Rubella is a mild viral infectious disease, usually occurs subclinically without a serious complication. But if occurs during pregnancy, specially the first trimester, it can transmit and invade to fetus causing congenital rubella syndrome or fetal death. In 2003, nearly all Iranians at the age of 5 to 25 years old were vaccinated against rubella and the vaccine was included in the compulsory immunization, MMR afterwards. This study was carried out on girls attended at a marriage consultancy center in Kermanshah city (West of Iran) in 2006. Considering 95% of confidence, the sample size was estimated at 140. All samples were tested using ELISA serologic method and compared with similar study conducted on 240 unvaccinated girls at the same place in 1999. Antibody positivity was observed in 99.3%, compared to 79.58% of the previous study. A rise of 19.72% (95% CI 12.7%-26.7%) of seropositivity was observed in vaccinated girls versus unvaccinated ones (P < 0.001). In our previous study, we had recommended to screen for susceptibility to rubella before marriage, which is no longer required since more than 99% of vaccinated girls showed immunity at the time of marriage. However, as sustainability of immunity after rubella vaccination is usually less than immunity due to illness, we recommend screening for rubella protective antibody every few years.

N‑3 Fatty acids reduce the risk of cardiovascular disease. Previous studies have shown that they may reduce inflammation, oxidative stress, and fat mass in patients with type 2 diabetes, but the results are inconclusive, due, in part, to type of omega‑3 fatty acids used. The aim of this study was to determine the effects of pure eicosapentaenoic (EPA) and docosahexaenoic acids (DHA), the two major omega‑3 fatty acids, on inflammation, oxidative stress, and fat mass in patients with type 2 diabetes. Sixty patients with DM‑II were randomly allocated to receive daily either ~1 gr EPA or ~1 gr DHA, or a canola oil as placebo for 12 weeks in a randomized triple‑blind, placebo‑controlled trial. Serum MDA, CRP, body weight, BMI, and fat mass were measured at baseline and after intervention. Forty‑five patients with a mean (±SD) age of 54.9 ± 8.2 years with BMI of 27.6 ± 4.1 kg/m2 and fasting blood glucose 96.0 ± 16.2 mg/dl completed the intervention. Neither EPA nor DHA had significant effects on serum FBS, C‑reactive protein, body weight, BMI, and fat mass after intervention (P > 0.05). In addition, while MDA increased 18% in the placebo group (P = 0.009), it did not change in the EPA or DHA group (P > 0.05). Twelve weeks of supplementation with 1gr/d EPA or DHA prevent increasing oxidative stress without changing marker of inflammation. This study is the first report demonstrating that neither EPA nor DHA have effects on body fat mass in type 2 diabetic patients.

There is scant information on the facilitators and inhibitors of health‑promoting behaviors among reproductive‑aged Iranian women. This study aims to explore the experience of factors influencing health‑promoting behaviors among Iranian women of reproductive age from a qualitative perspective. This study was performed in Tehran in 2011, over about 8 months. Qualitative methods, specifically in‑depth interviews, were used to gather data on 15 women of reproductive age. Data continued to be collected until introduction of new information ceased. The interviews were recorded, transcribed verbatim, and analyzed by conventional content analysis. The reported factors were categorized into four main groups and 12 subgroups: (1) personal barriers (lack of time, school or work duties, lack of preparation or motivation, physical disability); (2) socio‑environmental barriers (family responsibilities, environmental pressures, high‑costs and financial pressures); (3) personal facilitators (personal interest and motivation, experience of disease); and (4) socio‑environmental facilitators (family and social support networks, encouraging and motivating environment, media, and public education). In these women’s experience, factors influencing health‑promoting behaviors were either facilitators or inhibitors; most were inhibitors. The findings of this study show that, in addition to personal factors, the pursuit of health‑promoting behaviors is affected by socio‑environmental factors. These results will be useful in designing interventions and plans for women’s health promotion that focus on the improvement of their environment and the modification of social factors.

Body concerns and its health consequences such as eating disorders and harmful body change activities are mentioned in Asian countries. This study evaluates factors contributing to body image/shape changes in an Iranian population. In this cross‑sectional study we focused on four main body change activity (diet, exercise, substance use, and surgery) and their risk factors such as demographic variables, Body Mass Index (BMI), Media, Body‑Esteem, Perceived Socio‑cultural Pressure, Body dissatisfaction and, Self‑Esteem. Approximately, 1,200 individuals between 14‑55 years old participated in this study. We used a multistage sampling method. In each region, the first household was selected at random. The probability of outcomes was estimated from logistic models. About 54.3% of respondents were females. The mean (SD) of age was 31.06 (10.24) years. Variables such as gender, age, BMI, use of media and socio cultural factors as, body dissatisfaction, body‑esteem and pressure by relatives were the main factors that influenced body change methods. In particular we have seen that male are 53% less likely to follow surgical treatments, but 125% were more likely to use substances. Investigation of body concern and its health related problem should be assessed in cultural context. For effectiveness of interventional programs and reducing harmful body image/shape changes activities, socio‑cultural background should be noted.

To reach fetal appropriate growth during the third trimester, the requirements for dietary calcium and iron intakes during the pregnancy increases. This study was carried out to determine the effects of daily consumption of probiotic yoghurt on serum calcium and iron levels and liver enzymes among Iranian healthy pregnant women. In this controlled clinical trial, 70 primigravida pregnant women carrying singleton pregnancy at their third trimester were participated. Participants were randomly divided into two groups of consuming 200 g/d of conventional (n = 33) or probiotic yogurts (n = 37) for 9 weeks. The probiotic yogurt contained Lactobacillus acidophilus and Bifidobacterium lactis with a total of min 1 × 107 CFU. To measure serum calcium, iron, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, blood samples were drawn in a fasting state at baseline and after 9 weeks intervention. Consumption of probiotic yogurt resulted in maintaining serum calcium levels compared with the conventional yogurt (P = 0.01). Within‑group differences in the conventional yogurt group revealed a significant reduction of serum calcium levels (−1.7 mg/dL, P < 0.0001).No significant differences were found between the two yogurts in terms of their effects on serum iron, AST and ALT levels. Consumption of probiotic yogurt among pregnant women resulted in maintaining serum calcium levels compared with the conventional yogurt; however, it could not affect serum iron, ALT and AST levels.

Nephrotic syndrome (NS) is a major clinical concern in human health, especially in children. Despite of the etiology, the prediction of remission in different treatment regimens based on suitable biomarkers is under development. The goal of this evaluation was the demonstration of correlation between serum level of Neutrophil gelatinase associated lipocalin (NGAL) and cystatin‑C with kidney function in patients with NS. During the period between September 2008 and December 2011, 52 patients admitted to St. Al Zahra University Hospital were selected for evaluation. The measured parameters consisted of NGAL, cystatin‑C, creatinine, albumin, blood urea nitrogen, urine protein, glomerular filtration rate. Demographic data were collected and considered in comparisons. Comparison between variables and their correlations were examined. Means of serum NGAL and cystatin‑C were significantly higher in case than the control group, P < 0.05. The mean of serum NGAL in patients without remission and who achieved remission were 23.09 (standard deviation [SD] ±10.11) and 36.26 (SD ± 20.10) ng/ml respectively; P < 0.05. Serum NGAL levels had a correlation with the following factors: Systolic blood pressure, diastolic blood pressure (DBP), cystatin‑C, remission. Linear regression analysis showed a significant correlation between cystatin‑C and systolic and DBP. Based on the results, serum NGAL can be used as a prognostic marker for remission. In addition, NGAL and cystatin‑C are biomarkers of kidney injury in NS.

Kikuchi‑Fujimoto disease also known as histiocytic necrotizing lymphadenitis is a benign disorder characterized histologically by necrotic foci surrounded by histiocytic aggregates, and with the absence of neutrophils. The patient was a 21‑year‑old man with chills, fever and cervical lymphadenopathy. He had swelling and tenderness of cervical area. Multiple enlarged lymph nodes were palpable. Cervical lymph node excisional biopsy was performed. Microscopic examination showed reactive follicular hyperplasia with vast areas of necrosis without neutrophilic infiltration. No sign of malignancy was seen. Final diagnosis was Kikuchi‑Fujimoto necrotizing lymphadenitis. Kikuchi‑Fujimoto disease should be considered as one of the differential diagnoses in patients with prolonged fever and cervical lymphadenopathy. It should be differentiated from tuberculous lymphadenitis in regions where tuberculosis is prevalent.

The keratocystic odontogenic tumor (KCOT) is a relatively common oral and maxillofacial lesion with specific characteristics such us rapid growth, extension into the surrounding tissues and high rates of recurrence. Various treatment modalities have been reported. Due to the very thin and friable lining characteristic of the tumor, enucleation can be difficult undertaken and for this reason it is associated with the highest recurrence rates. A 22‑year‑old male referred to our clinic due to a slight expansion in the right mandible from 2 years ago. He has a history of occurrence of KCOT in this region that was treated surgically by enucleation and curettage 5 years ago. Cone beam computed tomography showed a multilocular radiolucent lesion that extended from the angle of the mandible to the symphysis. Incisional biopsy showed a KCOT recurrence that surgically treated with resection of the right mandible by continuity preservation. Selection of the best treatment modality and also a periodical lifelong follow‑up is very important to reduce the rate of recurrence and morbidity of the patient.

Depression is the most common geriatric psychiatric disorder. Other than organic, socio‑demographic factors, have been found to play an important role in mental health. In this study we evaluated the association of some socio-demographic factors with geriatric depression A cross‑sectional study was carried out in the Out Patient Department registration area of a tertiary care teaching hospital in Delhi. Questionnaire based interviews were conducted among the elderly people visiting the hospital. A 15‑item geriatric depression scale‑Hindi was used to assess depression. Six hundred and seventy eight subjects were interviewed. The age of the subjects ranged from 65 to 85 years. About three‑fourth of the study population were males. About 61.4% scored positive for depression. Multiple logistic regression analysis revealed that the following were significant (P<0.05) independent predictors of depression: Higher age, low educational status, financial dependence and presence of any chronic health problem. The present study found that the prevalence of depression among the study subjects was high. Also the independent risk factors found in this study need to be targeted in formulating mental health policy for geriatrics.Keywords:

Chronic arsenic poisoning is an important public health problem and most notable in West Bengal and Bangladesh. In this study different systemic manifestations in chronic arsenic poisoning were evaluated. A nonrandomized, controlled, cross‑sectional, observational study was carried out in Arsenic Clinic, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, over a period of 1 year 4 months. Seventy‑three cases diagnosed clinically, consuming water containing arsenic ≥50 mg/L and having hair and nail arsenic level >0.6 mg/L, were included. Special investigations included routine parameters and organ‑specific tests. Arsenic levels in the drinking water, hair, and nail were measured in all. Twenty‑five nonsmoker healthy controls were evaluated. Murshidabad and districts adjacent to Kolkata, West Bengal, were mostly affected. Middle‑aged males were the common sufferers. Skin involvement was the commonest manifestation (100%), followed by hepatomegaly [23 (31.5%)] with or without transaminitis [7 (9.58%)]/ portal hypertension [9 (12.33%)]. Restrictive abnormality in spirometry [11 (15.06%)], bronchiectasis [4 (5.47%)], interstitial fibrosis [2 (2.73%)], bronchogenic carcinoma [2 (2.73%)], oromucosal plaque [7 (9.58%)], nail hypertrophy [10 (13.69%)], alopecia [8 (10.95%)], neuropathy [5 (6.84%)], and Electrocardiography abnormalities [5 (6.84%)] were also observed. Mucocutaneous and nail lesions, hepatomegaly, and restrictive change in spirometry were the common and significant findings. Other manifestations were characteristic but insignificant.