Iranian Journal of Public Health
Volume:42 Issue: 8, Aug 2013

Tourism, combined with the phrase medical, seems to be a new form of tourism which has gained huge popularity in recent decades. Though, a number of literatures available with regard to the tourism industry and the competitiveness of the destination, however, the major aspects which determine the satisfaction of medical tourists are hardly focused specifically on Malaysia. There is a lack of empirical evidence in this area of study which needs to be bridged. Hence, this study aimed at investigating the various factors contributing towards the development of medical tourism in Malaysia. As the purpose of the research was to find out various factors contributing towards the development of medical tourism in Malaysia, so this study used Structural Equation modeling (SEM) for data analysis. The target population for this study consisted of the medical tourists coming to Malaysia with the primary intension of seeking medical procedures other than sightseeing. A total sample size of 266 was collected through non-probability judgment sampling during the period between December 2012 and February 2013. The result confirms that destination competitiveness and service quality play an important role in the medical tourist’s mind towards medical tourism aspect in Malaysia. Thus, Malaysia need to promote various medical success stories together with the services they offer to attract more foreign patients. This study contributes to the theoretical development in the tourism industry by offering the structured relationship among various aspects contributing towards the development of medical tourism in Malaysia.

The World Health Organization Quality of Life-BREF (WHOQOL-BREF) has generally been used for patients，few studies in migrants who move from rural to urban within one country. Many studies asserted that social isolation presents a risk to individual health. Poor social networks are associated with worse QOL. This study examined health-related quality of life (HRQOL) and social support in new-generation migrant workers and compared it with urban workers. Nine hundred thirty new-generation migrant workers and 939 urban controls completed the WHOQOL-BREF questionnaire and Social Support Rating Scale (SSRS) by stratified sampling in 2011. Spearman’s correlation was performed to clarify the relationship between social support and HRQOL in migrants. Multiple linear regression analyses were used to identify the variables that were associated with HRQOL. The general health, psychological health, and environmental scores of QOL in new-generation migrant workers were lower than in urban workers. New-generation migrants had poorer social support compared with urban controls with regard to general support, objective support, and support utilization. A positive correlation was found between social support and HRQOL. Workers with a higher level of education achieved better psychological, environmental, and general scores than workers with a primary education. Physical, social, environmental, and general health was also closely connected with the age factor. Physical health scores were higher in males than in females. These data suggest that new-generation migrant workers have significant impairment in HRQOL and receive less social support. HRQOL may be affected by social support, education, age, and gender.

Long-term ingestion of large amounts of fluoride can lead to potentially severe skeletal problems and neurological consequences. The study was conducted to assess and compare intelligence quotient of children living in high and low fluoride areas in Kutch, Gujarat, India. A cross-sectional descriptive survey was conducted among 100 school children aged 8 to 10 years, living in Kutch District, Gujarat, India during July 2012. Mundra (2.4 to 3.5 mg/L) and Bhuj (0.5mg/L) were the two villages randomly selected to represent the high and low water fluoride areas respectively. Seguin Form Board Test was used to assess the intelligence quotient (IQ) level of children. Descriptive statistics and independent sample t-test was used for analysis. Mean scores for average, shortest and total timing category were found to be significantly higher (P<0.05) among children living in Mundra (30.45±4.97) than those living in Bhuj (23.20±6.21). Mean differences at 95% confidence interval for these timings were found to be 7.24, 7.28 and 21.78 respectively. In both the villages, females had lower mean timing scores than males but the difference was not statistically significant (P>0.05). Chronic exposure to high levels of fluoride in water was observed to be associated with lower intelligence quotient.

To study the prevalence of low back pain in medical and nursing undergraduate students in our institutes and its association with physical activity, smoking, depression, use of computer and other variables. It was a comparative cross sectional study carried out at two institutes of Dow University of Health Sciences, Karachi, Pakistan during October to December 2011. Two hundred and fifteen undergraduate students representing different semesters were asked to fill out the structured questionnaire. Back pain was assessed in terms of lifetime, one year and point prevalence. Bivariate analysis was done to study the relationship between back pain and different variables; including gender, study program, smoking, computer use, depression and level of physical activity. Both the groups were compared for duration/intensity of pain, seeking medical advice and duration of computer use. There were 183 undergraduate students who completed the questionnaire for back pain. Mean age was 22.84 (SD ± 5.85) years. Gender distribution was nearly equal (females = 51.4%). Life time prevalence was 57.9% (72% in medical students; 41% in nursing students). Medical students were 0.47 times more at risk of having back pain (95% CI 0.15-1.48; P=0.198). Smoking (OD=0.39; 95% CI 0.04-3.6; P=0.001) and use of laptop (OD=4.9; 95% CI 1.2-19.2; P=0.031) were found to be associated with increased prevalence of back pain. Nursing students sought medical opinion more as compared to medical students but it was not significant. However duration of computer use was more in medical students which was significant (P=0.03). High lifetime prevalence of back pain was observed in undergraduate students. Medical students appeared to be more at risk. Preventive measures are required to improve the quality of life in future health care professionals.

Cystic echinococcosis (CE) is one of the most important parasitic zoonosis worldwide. Due to the high recurrence rate of the disease after surgery, follow up of the patient is necessary. The aim of current research was to assess the performance of Western blotting (WB), using sheep hydatid fluid, for serological diagnosis and post-treatment monitoring of human CE. Serum samples obtained from 50 clinically/radiologically proven cases of CE along with serum samples from non-CE patients and healthy persons were tested by WB, using sheep hydatid fluid as antigen. The WB test enabled the detection of antibodies in the pre-operative samples for proteins of 18-239 kDa in molecular weight. From 50 sera of CE patients, 31 cases (72.09%) detected 52 kDa subunit, 27 cases (62.79%) detected 24 kDa band, 26 cases (60.46%) recognised 39 kDa band and 21 cases (48.83%) identified 46 kDa component of sheep hydatid antigen. Sera from patients with other parasitic infections and malignancy showed cross-reactivity with the cluster of 54-59 kDa bands. The healthy control sera were not reactive to any antigenic fraction. The antigenic bands with molecular weight of 52, 24, 39 and 46 kDa were specific for CE, and may serve as useful diagnostic markers. The antibodies specific to proteins 24 and 39 kDa significantly decreased in the patients cured after surgery, while in patients with recurrent parasitism the bands present before surgery persisted. The WB with sheep hydatid antigen might be useful in the diagnosis and post-surgical monitoring of CE patients.

Mental health and mental disorders are determined by multiple and interacting social, psychological and biological factors which determine the prevalence, onset and course of mental and behavioral disorders. The aim of the study was to evaluate differences in mental health status regarding gender of the adult population in the Province of Vojvodina. Research was carried out as a retrospective cross-sectional study. Data was obtained from the “National Health Survey in Serbia, 2006” database that refers to the representative adult population of Vojvodina, aged 20 and over. A specially designed questionnaire was applied as a research instrument. This study included 3627 examinees, average age 49.9 years. In the month prior to the study, a half of the adult population in Vojvodina (48.4%) was exposed to stress and one third had emotional problems (32.9%), while both stress and emotional problems were more prevalent in females. The average score value on the psychological distress scale (presence of negative conditions and feelings) of all examinees was 64.1 (from 0 to 100) and it was statistically significantly lower in women (62.0), compared to men (66.6) (P<0.001). Statisticaly significant differences were also observed between average score values on the role-emotional and vitality scales (P<0.001). When mental health is considered, this research showed that female population is more vulnerable compared to males. Women are more often exposed to stressful situations and emotional problems and more often faced with negative conditions and feelings.

This study was conducted to identify the determinants of protective behavior in relation to HIV transmission. Since the risk of transmission is higher among those who have extramarital intercourse, the study sample constituted of such people. We started this study in 2010 and finished it in 2011. Participants were divided into low-risk and high-risk groups. High-risk people included sex workers and those who presented at drop-in centers. Interviewees were 18 men and women in the low-risk group and 12 men and women in the high-risk group. Data were collected through in-depth interviews and were analyzed using the thematic framework method. In both groups, protective behavior was influenced by willingness to protect, intention or decision to protect, and personal, social, and environmental barriers and facilitators. In terms of willingness, behavior was influenced to preserve sexual pleasure by avoiding condoms. In terms of barriers and facilitators, trust in partner, misperceptions, condom inaccessibility, unplanned sex, fear of contracting the disease, partner’s wish, ethical commitments were mentioned by both groups, stigma of condom possession by the low-risk group, and partner’s force was mentioned by the high-risk group. Educational programs need to focus on changing the concept that “condoms reduce sexual pleasure”. In addition, interventional programs to strengthen factors such as self-efficacy, ethical commitments, faithfulness, and correct beliefs such as undue trust in partner, misconception of being safe, unplanned sex, and the stigma of possessing condoms can be very effective in changing high-risk sexual behavior.

Literatures that focus on the risk factors of unintended pregnancy among married women are limited especially in developing countries. The aim of this study was to determine the predictors of unintended pregnancy in a west region of Iran. This case-control study was conducted from September to November 2011 in Hamadan City, western Iran. A stratified cluster random sampling method was used for data collection. All participants were enrolled voluntarily into the study including 181 cases and 391 controls. Cases were married women with unintended pregnancy. Controls were married women with planned pregnancy. Of 572 participants, 31 (5.4%) women had not used any methods of contraception prior to the recent pregnancy. The proportion of using ineffective contraceptive methods such as withdrawal was higher in cases than in controls. The most effective predictor of unintended pregnancy was the number of previous alive children so that the risk of unplanned pregnancy increased 3.68 per one child (P<0.001). This study introduced several effective predictors for unintended pregnancy among married women which may be useful for family planning programs. The high-risk population should be strongly advised to use highly effective contraceptive methods such as tubal ligation, vasectomy or OCP provided that being used correctly.

Anaerobic treatment methods are more suitable for the treatment of concentrated wastewater streams, offer lower operating costs, the production of usable biogas product. The aim of this study was to investigate the performance of an Anaerobic Fluidized Bed Reactor (AFBR)-Aerobic Moving Bed Bio Reactor (MBBR) in series arrangement to treat Currant wastewater. The bed materials of AFBR were cylindrical particles made of PVC with a diameter of 2-2.3 mm, particle density of 1250 kg/m3.The volume of all bed materials was 1.7 liter which expanded to 2.46 liters in fluidized situation. In MBBR, support media was composed of 1.5 liters Bee-Cell 2000 having porosity of 87% and specific surface area of 650m2/m3. When system operated at 35 ºC, chemical oxygen demand (COD) removal efficiencies were achieved to 98% and 81.6% for organic loading rates (OLR) of 9.4 and 24.2 g COD/l.d, and hydraulic retention times (HRT) of 48 and 18 h, in average COD concentration feeding of 18.4 g/l, respectively. The contribution of AFBR in total COD removal efficiency at an organic loading rate (OLR) of 9.4 g COD/l.d was 95%, and gradually decreased to 76.5% in OLR of 24.2 g COD/l.d. Also with increasing in organic loading rate the contribution of aerobic reactor in removing COD gradually decreased. In this system, the anaerobic reactor played the most important role in the removal of COD, and the aerobic MBBR was actually needed to polish the anaerobic treated wastewater.

Cobalt is one of the most important constituent present in ceramic industries. Glazers are the relevant workers when they are producing blue colored ceramic, causing occupational exposure to such metal. Through this study, urinary cobalt was determined in glazers in a ceramic industry when they were producing blue-colored ceramic glazes. In this case-control study, spot urine samples were collected from 49 glazers at the start and end of work shifts (totally 98 samples) in 2011. Control group were well matched for age, height, and weight. A solid phase extraction system was used for separation and preconcentration of samples followed by analysis by inductively coupled plasma-atomic emission spectroscopy (ICP-AES).All participants filled out a self administered questionnaire comprises questions about duration of exposure, work shift, use of mask, skin dermatitis, kind of job, ventilation system, overtime work, age, weight, and height. The lung function tests were performed on each control and cobalt exposed subjects. Analysis of covariance (ANCOVA) was used to evaluate the obtained results. Urinary levels of cobalt were significantly higher in the glazers compared to the control group. There were significant differences at urinary concentration of cobalt at the start and end of the work shift in glazers. Spirometric parameters were significantly lower in the glazers compared to the control group. Among the variables used in questionnaire the significant variables were dermatitis skin, mask, ventilation, and overtime work. This study verified existence of cobalt in the urine glazers, showing lower amount than the ACGIH standard.

This study was designed to present and compare Iranian hospitals` performance applying ratio analysis technique. This cross-sectional survey was conducted to present an instant image of 139 Iranian hospitals` performance status applying ratio analysis as one of the non parametric technical efficiency assessment methods in 2008. Data was collected using nine dimensional questionnaires supported by world wide web to achieve main hospital ratios. Final analysis was performed applying classic statistics and relevant statistical tests on significant level of 0.05. Four hospital performance indicators were estimated in the studied hospitals as follows: Bed turnover rate (BTR) was fluctuated from 64.5 to 114.8 times for hospitals located in rich and poor areas respectively. Moreover Bed Interval Rate (BIT) was calculated 1.36 versus 2.4 in the poor and rich areas. Average length of stay (ALS) was computed 1.82 for the poor regions but 3.27 for the rich ones furthermore, a positive statistical significant correlation was seen between ALS and the hospital size (P=0.001,r=0.28). Average bed occupancy rate (BOR) was 57.8% and its variation was from 31.4% to 64.5% depending on the hospital size so that there was a positive statistical significant relationship between the hospital size and BOR (P=0.006, r=0.32). Regarding that BOR, ALS, BTR and BIT along with mortality rates are mentioned as the most considerable performance indicators, applying analytic frameworks more than considering single and raw indicators are severely recommended.

Drug resistance in malaria parasites is extending in the world particularly in chemical synthesized drugs such as 4- aminoquinolines and aminoalcoholes. Employing herbal extracts is encouraged by WHO in the malarious areas. In this study, the effectiveness of ethanolic extract of Artemisia aucheri individually and in combination with chloro­quine, has been considered against chloroquine - sensitive strain of Plasmodium berghei. At the first stage, ED50 of A. aucheri and chloroquine on P. berghei was calculated using in vivo test. Then based on the ED50s combination of A. aucheri and chloroquine with ratios of 0/100,10/90,20/80,30/70,40/60,50 /50,60/40,70/30,80/20,90/10 and100/0 were tested against the parasite. For evaluat­ing the adverse effect of A. aucheri on the mice, for two weeks 1000mg/kg of the extract was daily employed and the mice were followed up for fifty days ED50s for chloroquine and A. aucheri were 1.6mg/kg and 1000mg/kg respectively. The outcome of two drugs combination on the mice showed antagonistic effects on the chloroquine – sensitive strain of parasite. Two weeks daily administration of A. aucheri had no toxic effect on the mice. A. aucheri individually can be effective in reducing the parasite while in combination with chloroquine loses its property.

Dental caries is one of the most preventable yet prevalent chronic diseases worldwide. Our objective was to evaluate the effect of family structure and behavioral and eyesight problems as they relate to caries severity in schoolchildren. This research was carried out on 845 primary schoolchildren aged 9 yr in Kerman, Iran, in 2012. Ten variables, including health records, family structure information and a dmft/DMFT index, were collected. Children were categorized into three groups based on the WHO caries severity classification. Low caries level was defined as dmft/DMFT<2.6, moderate as dmft/DMFT of 2.7-4.4 and high as dmft/DMFT>4.4. The Cochran–Armitage test and ordinal logistic regression were employed for data analysis. Almost half of pupils had moderate or high caries severity. The odds of being in a higher caries severity category in pupils with behavioral problems (OR=2.37, 95% CI: 1.29-4.38) and girls (OR=1.6, 95% CI: 1.22-2.06) were higher than in other categories. In addition, pupils with eyesight problems (OR=0.58, 95% CI: 0.37-0.90) and overweight pupils (OR=0.46, 95% CI: 0.31-0.71) had lower caries severity than others. The effects of parents’ education, birth rank, living with parents and consanguineous relationship between parents were not significant on caries severity (P>0.05). Female pupils with behavioral problems were at a higher risk of caries severity than other pupils. These pupils need to be educated and coached on proper dental care. In addition, overweight pupils and those with eyesight problems had less caries severity than others. Family structure in this study did not have an effect on the severity of dental caries.

To evaluate the effectiveness of a relapse prevention cognitive-behavioral model, based on Marlatt treatment approach, in Opioid-dependent patients participating in the Methadone Maintenance Treatment (MMT) in Iran. The study consisted of 92 individuals treated with methadone in Iranian National Center of Addiction Studies (INCAS). Participants were randomized into two groups: educational intervention group (N=46) and control group (N=46). The intervention was comprised of 10 weekly 90 minute sessions, done during a period of 2.5 months based on the most high risk situations determined using Inventory Drug Taking Situation instrument. Relapse was defined as not showing up for MMT, drug use for at least 5 continuous days, and a positive urinary morphine test. While, only 36.4% of the intervention group relapsed into drug use, 63.6% of the control group relapsed. The result of the logistic regressions showed that the odd ratio of the variable of intervention program for the entire follow up period was 0.43 (P<0.01). Further, the odd ratio of this variable in one month, three months, and 195 days after the therapy were 0.48 (P<.03), 0.31 (P<.02), and 0.13 (P<.02) respectively that revealed that on average, the probability of relapse among individuals in the intervention group was lower than patients in control group Relapse prevention model based on Marlatt treatment approach has an effective role in decreasing relapse rate. This model can be introduced as a complementary therapy in patients treated with methadone maintenance.

Natural background radiation is the main source of human exposure to radioactive material. Soils naturally have radioactive mineral contents. The aim of this study is to determine natural (,, ) and artificial () radioactivity levels in wheat and corn fields of Eilam province. HPGe detector was used to measure the concentration activity of and series, and in wheat and corn samples taken from different regions of Eilam province, in Iran. In wheat and corn samples, the average activity concentrations of, , and were found to be 1,67, 0.5, 91.73, 0.01 and 0.81, 0.85, 101.52, 0.07Bq/kg (dry weight), respectively. Hex and Hin in the present work are lower than 1. The average value of Hex was found to be 0.02 and 0.025 and average value of Hin to be found 0.025 and 0.027 in wheat fields samples and corn samples in Eilam provinces, respectively. The obtained values of AGDE are 30.49 mSv/yr for wheat filed samples and 37.89 mSv/yr for corn samples; the AEDE rate values are 5.28 mSv/yr in wheat filed samples and this average value was found to be 6.13 mSv/yr in corn samples in Eilam. Transfer factors (TFs) of long lived radionuclide such as, , and from soils to corn and wheat plants have been studied by radiotracer experiments. The natural radioactivity levels in Eilam province are not at the range of high risk of morbidity and are under international standards.

Regarding the public health concerns over the use of food preservatives in yoghurt drink “Doogh«, the aim of this study was the determination of sodium benzoate, potassium sorbate and natamycin in Doogh. Based on Iranian national standard, none of these preservatives are permitted to be used in Doogh. A total of 39 Doogh samples were analyzed through RP- HPLC in order to quantify sodium benzoate, potassium sorbate and natamaycin simultaneously. Exposure to each preservative is estimated by mean and maximum concentrations as the residue levels. The per capita Doogh consumption was calculated by the published data from official reports for Doogh annual production in Iran. All samples were shown to contain sodium benzoate while natamaycin was detected in 10. 25% of the samples and potassium sorbate was not detected in any of them. Sodium benzoate concentration extremely varied among the investigated samples ranged from 0. 94 to 9. 77 mg/l. Due to the result of the exposure estimation, no serious public health concern would exist regarding the mentioned preservatives. The detection of sodium benzoate in all Doogh samples could indicate the natural production of benzoic acid in yoghurt. Sodium benzoate may be formed through the interaction of the added food grade salt to the Doogh formula which contains benzoic acid. The results of exposure estimation show the lack of health risk within the usage of preservatives in spite of the national regulatory agencies does not permit the preservative use.