Iranian Journal of Public Health
Volume:42 Issue: 9, Sep 2013

Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug abuse: patients? need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment protocols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating addicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barriers, oral health care at various levels including education, prevention, and treatment should be integrated into general care services for addicts.

It is widely accepted in many parts of the world that community nurses are of vital importance in various phases of disaster response and management. In China, however, it is not clear whether the Chinese community nurses are able to assume disaster-related duties due to the lack of a systematic assessment. A pre-designed and well-tested questionnaire was employed to evaluate the competency in disaster response and management among 205 valid registered Chinese community nurses between September and October 2009. Statistical analyses were performed with SPSS Version 13.0 using one way ANOVA, Least Significant Difference (LSD) and multiple stepwise regression analysis. This group of Chinese community nurses scored at an intermediate level of competency (a score of 3.68 (SD 0.48) out of a perfect score of 5) in disaster response and management, suggesting that they have the basic ability to participate in disaster-related nursing. Four factors, namely, Experiences in Disaster Relief, Participation in Disaster Training, the Age and Duration in Job, were identified to be the predominant factors contributing significantly to the integrated competency in disaster response and management of an individual. Most of the Chinese community nurses have basic qualifications and competencies to undertake the responsibilities of disaster response and management. However, more targeted disaster training including virtual-reality based drills should be provided in order to improve their competency.

This cross-sectional study aimed to examine the relationship between several dimensions of the burnout syndrome with certain stress-coping strategies, seniority level and marital status in male staff from National Police in Vapara?so, Chile. The sample collected in 2010 was composed of 338 male officers coming from various special units of a National Police in Valpara?so. Burnout and Coping Strategies were assessed and classified according Maslach Burnout Inventory (MBI) and COPE Inventory, respectively. Data was analyzed using Pearson product-moment correlation, t-test for independent measures and Multiple Linear Regression to generate a predictive model. The prevalence of the burnout syndrome disaggregated by grouping criteria, the dimensions concentrated in middle levels for emotional exhaustion with a 52.1%, a 51.8% for depersonalization and finally, personal achievement with a 48.8%. Only 28% of participants showed more exacerbated dimensions of the burnout syndrome. There was a weak and direct yet statistically significant relationship between personal achievement and active coping. Mental disconnection had a weak direct relationship between both coping strategies and emotional exhaustion also existed. Certain correlations between burnout dimensions and coping strategies focused on emotion as predictor variables over the criterion variable corresponding to emotional exhaustion were mental disconnection in first place, secondly, focusing on emotions, and emotional social support. Burnout dimensions scored medium values? ?focusing mainly on emotional exhaustion and reduced personal accomplishment. Coping strategies are used in parallel and in general are not mutually exclusive. Finally, there were not any relationship between variables seniority level and marital status.

Estimating maternal mortality level is constantly challenging researchers and planners both in rich and poor countries. In developing countries, particularly in Burkina Faso where the registration system is not working properly, censuses and surveys are the main providers of maternal mortality estimates. However, censuses provide more reliable data about maternal mortality especially at sub-national level. Strength of this situation, the census 2006 of Burkina Faso collected information about maternal mortality. Unfortunately, the census also under reported the phenomenon. In this regard, a methodology was developed to provide adjusted estimates of the phenomenon. This paper aims to assess the census 2006 estimates of maternal mortality through a critical review of the questionnaire, data quality, adjustment technique and outputs. Incoherencies, duplicated cases and missing data were the key aspects of the data quality assessment. The assumptions and outputs of the method were examined and comparison made with existent estimates. Findings highlighted weaknesses regarding the assumptions of the method and showed that the levels of the phenomenon were still under-estimated. In this research, propositions have been made concerning data cleaning, situations of adjustment coefficients less than 1 and the problem of weak assumptions. Findings led to a MMRatio of 331 [293-402] maternal deaths per 100?000 live births. The level of maternal mortality as published in the census 2006 report (MMRatio of 307) is acceptable because falling in the range 293-402. However, the questionnaire, data and method used needed improvements.

Non-communicable diseases (NCDs) exist in slums as the inhabitants adopt an urbanized lifestyle which places them at a higher risk for. Lack of knowledge about the morbidity, complications and the method of control contributes to a large percentage of undetected and untreated cases. This cross-sectional survey polled 2,434 respondents from Ijora Oloye, Ajegunle and Makoko, three urban slums in Lagos metropolis, southwestern Nigeria between June 2010 and October 2012. We investigated the prevalence of hypertension, diabetes and obesity. Respondents signed consent forms and their health conditions were documented based on self-reported history of diabetes, hypertension and family history using a semi-structured questionnaire. Diagnostic tests; weight and height for body mass index, blood glucose, and blood pressure were performed. More than one quarter of the participants were suffering from hypertension and only half of this were diagnosed earlier, while a further few were already on treatment. Therefore on screening, it had been possible to diagnose over three hundred more respondents, who were not previously aware of their health status. The respondents? BMI showed that more than half of them were either overweight or obese and are at risk for diabetes, while 3.3% were confirmed as being diabetic, with their sugar levels greater than the normal range. This study therefore revealed the near absence of screening programs for chronic diseases such as hypertension, diabetes and obesity in these urban slums. This was further confirmed by the detection of new and undiagnosed cases of hypertension in about one quarter of the respondents.

Cervical cancer is the third most common cancer among women in Malaysia. The objective of this study was to estimate the effect of explanatory variables on survival time of cervical cancer patients receiving treatment at a hospital in Malaysia. In this retrospective record review study, cervical cancer data obtained from Hospital Universiti Sains Malaysia (HUSM) was analysed. The data comprises of 120 patients who had been diagnosed as cervical cancer between 1st July 1995 and 30th June 2007, and obtained treatment from the hospital. The outcome variable was survival time (in months) from cervical cancer diagnosis to death. A stratified Weibull model was applied to study the effect of explanatory variable on survival time when there was time-dependent covariate in the model. Stage of disease and metastases were important prognostic variables. However, metastasis had been stratified because this variable did not satisfy the proportional hazard assumption. In without metastasis stratum, patients who were diagnosed at stage III & IV are at 2.30 times the risk of death as those in stage I & II. Meanwhile, in with metastasis stratum, patients in stage III & IV group had 3.53 times the hazard faced by patients in stage I & II. The prognosis of cervical cancer patients was dependent upon the stage at diagnosis, after the stratification of the metastasis variable. A poorer prognosis on survival was observed for patients in stage III & IV than those in stage I & II.

The efficiency of the health care system is significantly dependent on the appropriate leadership and guidance of employees. One of the most frequently used new approaches in human resources management is the study of competencies and competency models. The aim of this research is to develop a competency model for leaders in nursing, and to compare it with the leadership competency model for state administration. A survey was conducted among 141 nurse leaders in Slovenia. The respondents were asked to complete questionnaire with 95 leadership behaviours that form the leadership competency model for leaders in nursing. The data were analysed by ANOVA and Tukey''s honestly significant differences test. The levels of competencies set for themselves by leaders at the third leadership level in nursing (leaders of small units and teams) are significantly lower than those set by all other leaders, both in nursing and in state administration. Statistically significant differences were apparent in the majority of areas. Within the context of the comparison of competency models, the greatest need for training can be observed at the third level of leadership in nursing. A comparison of models formulated in this way enables the exchange of good practices among leaders from various professional groups and easier identification of the training needs of individual groups of leaders in public administration. The proposed concept is designed to significantly simplify and unify the building of competency-based leadership models in public sector.

Child with Down''s syndrome is an individual who is suitable and eligible to receive early intervention services. This study aimed to measure the family outcome among parents of Down syndrome children, on the impact of receiving early intervention and identify the factors influencing it. A cross sectional was conducted from April 2009 until January 2010 with a total of 125 parents of children with Down syndrome. There are five domains of family outcomes that has been studied which are understanding the strengths, abilities and special needs of children, knowing the rights and talk on children behalf, assisting the child to grow and learn, having a support system and be involved in the community. Children with Down syndrome aged four to 15 years was chosen as the respondents when they were accompanying their children in seven rehabilitation centers or during house visits. Family outcomes among parents of Down syndrome children who receive early intervention is better, 67.3 percent, compared to parents of Down syndrome children who receive late intervention, 41.4 percent. There are significant relationship between the acceptance level of intervention, parents education level, family income and the family outcomes. Parents of children who receive early intervention were more positive in understanding the strengths, abilities and special needs of their children compared to other family outcomes. Families whom children received early intervention had indirectly proved the importance and benefit of early intervention, not only for children with special needs, but for their family as well.

Glucose-6-phosphate dehydrogenase is one of the most common genetic deficiencies, which approximately 400 million people in the world suffer from. According to authors'' initial search, numerous studies have been carried out in Iran regarding molecular variants of this enzyme. Thus, this meta-analysis presented a reliable estimation about prevalence of different types of molecular mutations of G6PD Enzyme in Iran. Keywords «glucose 6 phosphate dehydrogenase or G6PD, Mediterranean or Chatham or Cosenza and mutation, Iran or Iranian and their Persian equivalents» were searched in different databases. Moreover, reference list of the published studies were examined to increase sensitivity and to select more studies. After studying titles and abstracts of retrieved articles, excluding the repeated and unrelated ones, and evaluating quality of articles, documents were selected. Data was analyzed using STATA. After performing systematic review, 22 papers were entered this meta-analysis and 1698 subjects were examined concerning G6PD molecular mutation. In this meta-analysis, prevalence of Mediterranean mutation, Chatham mutation and Cosenza mutation in Iran was estimated 78. 2%, 9. 1% and 0. 5% respectively. This meta-analysis showed that in spite of prevalence of different types of G6PD molecular mutations in center, north, north-west and west of Iran, the most common molecular mutations in people with G6PD deficiency in Iran, like other Mediterranean countries and countries around Persian Gulf, were Mediterranean mutation, Chatham mutation and Cosenza mutation. It is also recommended that future studies may focus on races and regions which haven''t been taken into consideration up to now.

Congenital hypothyroidism is a condition of thyroid hormone deficiency. Approximately 1 in 4000 newborn infants has a deficiency of thyroid function. The aim of this study is determination of the prevalence of permanent and transient congenital hypothyroidism (CH) in Yazd, Iran. From May 2006 to June 2008, 35377 newborns were screened by measuring serum TSH obtained by heel prick. The neonates who had a TSH?5mU/L were recalled for measurement of serum T4 and thyroid stimulating hormone (TSH) in venous samples. Based on the results of the secondary measurements (between days 7 and 28), neonates were considered hypothyroid if their T4 was <6.5 mg/dl and their TSH was? 10mIU/L. In 22 primarily diagnosed as cases of CH, treatment was discontinued at age 3 years for 4 weeks and T4 and TSH were measured again. Permanent or transient CH was determined from the results of these tests; Patients with TSH levels? 5 mIU/l were diagnosed with permanent CH. The incidence of congenital hypothyroidism was found to be 1:1608 with a female to male ratio of 0.69:1. In 22 patients with CH, 10 patients were diagnosed with permanent CH (45.5%) and 12 with transient hypothyroidism (54.5%). Permanent CH was associated with higher TSH levels at first measurement than transient hypothyroidism (P-value=0.041). The rate of transient CH in our study was higher than the comparable worldwide rate, so more and larger studies are needed to find clear information about the etiologic factors of this disease.

The aim of present study was to determine the impact of two different ICU management model, open and semi closed, on resources utilization in intensive care unit. Retrospective cohort analysis using data from hospital database was applied to compare the effect of ICU management model on ICU length of stay and bed disposition of 1064 patients admitted to the general ICU of Imam Khomeini Hospital of Tehran, Iran during the two consecutive 12-month periods from Mar, 2009 to Feb, 2010. In open and semi closed interval 380 and 684 patients were admitted to ICU respectively. There was no significant difference in age, gender and severity of illness (based on APACHE-II score) and nurse to bed ratio between two groups. Average ICU length of stay, net mortality rate and bed turnover rate were lower in semi closed model than open model management significantly (P<0.05). Semi closed model improves patient care and lead to lower mortality rate and resources utilization too.

Studies have shown that Mindfulness Based Stress Reduction (MBSR) has positive effect on physical and psychological dimensions of chronic illnesses. In this study for the first time we examine the effect of this new technique on quality of life and pulmonary function in chemically pulmonary injured veterans who have chronic pulmonary problem, psychological problems and low quality of life. Forty male pulmonary injured veterans were randomly replaced in two groups with 20 participants (MBSR and control Wait List (WL)). Then MBSR group received 8-weekly sessions intervention. We evaluate quality of life (used SF-36 questionnaire) and Spirometry parameters two times; before and after intervention in two group. We used «mixed factorial analyses of variance» test for analyzing data in each dependent variables. Then if we have significant interactional effect, we used? paired- sample t-test «for comparing before and after intervention data of each group, and» Independent-Sample t-test«for comparing after intervention data of two groups. The MBSR compare to WL group improved SF-36 total score, (F (1, 38) =12. 09, P=0. 001),»Role limitations due to physical problems«(F(1, 38) = 6. 92, P=0. 01),»Role limitations due to emotional problems«(F(1, 38) = 7. 75, P=0. 008),»Social functioning«(F(1, 38) = 9. 89, P=0. 003),»Mental health«(F(1, 38) = 15. 93, P=0),»Vitality«(F(1, 38) = 40. 03, P? 0. 001), and»Pain«(F(1, 38) = 27. 60, P? 0. 001). MBSR had no significant effect on»FEV1«(F (1, 38) = 0. 03, P=0. 85),»FVC«(F (1, 38) = 0. 16, P=0. 69) and»FEV1/FVC«(F (1, 38) = 2. 21, P=0. 14). MBSR can improve individual? s quality of life but not lung function in chemically pulmonary injured veterans.

Emergency physicians are at risk of burnout, which can affect their mental health, as well as patient care. We assessed burnout level among Iranian emergency physicians and investigated demographic, work-related factors and stressors associated with higher burnout. In a cross-sectional study, we surveyed all 188 emergency medicine residents and practitioners in Iran. We measured burnout using 22-item Maslach Burnout Inventory assessing emotional exhaustion, depersonalization and personal accomplishment, also demographic factors, work related factors and sources of stress in emergency department using anonymous self-administered questionnaire. Descriptive analysis, univariate analysis to evaluate association with higher score of burnout, and multivariate logistic regression analysis to predict high burnout in 3 subscales was performed. Totally, 165 questionnaires were filled (response rate: 88%; mean age: 33.6 years, 91% male). Mean burnout scores were 22.94 for emotional exhaustion (95% CI=20.78-25.01; moderate), 9.3 for depersonalization (95% CI=8.24-10.36; moderate to high), and 31.47 for personal accomplishment (95% CI=29.87-33.07; moderate to high). Frequent reported sources of stress were shortage of equipment, problem with work physical environment, and relationship with other services. All 19 sources of stress were associated with higher score of emotional exhaustion and depersonalization; while twelve out of 19 were significantly associated with lower level of personal accomplishment. In logistic regression model, the significant predictors for high emotional exhaustion were work overload, feeling of insecurity for future career and difficulties to balance professional and private life. Burnout is high among Iranian emergency medicine practitioners and some interventions can be proposed to reduce stress.

Prediction of the onset of menstruation (menarche age) using height, weight and Body Mass Index (BMI) is a major health procedure. The present study was conducted to determine the relationship between anthropometric indices and menarche age in 488 girls 11-17 years in southern Iran (Kish Island) in 2011. Data was collected using questionnaires as well as measurements of the children?s height and weight. This data was analyzed using t-test and logistic regression. Median age of menarche of menstruated girls as inferred from the age of menarche cumulative distribution was 12.9 years. Mean (SD) BMI in menstruated and non-menstruated girls were 21.97 (4.5) and 19.17 (3.7), respectively. Mean (SD) weight and height of the menstruated girls were 53.65 (12.3) kg and 156.06 (5.5) cm, respectively which are higher than respective figures of the non-menstruated participants 43.70 (10.7) kg and 150.21 (6.3) cm, respectively. Our results revealed a significant correlation between BMI and menarche age. Menarche age and BMI are significantly correlated with higher BMI related to lower menarche age.

Surveillance of dermatophytosis is essential to determine the likely changes in etiological trends and distribution profile of this infection. In this study beta tubulin gene (BT2), was used as the first time in a PCR-RFLP format to clarify the distribution of dermatophytosis agents in some parts of Iran. A total of 603 clinical isolates was obtained from 500 patients in Tehran, Isfahan, Mazandaran and Guilan provinces. The isolates were identified using macro/micro-morphological criteria and electrophoretic patterns of PCR amplicons of BT2after digestion with each of the restriction enzymes FatI, HpyCH4V, MwoI and Alw21I. Among the patients, 59.2% were male and 40.8% female. The most prevalent clinical form was tinea pedis (42.4%), followed by tinea cruris (24.2%), tinea unguium (12.3%), tinea corporis (10.8%), tinea faciei (4%), tinea manuum (3.14%), tinea capitis (3%) and tinea barbae (0.16%), respectively. Trichophyton interdigitale ranked the first, followed by T. rubrum, Epidermophyton floccosum, Microsporum canis, T. tonsurans, T. erinacei and T. violaceum (each 0.49%) and the less frequent species were T. schoenleinii, M. gypseum and T. anamorph of Arthroderma benhamiae (each 0.16%). A case of scalp infection by E. floccosum was an exceptional event in the study. No case of T. verrucosum was found. Trichophyton species and E. floccosum are yet the predominant agents of infection in Iran, while Microsporum species are decreasing. T. interdigitale and Tinea pedis remain as the most causal agent and clinical form of dermatophytosis, respectively. It seems that BT2 can be a useful genetic marker for epidemiological survey of common pathogenic dermatophytes.

Hospital Survey on Patient Safety Culture, known as HSOPS, is an internationally well known and widely used tool for measuring patient safety culture in hospitals. It includes 12 dimensions with positive and negative wording questions. The distribution of these questions in different dimensions is uneven and provides the risk of acquiescence bias. The aim of this study was to assess the questionnaire against this bias. Three hundred nurses were assigned into study and control groups randomly. Short form of HSOPS was distributed in the control group and totally reversed form of it was given to the study group. Percent positive scores and t-test were applied for data analysis. Statistical analyses were conducted using SPSS Version 16. Finally a total of 272 nurses completed the questionnaire. All dimensions with positive wording items in both groups had higher scores compared with their negative worded format. The first dimension «organizational learning and continued improvement» which had the only statistically significant difference, got 16. 2% less score in the study group comparing the other group. In addition six out of 18 differences in questions were statistically significant. The popular and widely used HSOPS is subject to acquiescence bias. The bias might lead to exaggerate the status of some patient safety culture composites. Balancing the number of positive and negative worded items in each composite could mitigate the mentioned bias and provide a more valid estimation of different elements of patient safety culture.

Transmission of human pathogens can be occurred via inert objects. Paper currency is a further common contact surface whereby pathogens can be transferred within a population although the significance remains unknown. Hence, the aim of the present study was to investigate microbial populations associated with Iranian paper currency. This study was carried out by getting 108 samples of the Iranian currency notes (1000, 2000, 5000, 10000, 20000 and 50000 RIALS) from food-related shops that included food service outlets, greengrocery, supermarket, bakery, confectionary and poultry meat retail outlets. All currency notes were examined for total bacterial count and identification of pathogenic bacteria. The average total bacterial count that was recovered from currency notes was found to be 3.27?0.31 colony forming unites. 2000R had the highest total bacterial count, followed by 5000R, 10000R and the lowest in 50000R. In this study, the isolated bacteria recovered were Bacillus cereus (8.33%), E. coli (48.14%), Staphylococcus aureus (28.7%), Salmonella (0.92%), Listeria monocytogenes (0.92%), Yersinia entrocolitica (6.48%). It was revealed that all the pathogens screened for where encountered on currency notes were recovered from one sample. There were no significant (P>0.05) correlations between the carriage of pathogens/fecal indicator bacteria and currency note condition. Our findings demonstrate that Iranian currency notes represent a significant vehicle for human pathogens.