International Journal of Preventive Medicine
Volume:4 Issue: 12, Dec 2013

The “French paradox” has been postulated to be related to the widespread consumption of wine. However, this French paradox is being questioned and the results from the MONICA studies showed that France is not lowest among populations for cardiovascular disease. Thus, France would not be an exception but would follow that geographic gradient. While numerous epidemiologic studies have provided evidence for a French exception, some studies have not found any difference between beer, wine, and spirits in their relation to CVD or CVD risk factors.In our study on mortality trends of ischemic heart disease (IHD) and stroke in Denmark, Finland, France, the Netherlands, Norway, Sweden and England and Wales, the IHD mortality increased between the 1950s and 1970s in all countries for both men and women, except for France with relatively less peak and more stable mortality trend compared to other countries. For stroke, the France mortality was similar to other countries first, but started to decline much faster than other countries. This French advantage would be repeated in the future too.It seems that our results support the “French Paradox; however, the question still remains: is this difference due to French paradox or other factors?

The most common cause of neurogenic bladder dysfunction (NBD) in newborn infants is myelomeningocele. The pathophysiology almost always involves the bladder detrusor sphincter dyssynergy (DSD), which if untreated can cause severe and irreversible damage to the upper and lower urinary tracts. Early diagnosis and adequate management of NBD is critical to prevent both renal damage and bladder dysfunction and to reduce chances for the future surgeries. Initial investigation of the affected newborn infant includes a renal and bladder ultrasound, measurement of urine residual, determination of serum creatinine level, and urodynamics study. Voiding cystogram is indicated when either hydronephrosis or DSD is present. The main goal of treatment is prevention of urinary tract deterioration and achievement of continuance at an appropriate age. Clean intermittent catheterization (CIC) in combination with anticholinergic (oxybutynin) and antibiotics are instituted in those with high filling and voiding pressures, DSD and/or high grade reflux immediately after the myelomeningocele is repaired. Botulium toxin‑A injection into detrusor is a safe alternative in patients with insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy. Surgery is an effective alternative in patients with persistent detrusor hyperactivity and/or dyssynergic detrusor sphincter despites of the CIC and maximum dosage of anticholinergic therapy. Children with NBD require care from a multidisciplinary team approach consisting of pediatricians, neurosurgeon, urologist, nephrologists, orthopedic surgeon, and other allied medical specialists.

Considering the importance to determine the reasons for the higher occurrence of congenital hypothyroidism (CH) in Iran, in this study we report the prevalence of permanent CH (PCH) in Isfahan province 7 years after initiation of CH screening program in Isfahan. In this cross‑sectional study, children with a primary diagnosis of CH studied. They clinically examined and their medical files were reviewed by a pediatric endocrinologist. Considering screening and follow‑up lab data, radiologic findings and the decision of pediatric endocrinologists the final diagnosis of PCH was determined. A total of 464,648 neonates screened in Isfahan province. The coverage percent of the CH screening and recall rate was 98.9% and 2.1%, respectively. A total of 1990 neonates were diagnosed with primary CH. PCH was diagnosed in 410 neonates. The prevalence of PCH and transient CH (TCH) was 1 in 1133 and 1 in 294 live births. The most common etiology of CH was thyroid dyshormonogenesis. Though the prevalence of PCH is high, but the higher prevalence of CH in Isfahan is commonly due to cases with TCH. Hence, the necessity of determining new strategies for earlier diagnosis of patients with TCH is recommended.

The mother‑generated index (MGI) is one of only a few existing specific questionnaires for assessing the postnatal quality of life (QoL). MGI is a single‑form questionnaire that asks postnatal mothers to specify up to eight areas of their lives which have been affected by giving birth to a baby. Using this tool, it is possible to score and rank the QoL of mothers. This study aimed to validate the questionnaire for use in Iran. Forward translation was used to translate the questionnaire from English to Farsi (Persian). The questionnaire was then administered to a sample of postnatal women attending two teaching hospitals in Tehran, Iran. Face validity and criterion validity were performed to establish the validity for the Iranian version of the MGI. Face validity was assessed by asking women to indicate whether they understood the wording of the questions, how easy the questionnaire was, and so on. Criterion validity was examined using the Short Form 36‑item (SF‑36) Health Survey. It was hypothesized that the MGI would significantly correlate with the SF‑36. In all, 124 women were approached. Of these, 119 women were eligible and 96 women agreed to take part in the study. Face validity was good and all of the women found the MGI straightforward to complete; as criterion validity, the MGI scores and the subscales of the SF‑36 were moderately correlated (for all subscales: Pearson r > 0.4; P < 0.001). The mean MGI primary score was 5.38 (SD = 3.05). Women who had comorbidity had significantly lower MGI scores than women without comorbidity (P = 0.04). Correlation between aggregate of comments and primary score was high (r = 0.68, P < 0.01). In general, the Iranian version of the MGI performed well and our data suggest that it is a valid measure to assess health‑related QoL among postnatal women.

The loss of muscle mass is associated with aging. The aim of this study was to determine the effects of resistance training and detraining on muscle mass in elderly women. Twenty post‑menopausal women aged ≥50 years old were enrolled. Matching for age, they were randomly assigned into control and resistance training group (RT). The intervention consisted of three sets of 10 repetitions for 10 movements with Thera‑Band tubing (based on 80-100% 10‑RM), three times a week, for 12 weeks and thereafter, four weeks detraining. Skinfold thickness was determined by caliper. Percentage of body fat was estimated from skinfold thickness (triceps and subscapular) by McArdle method. Fat mass (FM) and fat‑free mass (FFM) were calculated. Range of motion for trunk flexion and extension was determined. During 12 weeks of intervention, significant increases were observed in 1‑RM of biceps curl, FFM, trunk flexion and extension and significant decreases during four weeks detraining in RT group. The RT group demonstrated significant decreases during resistance training and increases during detraining in skinfold thickness. FFM, trunk flexion, and extension decreased and skinfold thickness, %FM, and weight of body fat increased in the control group (P < 0.05). Resistance training with Thera‑Band enhanced strength and muscle endurance in elderly women and a 4‑week detraining period had an adverse effect on muscle power. This suggests that a strength training program is an effective intervention to prevent functional reductions, and can contribute to improve neuromuscular function in older adults.

The success of immunization depends highly on the level of cold chain maintenance. The aim of the study was to assess the condition of cold chain equipment, practices adopted for cold chain maintenance and knowledge of the vaccinators. It was a cross‑sectional study conducted in 20 UHCs of Surat Municipal Corporation (SMC). Cold chain equipment were observed with regards to their condition, along with the practices adopted by vaccinators for cold chain maintenance. A pre‑designed and pre‑tested questionnaire was used to interview the vaccinators regarding their knowledge and awareness regarding cold chain practices, management and handling. Data were entered and analyzed using Epi Info v 3.5.1. Simple proportions were calculated. Absence of separate stabilizer for deep freezers and ILRs (85%), ill‑maintained temperature‑record register, lack of criss‑cross pattern of ice packs in deep freezer (65%), presence of things other than ice packs in deep freezer (10%) and things other than vaccines in ILR (10%) indicate poor cold chain maintenance. In addition to this, expired vaccines in ILR (5%), vaccines in the “unusable” stages of VVM (15%), lack of emergency contact number nearby in case of cold chain failure (85%), lack of inverter (85%), lack of generator (85%) and failure to note time of reconstitution on the vaccine vial at the time of vaccination (25%) indicate poor cold chain practices. Lack of knowledge of defrosting of ILR and deep freezer (45%), lack of knowledge about Shake test (40%), lack of knowledge of temperature range to be maintained in deep freezer (70%) and in ILR (15%) indicate poor knowledge of vaccinators. Cold chain maintenance and practices need improvement. Knowledge of vaccinators was overall unsatisfactory.

Sirtuin1 is an enzyme that deacetylates histones and several non‑histone proteins including P53 during the stress. P300 is a member of the histone acetyl transferase family and enzyme that acetylates histones. Hereby, this study describes the potency combination of Salermide as a Sirtuin1 inhibitor and cholera toxin B (CTB) as a P300 activator to induce apoptosis Michigan Cancer Foundation‑7 (MCF‑7) and MRC‑5. Cells were cultured and treated with a combination of Salermide and CTB respectively at concentrations of 80.56 and 85.43 μmol/L based on inhibitory concentration 50 indexes at different times. The percentage of apoptotic cells were measured by flow cytometry. Real‑time polymerase chain reaction was performed to estimate the messenger ribonucleic acid expression of Sirtuin1 and P300 in cells. Enzyme linked immunosorbent assay and Bradford protein techniques were used to detect the endogenous levels of total and acetylated P53 protein generated in both cell lines. Our findings indicated that the combination of two drugs could effectively induced apoptosis in MCF‑7 significantly higher than MRC‑5. We showed that expression of Sirtuin1 and P300 was dramatically down‑regulated with increasing time by the combination of Salermide and CTB treatment in MCF‑7, but not MRC‑5. The acetylated and total P53 protein levels were increased more in MCF‑7 than MRC‑5 with incubated combination of drugs at different times. Combination of CTB and Salermide in 72 h through decreasing expression of Sirtuin1 and P300 genes induced acetylation of P53 protein and consequently showed the most apoptosis in MCF‑7 cells, but it could be well‑tolerated in MRC‑5. Therefore, combination of drugs could be used as an anticancer agent.

Assessing growth is a useful tool for defining health and nutritional status of children. The objective of this study was to construct growth reference curves of Iranian infants and children (0‑6 years old) and compare them with previous and international references. Weight, height or length of 2107 Iranian infants and children aged 0‑6 years old were measured using a cross‑sectional survey in Tehran in 2010. Standard smooth reference curves for Iranian population were constructed and compared to multinational World Health Organization 2006 reference standards as well as a previous study from two decades ago. Growth index references for Iranian girls are increased in compare to data from two decades ago and are approximately close to the international references. In boys; however, the increment was considerably large as it passed the international references. Not only the values for indexes was changed during two decades, but also the age at adiposity rebound came near the age of 3, which is an important risk factor for later obesity. During two decades, growth indexes of Iranian children raised noticeable. Risk factors for later obesity are now apparent and demand immediate policy formulations. In addition, reference curves presented in this paper can be used as a diagnostic tool for monitoring growth of Iranian children.

Problematic Internet Use (PIU) is a growing problem in Egyptian adolescents. This study was designed to assess the prevalence of PIU among high school students in El‑Minia Governorate and to determine the personal, clinical, and social characteristics of them. A cross‑sectional study was applied among a random sample of high school students in El‑Minia Governorate. PIU was assessed by the 20‑item Young Internet Addiction Test (YIAT). Information was also collected on demographics, dietary, and health‑related factors. Statistical analysis used: Statistical Package for Social Sciences (SPSS‑16) software was used. Chi‑square test (X2), Fisher’s Exact Test, and one‑way analysis of variance (ANOVA) were used whenever, applicable. Multinomial logistic regression analyses were also applied in order to calculate the odds ratios (OR). Of the 605 students, 16 (2.6%) were Problematic Internet Users (PIUs), 110 (18.2%) were Potential (PIUs). Adolescents with PIU were associated with male gender, poor friends’ relations, bad family relations, irregular bedtime, and bad personal hygiene. PIUs were more likely to suffer from physical symptoms; weight gain, joint stiffness, lack of physical energy, and emotional symptoms. The prevalence of PIU reported in this study is low, however, the Potential PIUs was high and preventative measures are recommended.

In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. In this study, we aimed to compare reverse trendelenburg position and head‑up position on intra‑operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. In this study, 30 ASA I (American Society of Anesthesiology physical condition classification) patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head‑up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ± 13.20 ml) than head‑up position (83.33 ± 21.18 ml), although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Our results showed that patient bleeding is not increasedbecause of positioning per se. In conclusion, perhaps in the futurereverse trendelenburg will be given more often during rhinoplasry.

To estimate the economic loss due to road traffic injuries (RTIs) of the World Health Organization (WHO) member countries and to explore the relationship between the economic loss and relevant health system factors. Data from the World Bank and the WHO were applied to set up the databases. Disability‑adjusted life year (DALY) and gross domestic product per capita were used to estimate the economic loss relating to RTIs. Regression analysis was used. Data were analyzed by IBM SPSS Statistics, Versions 20.0. In 2005, the total economic loss of RTIs was estimated to be 167,752.4 million United States Dollars. High income countries (HIC) showed the greatest economic losses. The majority (96%) of the top 25 countries with the greatest DALY losses are low and middle income countries while 48% of the top 25 countries with the highest economic losses are HIC. The linear regression model indicates an inverse relationship between nurse density in the health system and economic loss due to RTI. RTIs cause enormous death and DALYs loss in low‑middle income countries and enormous economic loss in HIC. More road traffic prevention programs should be promoted in these areas to reduce both incidence and economic burden of RTIs.

The fourth survey of the surveillance system named ‘‘childhood and adolescence surveillance and prevention of adult non‑communicable disease’’ (CASPIAN-IV study), was conducted among a national representative sample of Iranian students. This paper describes the methods and early findings of this survey. This nationwide school‑based study was conducted in 2011-2012 in 30 provinces of Iran among 13,486 students, 6‑18 years (6640 girls, 75.6% from urban areas) and one of their parents. Mean age of students was 12.5 years. Based on the World Health Organization growth curves, 12.2% were underweight, 9.7% overweight and 11.9% were obese. Abdominal obesity was observed in 19.1% of students. The dominant type of cooking oil in urban families was liquid oil and hydrogenated fat (39% and 32%), most rural families used hydrogenated fat (53%), respectively. A total of 18% of students had at least 30 min of daily physical activity; 41% of students used computer in weekdays and 44% used it in weekends. Almost 34.5% of students reported to have at least one cigarette smoker and 21.5% reported to have a waterpipe smoker in their relatives. Moreover, 20.3% of students reported that they had suffered an injury needing the help of school health providers during the year prior to the study. Current evidence on the health risky behaviors among Iranian children and adolescents confirms the importance of conducting comprehensive surveillance surveys to identify health risk behaviors. Data of this survey and the trend of variables provide necessary information for health policy makers to implement action‑oriented interventions.

There are few published studies that consider the joint effect of multiple risk factors on avoidable burden of cardiovascular diseases (CVDs). This study aimed to estimate the joint effect of avoidable burden of multiple risk factors to CVDs. Estimates of avoidable burden to CVDs were made using potential impact fraction (PIF). In order to calculate PIF, data on the Prevalence of the risk factors include diabetes, hypertension, central obesity, and hypercholesterolemia were obtained from 3rd national Surveillance of Risk Factors of Non‑Communicable Diseases‑2007 in Iran and data on corresponding measures of effect were derived from a cohort study with multivariate adjusted hazard ratios. Then, joint effect of risk factors was calculated. About 37% (95% uncertainty interval: 21.7‑50.2) of attributable disability adjusted life years (DALYs) to CVDs in adult males and 59.4% (95% uncertainty interval: 30‑76) in adult females due to selected risk factors are avoidable in theoretical minimum risk levels. After changing the current prevalence of these risk factors to the plausible minimum risk levels, 17.8% (95% uncertainty interval: 10.1‑25.1) of CVDs’ attributable DALYs among adult males and 34% (95% uncertainty interval:20‑46.7) in adult females can be avoided. To better priority setting as well as reporting the magnitude of avoidable DALYs rather than the percentage of avoidable burden, PIF should be applied to updated and revised burden of CVDs.

Disseminated mucormycosis is a rare entity most frequently seen in neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy. We report a 64‑year‑old immunocompetent male with an acute pneumonia and a generalized jaundice who died within 24 h. In the autopsy, extensive perforations of spleen and multiple hemorrhage foci on the pancreas were two significant findings. Histopathological study of tissue sections revealed typical zygomycetes hyphae in the left lung, pancreas, spleen and brain. Involvement of pancreas in this patient was one of the rare features of mucormycosis reported occasionally in the literature. Our case implies an unusual clinical presentation of disseminated mucormycosis and highlights that disseminated mucormycosis should be regarded even in the immunocompetent patients.

Scrub typhus is the most common zoonosis of public health importance in rural areas of Asia, Northern Australia and Pacific Islands. The clinical spectrum of the disease varies from acute febrile illness to multi‑organ involvement with systemic complications. Delay in diagnosis and treatment often lead to increased morbidity and mortality. Rhabdomyolysis is a rare complication seen in an infectious disease. We report a 50‑year‑old farmer with scrub typhus presented with rhabdomyolysis and acute renal failure who succumbed to the disease in hospital.

The aim of study was to compare the serum level of magnesium in mothers having low birth weight with those having normal birth weight neonates. In a case‑control study, women who delivered low birth weight neonate (cases), compared with normal birth weight (controls) in serum concentration of magnesium. Blood samples collected within 24 h after delivery. Concentration of magnesium assessed by standard atomic absorption spectro‑photometry. Multiple linear regression analysis was performed to control of potential confounding variables. A total of 116 mothers (67 cases and 49 control) were studied. Mothers in two groups did not differ in age, body mass index, and socioeconomic or demographic factors. Maternal magnesium concentration did not differ between two groups 0.86 ± 0.11 m. mol/l versus 0.94 ± 0.22 m.mol/l respectively (P = 0.09). There is no significant difference between serum magnesium levels of low birth weight infants’ mother and normal weight infants’ mother.

India is the highest tuberculosis (TB) burden country accounting for one‑fifth of the global incidence. It is estimated that, annually, 1.9 million cases are from India and about 0.8 million are infectious, new smear, positive pulmonary TB cases. The present study was a cross‑sectional study conducted in a tertiary care hospital to determine the extent of delay in diagnosis and initiating the treatment after diagnosis in new smear, positive pulmonary TB patients attending a tertiary care hospital of Haryana during a 1‑year period. A total of 204 patients were interviewed after being diagnosed as new sputum, positive TB (NSP‑TB) by the treating doctor at the tertiary care hospital and re‑interviewed at their home after initiation of anti‑TB treatment. Chi‑square test and analysis of variance (ANOVA) were used for statistical analysis. More than half of the study patients delayed their first consultation with a health care system. The mean and median patient delay was 32.97 and 16 days, respectively. Lack of awareness of the disease was the leading cause for the patient delay. The mean duration of delay at peripheral health care provider was 60.46 days. The mean and median delay at tertiary care hospital was 8.35 and 4 days, respectively. Most of the patients delayed for diagnosis as per revised national TB control program (RNTCP) guidelines. The mean total delay in diagnosis was 75.71 days. There is an urgent need to scale up the information education communication activities to decrease the patient delay. Doctor at all level of health care need to be actively involved for subjecting the suspects to sputum examination at the earliest possible, as per RNTCP guidelines.