Iranian Journal of Public Health
Volume:43 Issue: 1, Jan 2014

Industrial growth is occurring exponentially, for unimpeded growth, industrial workers are recruited on a large scale globally. There are various sectors of industries present for which laborers are trained in accordance to their requirements. As workers possess the general health risk of occupational hazards, various labor laws, schemes and policies are undertaken by the government which are implemented by industries, but very few attention for oral health is being given because of which laborers are more progressing towards hidden adverse oral effects which can affect their working efficacy. Various studies on different sector workers were carried out focusing their oral health status but for acid factory workers it is neglected and therefore unrevealed to the society. For this purpose, in this article, though, paucity of literature, still, tries to enlighten the oral health status in acid factory industrial workers with available resources.

The aim of this study was to explore the relationship between diabetes and depression and investigate the effects of comorbid diabetes and depression on healthcare utilization. The study sample included 10,179 Korean adults aged ≥45 years. The presence of diabetes was assessed by asking participants if the participants had ever been diagnosed with diabetes. Depression was measured using the 10-item Center for Epidemiological Studies–Depression scale. Healthcare utilization was assessed by self-report. Multiple logistic regression analyses were performed. Diabetes was positively associated with depression after controlling socioeconomic and health variables. Diabetic patients who had low socioeconomic status, who were obese, who were smokers, and who had higher numbers of chronic diseases had a higher depression risk. Diabetes and depression was associated with increased healthcare utilization. People with both diabetes and depression had significantly increased odds of multiple physician visits, multiple hospital admissions, and prolonged hospitalization compared with individuals with neither diabetes nor depression. Patients with both diabetes and depression had greater odds of multiple hospital admissions than patients with diabetes alone. We found a positive association between diabetes and depression. Depression in persons with diabetes is associated with increased multiple hospital admissions. More research is warranted to clarify an association between co-occurring depression with diabetes and increased healthcare utilization.

Caesarean section (c-section) rates have been increasing dramatically in the past decades around the world. This increase has been attributed to multiple factors such as maternal, socio-demographic and institutional factors. Therefore, this study examines the impact of maternal, socio-demographic and relevant characteristics on caesarean delivery in the northern region of Bangladesh. This study is based on a total of 1142 delivery cases from four private hospitals and four public hospitals during the period of January to March 2010. The study was carried out using a cross-sectional design where data were collected by simple random sampling. In order to data analysis, first, an initial bivariate analysis was performed by the chi-square and Fisher exact test. Secondly, the risk factors which are associated with c-section identify by logistic regression model. Finally, a stepwise regression analysis was carried out to isolate the most influential risk factors. Among the 17 risk factors, nine were found significantly associated with type of delivery. Eight of the risk factors i.e. previous c-section, pregnancy-induced swollen of leg, prolonged labour, maternal education status, maternal age more than 25 years, low birth order, length of baby more than 45cm and irregular intake of a balanced diet remained independently significant for caesarean delivery. The value of P<0.05 was considered statistically significant. Maternal complications were found to be more significant in public hospitals than in private ones and conversely for the demographic characteristics. The findings of this study suggested that the above factors may influence the health-seeking behaviour of women in the northern region of Bangladesh.

Malaria is the second most frequent clinically suspected disease entity after acute respiratory tract infection in developing countries. Active malarial transmission occurs throughout the year، while aggressive out bursts of disease are seen mainly during and after the ‘monsoon’ season. This study aimed to determine the morbidity and mortality associated with malaria during flood at Isra University Hospital، Hyderabad. This prospective observational study was done at Isra University Hospital Hyderabad during monsoon flooding from July 2011 to October 2011. All 883 patients presented with symptoms of malaria (fever، headache، and vomiting) were evaluated and diagnostic tool ICT-MP was used for the detection of malaria parasite among them. Seventy four (8. 38%) patients diagnosed for malaria. The mean age and SD was 30. 11 ± 1. 67 years. Overall mortality due to malaria observed (18. 9%). Mortality rate significantly observed high in pregnant women (0. 005) and in those patients who developed complications such as، pneumonia (P = 0. 04)، renal failure (P = 0. 04)، Unconsciousness (P = 0. 001)، and Septicemia (P = 0. 001). A Significant increase in the morbidity and mortality in patients with malaria after flood noticed. The probability of getting poor outcome is also associated when patient develop complications.

The environmental pollution is one of the factors contributing to the decrease of sperm quality for human beings. The aim of this study was to assess cadmium (Cd), chromium (Cr), and copper (Cu) concentration of man in environmental pollution site, and explore relationships between men exposure to Cd, Cr, and Cu and semen-quality parameters in environmental pollution site. Ninety five men were recruited through pollution area and controls in 2011. We measured semen quality using Computer-aided Semen Quality Analysis, and Cd, Cr, and Cu levels in seminal plasma using Graphite Gurnace Atomic Absorption Spectroscopy. Spearman rank correlation analysis was used to evaluate the correlation between Cd, Cr and Cu concentration in seminal plasma and semen quality. The mean of seminal plasma Cd, Cr, and Cu values in pollution area was higher than the controls. Seminal plasma Cr values displayed a significant negative correlation with total motility and normomorph sperm rate. Seminal plasma Cu values also displayed a negative correlation with normomorph sperm rate. Male reproductive health may be threatened by environmental pollution, and it may be influence local population diathesis.

The advancement in the healthcare systems, stringent interventions for infectious diseases and improved diet has significantly shifted the patterns of morbidities, and consequently hereditary and congenital anomalies (CA) and non-communicable diseases (NCDs) have emerged as the most common causes of morbidity and mortality. In Pakistan, there is no systematic health surveillance system to assess the impact of such diseases particularly on the young and adult populations. In order to glean into the health and morbidity profile of Azad Jammu and Kashmir we have carried out an epidemiological study in Bhimber District in the north-east of Pakistan. A total of 1,731 female subjects of age 12-75 yr originating from Bhimber were recruited through a cross-sectional study. There were 74 cases (and 15 types) of CA with a prevalence estimate of 42.75/1,000. CA was significantly higher in subjects who were illiterate and married, speaking Pahari language and belonged to rural areas and nuclear families. Additionally, there were 104 cases (and 21 types) of NCDs (prevalence 60.08/1,000). NCDs were observed to have higher prevalence in subjects who were illiterate and married, speaking Punjabi language, and belonged to higher age groups and nuclear families. This study explores the types and dynamics of morbidity across the major socio-demographic parameters of adult females of Bhimber and would be helpful in estimating the impact of morbidity in this population. A comprehensive country-wide study is the need of the time to identify specific risk factors associated with certain morbidity types and help prioritize areas for interventions.

Visceral leishmaniasis (VL) or kala-azar is considered as a parasitic disease caused by the species of Leishmania donovani complex which is intracellular parasites. This systemic disease is endemic in some parts of provinces of Iran. The aim of this study was to determine the seroprevalence of VL in Qom Province, central Iran using direct agglutination test (DAT). Overall, 1564 serum samples (800 males and 764 females) were collected from selected subjects by randomized cluster sampling in 2011-2012. Sera were tested and analyzed by DAT. Before sampling; a questionnaire was filled out for each case. Data were analyzed using Chi-square test and multivariate logistic regression for risk factors analysis. Of 1564 individuals, 53 cases (3.38%) showed Leishmania specific antibodies as follows: with 1:400 titer 16 cases (1.02%), with 1:800 titer 20 cases (1.27%), with 1:1600 titer 16 cases (1.02%) whereas only one subject (0.06%) showed titers of ≥ 1:3200. There was no significant association between VL seropositivity and gender, age group and occupation. Binary logistic regression showed that rural areas was 0.44 times at higher risk of infection than urban areas (OR= 0.44; %95 CI= 0.25- 0.78). Although the seroprevalence of VL is relatively low in Qom Province, yet due to the importance of the disease, the surveillance system should be monitored by health authorities.

Bladder cancer is the most frequent genitourinary malignancy in Iran. Environmental and genetic factors are the two factors linked with bladder cancer expansion. The aim of this study was to investigate the role of PTEN gene and environmental risk factors on the progression and prognosis of bladder cancer. We evaluated 55 tumor specimens and 66 bladder mucosa samples of non-cancerous patients between 2011 and 2013. All samples were analyzed for PTEN mutations using PCR and direct DNA sequencing methods. Demographic data collected, were analyzed using SPSS version 19.0 software and a P value of < 0.05 was considered statistically significant. Of the 55 patients examined, tumor stage was T1, T2 (T2a, T2b) in 34 (61.8%) and 21 (38.2%) and tumor grade was high, low in 34 (61.8%) and 21 (38.2%), respectively. No mutations in the PTEN gene were found in patients with bladder cancer and control. Among the risk factors studied, only the occupation and history of urinary tract stones, were significantly associated with bladder cancer (P value<0.05). However, other risk factors did not show such a relationship. No mutation was found in PTEN gene of patients with bladder cancer. Therefore, mutations in this gene cannot predict the prognosis and progression of urothelial bladder cancer. On the other hand, significant relationship was found between occupation and urinary stones with bladder cancer. This communication reflects the impact of these factors on the risk of bladder cancer.

General knowledge of at risk people regarding malaria is key element to facilitate appropriate treatment and prevention behaviours. The aim of this study was to assess the family heads'' understanding of malaria transmission, signs and symptoms, and preventive measures in malaria-affected districts of Iran. In 2009 in a cluster randomized cross-sectional survey data were collected from the heads of 5,466 randomly selected households by trained interviewers and a validated questionnaire. Only one adult person was interviewed per household Once all the information collected and entered to the SPSS Ver. 18 analysis was done and descriptive statistics were used to summarize results. Point estimates and 95% confidence intervals were also estimated for indicators. 63.8% [95% CI: 62.2 - 65.4] of the participants recognized fever as a sign of malaria, 56.4% [95% CI: 54.6 - 58.2] reported that mosquito bites cause malaria and about 35% [95% CI: 32.7 - 37.1] of participants mentioned that the use of mosquito nets could prevent malaria. Furthermore, about one-third of selected samples in target districts did not know symptoms, transmission route and appropriate prevention method of malaria. Data also suggests a slight variation by residency, but substantial discrepancy according to the region. General knowledge of respondents concerning malaria is too far from the levels required to be constructive for malaria elimination. Therefore, the survey suggests developing, and implementing effective health promotion policies to increase the awareness of households about the symptoms, transmission route and control measures of malaria.

To estimate the prevalence and analyze factors associated with both public and private health services utilization in women population in a western district of Iran. A cross-sectional study with 1200 individuals aged 18-49 years carried out in different districts of Sanandaj City, western Iran, in 2012. The main outcome variable was use of health service in the previous 12 months. The independent variables were age, education level, place of residence, marital and pregnancy status, household wealth, occupation and duration time of employment, and rating of quality of health services. The prevalence of public and private health services utilization were 60.8% [95%CI: 57.8, 63.8] and 53.8% [95%CI: 50.8%, 56.8%], respectively (P=0.001). After controlling other investigated factors using logistic regression; the academic educational level (OR=1.36, 95%CI: 1.03, 1.80; OR=1.76, 95%CI: 1.33, 2.33), residents of urban (OR=1.65, 95%CI: 1.10, 2.47; OR=1.60, 95%CI: 1.10, 2.42), pregnancy status (OR=2.38, 95%CI: 1.60, 3.55; OR=2.36, 95%CI: 1.61, 3.47), and high level of quality of health services (OR=1.61, 95%CI: 1.15, 2.27; OR=1.70, 95%CI: 1.20, 2.40) were found to be predictors of utilization of both public and private health care respectively. There was also statistically relation between high level of household wealth (OR=3.01, 95% CI: 2.00, 4.57) and private health services utilization. Prevalence of health services utilization varied according to the individual and social factors of population studied. Present study emphasizes the need to develop care models that focus on the characteristics and demands of the subjects.

The gene coding claudin (CLDN5) is located on 22q11. Since the proteins of CLDN5 family are a major component for barrier-forming tight junctions, it may be important to test whether or not the CLDN5 locus could be associated with schizophrenia. A total of 150 individuals affected with schizophrenia and 150 healthy persons were recruited. The relationship between the three single nucleotide polymorphism (SNPs) and schizophrenia disease was studied using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) technique. The PCR products were completely digested with restriction enzymes of DpnII, PvuII and BstNI, and then separated on agarose gel. The statistical investigations and haplotype analysis were also performed. The transmission disequilibrium test (TDT) exhibited weak association between rs10314 [C/G] and schizophrenia (v2 = 3.55, P = 0.022), but the other two SNPs did not show such an association. The global chi-square test showed that the 3-SNP haplotype system was not associated with schizophrenia although the 1-df test for individual haplotypes showed that the rs1548359(C)-rs10314(G)-rs739371(C) haplotype was excessively non-transmitted (v2 = 6.33, P = 0.025). The v2 test for LD between SNPs indicated that these three SNPs were in strong LD. Collectively, LD analysis showed that the CLDN5 locus was associated with schizophrenia in an Iranian population.

Methicillin-resistant Staphylococcus aureus (MRSA) is the main cause of hospital infection emerged over the last decades. Rapid detection of MRSA is important for patient care and proper usage of infection control. Detection of mecA genes (encoding resistance to methicillin and other similar antibiotics) and nuc genes (encoding staphylococcal thermostable nuclease) by PCR method is now considered for rapid identification of MRSA strain. The aim of this study was to determine the prevalence of MRSA isolated from patients in Tehran, Iran by PCR method for detection of mecA and nuc genes. Phenotypic method such as microscopic and colony morphology and catalase and coagulase tests were used for identification of S. aureus isolates. DNA was extracted from all isolates and the presence of nuc and mecA gene was detected by PCR method. For determination of MRSA by phenotypic methods, oxacillin disk diffusion test were used. Data were analyzed by SPSS software. Out of 126 clinical sample identified by phenotypic method, 101 isolates had nuc gene. In disk diffusion tests by oxacillin disk, 78.2% of isolates were considered to be MRSA, but in PCR method for mecA gene, 69% isolates were positive. The results showed a high prevalence of methicillin-resistance among S. aureus isolates. Identifying MRSA strains, isolating MRSA-positive patients and carrier’s treatment in a hospital to prevent MRSA infection is important in limiting the spread of MRSA. The PCR method for detection of nuc and mecA genes has potential for rapid and accurate diagnosis of MRSA strains.

Universities of Medical Science and Health Services (UMSHSs) are among the main organizations in Iran’s health-care section. Improving their efficiency in financial resource management through creating an appropriate coordination between consumption and resources is strategically vital. Investigating the financial performance as well as ranking the Iranian UMSHSs is the research objective. The study is of descriptive and applied type. The study population includes the UMSHSs of Iran (n=42) among which 24 UMSHSs are selected. DEA is used with the aim to model and assess the financial performance including 4 inputs and 3 outputs. Also, linear regression is applied to determine the effectiveness of the applied indices as well as the level of the financial performance. Data are obtained from the Budgeting Center in the Ministry of Health and Medical Education, during 2010 mainly through forms designed based on the available balance sheets. The average score of financial performance assessment for UMSHSs based on the DEA of input-oriented data is 0.74, assuming a constant scale of DEA-CRS. Thus, approximately 25% of the studied UMSHSs have maximum relative performance and totally, there is about a 30% capacity to increase the financial performance in these UMSHSs. Most Iranian UMSHSs do not have high financial performance. This can be due to problems in financial resource management especially in asset combining. Therefore, compilation and execution of a comprehensive program for organizational change and agility with the aim to create a kind of optimized combination of resources and assets is strongly recommended.

The present study was conducted to determine the association between social support and health-related QOL (HRQL) for a sample of 120 patients living with HIV/AIDS in Tehran. Eighty male and 40 female living with HIV referred to Iranian AIDS Research Center at Imam Khomini Hospital in Tehran, Iran in 2011 were randomly selected for assessment. Data was collected by means of Vaux''s Social Support questionnaire and Medical Outcomes Short-Form-36 (SF-36) QOL questionnaires. Pearson (P) Correlation Coefficient and Fisher z-test were used for statistical analysis. In general, social support was significantly associated with overall QOL in men (P = 0.001) and women (P = 0.009) living with HIV/AIDS. In men, social support was significantly associated with mental and physical domains of QOL (P = 0.001) while in women it simply associated with mental domain of QOL (P = 0.003). Our findings indicate that increasing social support for HIV/AIDS persons increases their QOL. This can help those physicians who are involved in care of HIV-infected persons and it maintains QOL across the spectrum of HIV disease.

Many studies have been carried out and many methods have been used for estimating health staff requirements in health facilities or system, each have different advantages and disadvantages. Differences in the extent to which utilization matches needs in different conditions intensify the limitations of each approach when used in isolation. Is the utilization-based approach efficient in a situation of over servicing? Is it sufficient in a situation of under-utilization? These questions can be similarly asked about the needs-based approach. This study is looking for a flexible approach to estimate the health staff requirements efficiently in these different conditions. This study was carried out in 2011 in some stages: It was conducted in order to identify the formula used in the different approaches. The basic formulas used in the utilization-based approach and the needs-based approach were identified and then combined using simple mathematical principles to develop a new formula. Finally, the new formula was piloted by assessing family health staff requirements in the health posts in Kashan City, Iran. Comparison of the two formulas showed that the basic formulas used in the two approaches can be combined by including the variable ‘Coverage’. The pilot study confirmed the role of coverage in the suggested combined approach. The variables in the developed formula allow combining needs-based, target-based and utilization-based approaches. A limitation of this approach is applicability to a given service package.

Exophthalmos, myxedema, and acropachy are collectively named Exophthalmos myxedema acropachy (EMA) syndrome, which is a rare syndrome associated with hypertcardiotrophia. Among patients with hyperthyreosis, EMA has an incidence less than 1%. Here, we reported a case of EMA and explored its diagnosis and treatment.

Most fetal heart rate patterns can be interpreted accurately so that management decisions can be made correctly. However, few fetal heart rate patterns are so ambiguous that the obstetricians cannot interpret them precisely. A 27-year-old woman at 38 weeks’ gestation in her first pregnancy was admitted with heavy vaginal bleeding and decrease in fetal movements. Fetal status was indeterminate according to an indefinite fetal heart rate tracing with regular decelerations. After emergent cesarean delivery, a ruptured vasa previa, traversing the fetal membrane, unsupported by either the umbilical cord or placental tissue, was clearly identified. Treatment decision-making is challenging in such patient with indefinite fetal heart rate pattern because limited data exist to guide management. Well-designed studies are needed to clarify the uncertainty about the effect of indefinite fetal heart rate pattern on clinical outcomes.