Iranian Journal of Public Health
Volume:43 Issue: 6, Jun 2014

Metallothionein (MT) manifests varying expression levels in carcinomas, and they may be considered as valuable cell cancerization biomarkers for diagnosis of patients with cancers. A meta-analysis was conducted to evaluate comprehensively the MT expression difference in various benign tumors and malignant tumors, which compared the high with low MT expression levels in patients of the available studies. Finally, a total of 13 studies dealing with various tumors were involved for this meta-analysis. The results indicated that lower expression of MT in various benign tumors tissue than that in corresponding malignant tumors with the pooled OR of 0.52 (95 % CI 0.18-1.47, P ＜0.001). In conclusion, MT expression difference is associated with tumor various stages in tumor patients and could be a useful clinical criteria of distinguishing benign tumors and malignant tumors for those patients.

Hepatitis B virus (HBV) is the most prevalent viral infection and is among the leading causes of human liver diseases. Nearly 360 millions of people are world widely infected with prolonged forms of hepatitis B including active and inactive chronic forms. Chronic hepatitis B (CHB) is associated with cirrhosis and hepatocellular carcinoma (HCC) in patients suffering from congenital and/or acquired immunodeficiency and also following immunosuppressive therapy. The target cell of human acquired immunodeficiency virus (HIV) is CD4 positive T cells. These cells play central role(s) in both cellular and humoral immunity so that the HIV attack of CD4 positive T cells causes suppression of both cell-mediated and humoral immune responses. One of the frequent complications in HIV positive patients is HBV co-infection and as a result, the co-transmission of these viral diseases is common. Due to the paramount importance of the co-infection of HBV and HIV, it is noteworthy to investigate the prevalence of hepatitis B in these patients for planning of an effective therapeutic strategy. Based on these considerations, the main aim of this review article was to collect and analyze the recent and relevant studies regarding the prevalence rate of hepatitis B co-infection among HIV positive patients world widely.

Development of evidence-based clinical guidelines to raising standards of medical care in diabetes is a core element of coping with the global diabetes epidemic. The purpose of this study was to develop a systematic clinical diabetes guideline from the latest scientific evidences and also to localize its recommendations according to regional and cultural needs of our society. Searches were conducted using NICE, SIGN, WDPCP, IDF, JDC, ADA, AACE, ICSI, CDA, AMDA, IDC, NyDoH guidelines which were examined and criticized and scored using Agree method. Guidelines which got higher score in some important areas of Agree scale including: rigor of development, clarity and comprehensiveness of the recommendations and applicability, especially in the climatic conditions of our country were selected. The existing recommendations were extracted by committee members and supporting evidences of each recommendation were determined based on the sources listed in the clinical guideline. Recommendations grading were classified from grade A to D based on the quality of their supporting evidences (BEL1-5). This guideline covered all areas related to diabetes including screening and diagnosis, lifestyle modification and patient education, management, complications and hypoglycemia. Regarding capacities of this guideline and lack of comprehensive and updated guidelines in our country and region, it is suggested that designing a pilot study to implement this Learner-centered guideline and finding its weaknesses can lead to patient care improvement and also propel us towards our goal to design a comprehensive guideline in compliance with regional and national needs in Middle East.

Visit-to-visit variability (VVV) in blood pressure (BP) creates challenges to hypertension control and was independent associated with increased all-cause mortality in hypertensive patients. The major goal of the present study was to investigate the association of VVV in systolic (S)BP with progression of carotid atherosclerosis and endothelial dysfunction in on-treated hypertensive patients. Overall, 356 hypertensive patients were enrolled and completed the trial. Clinic BP was measured at baseline and at 3 monthly thereafter. Carotid artery ultrasound and endothelial function were evaluated at baseline and annually follow-up visit. VVV in BP was assessed by standard deviation (SD) and coefficient of variation (CV) of serial follow-up BP measurements. The patients were divided into low, middle, and high group by tertile of SD in SBP. Decrease percentage of maximum intima-media thickness (IMT) and stiffness index β and increase percentage of brachial flow-mediated dilation (FMD) and nitric oxide (NO) in lower groups were significant greater than in higher groups (P < 0.05). Change percentage of stiffness index β and endothelin-1 positively, and change percentage of FMD and NO negatively correlated with SD, CV, maximum, and delta of SBP (P < 0.05). SD and CV of SBP were risk factors for change percentage of IMT, stiffness index β, FMD, NO, and endothelin-1 independently of other influential factors, such as age, and mean SBP. Excessive VVV in SBP maybe increase carotid atherosclerosis and impair endothelial function in on-treated hypertensive patients. Reducing VVV in SBP is benefit for patients with hypertension management.

Inequities in health need to be monitored and necessary actions should be taken to reduce them. This study aimed to determine the socioeconomic distribution of self-reported chronic diseases and self-assessed health (SAH) in Turkey and try to evaluate the determinants of such inequalities in terms of their contributions. Cross-sectional data from the Turkish Health Survey conducted during year 2008, covering 14,655 adults aged 15 or older were analyzed for the first time to assess socioeconomic inequalities in chronic disease and sub-optimal SAH prevalence by calculating concentration index (CI), which ranges from -1 to +1 (concentration of disease among lower and higher socioeconomic groups) and the relative index of inequality (RII), reflecting the prevalence ratio between the two extremes of wealth. Several diseases and sub-optimal SAH were more concentrated among those with lower incomes. The concentration indices of chronic obstructive pulmonary disease (COPD), arthritis, chronic bronchitis, migraine and poor SAH were−0.180 (95% CI = -0.241,-0.111), −0.126 (95% CI = -0.148,-0.105),−0.118 (95%CI = -0.149,-0.079), -0.248(95%CI = (-0.278,-0.219) respectively. Of all chronic diseases, COPD demonstrated the highest relative inequality with a RII value of 2.51 (95%CI: 1.57-4.01). Income was the major contributor to inequality in occurrence of COPD (88.2%), migraine (80.4%) and arthritis (77.7%). The findings indicate that majority of chronic diseases were more concentrated among less wealthy individuals in Turkey. Wealth and education had the largest contributions to observed inequalities. These inequalities need to be explicitly addressed and vulnerable subgroups should be targeted to reduce these socioeconomic disparities.

The peroxisome proliferator-activated receptors (PPARs) -α, -δ/β and -γ are the ligand-activated transcription factors involved in the regulation of fatty acid and lipoprotein metabolism, energy balance, cell proliferation and differentiation and atherosclerosis, etc. We investigated the associations of 10 single-nucleotide polymorphisms (SNPs) in PPARs with apolipoprotein (apo) A-I/ apoB ratio in Chinese Han population. Overall, 630 subjects (212 males, 418 females) were randomly selected from the Prevention of Metabolic Syndrome and Multiple Metabolic Disorders in Jiangsu Province of China Study Cohort. Population analyzed was as the general population which involved healthy people and individuals with disorders of apoA-I or apoB. 10 SNPs (rs1800206, rs135539, rs4253778, rs2016520, rs9794, rs10865710, rs1805192, rs709158, rs3856806 and rs4684847) were genotyped. Mean difference (Difference) and 95% confident interval (95%CI) were calculated. After covariates adjustment, rs1800206-V allele (LV+VV) and rs3856806-T allele (CT+TT) were significantly associated with a decreased apoA-I/ apoB ratio than those wild type carriers, Difference (95%CI) were -1.29（-1.96~-0.62）and -0.8 (-1.42~-0.17), respectively. Rs4253778-C allele was significantly associated with an increased apoA-I/ apoB ratio compared to the wild type carriers (GG), Difference (95%CI) was 0.76 (0.04~1.48). Generalized multifactor dimensionality reduction analysis showed that three-to-eight-locus models were significant with apoA-I/ apoB ratio (P<0.05). We chose the seven-locus model (P=0.0010) as the best GMDR model (cross-validation consistency was 7/10 and testing accuracy was 62.97%). Our data provided the evidence that PPARs polymorphisms might be involved in regulation of apoA-I/ apoB ratio in independently and/or in an interactive manner.

Kazakhstan, a developing middle-income country, has the highest road traffic collision (RTC) mortality in the European Region. The aims of this study were to determine main characteristics of road traffic fatalities in Semey region, Kazakhstan and to compare findings with National data and middle-income European countries. This descriptive surveillance study assesses RTC mortality rates and epidemiology in the Semey Region of East Kazakhstan Oblast. Data of all 318 road traffic fatalities form the Semey Regional Center for Forensic Medicine were analyzed for the 5-year period of January 1, 2006 through December 31, 2010. Over the study period, the average road traffic mortality in the Semey Region was 12.1 per 100,000 population with downward trend by 35.1% (p=0.002). The victims mean age was 37.1 (SD=17) years. Males predominated at 74.5%. Vehicle fatality was the most common mode of fatality at 61.3%. The majority of collisions, 53.1%, occurred on highways. Most victims, 67.3%, have died at the scene of collision; in 67.3% of fatalities, autopsies identified multiple injuries as cause of death. The high number of fatal collisions took place in “no snow” season (P<0.001), with an overall 5-years downward dynamic. High proportion of males, pedestrians and car occupants among road traffic fatalities; high proportion of death on scene in case of highway collisions are specifics for Semey region, Kazakhstan. These findings can be used to formulate preventive strategies to reduce fatalities and to improve the medical care system for road traffic fatalities.

Primary care physicians’ visit services for diabetes management are now widely delivered in China''s rural public health care. Current studies mainly focus on supply but risk factors from patients’ view have not been previously explored. This study aims to present the utilization of rural primary care physicians’ visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients’ view. This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, χ2 contingency table analyses and Logistic regression were used. 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration (OR=1.654), use of diabetic drugs (OR=1.869), consulting diabetes care knowledge (OR=1.602), recognition of diabetic complications (OR=1.662), needs of visit services (OR=2.338). The utilization of rural primary care physicians’ visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries.

The present study aimed to explore some risk factors affected the mean of the number of tuberculosis (TB) in West Azerbaijan Province, Iran between 2001 and 2010. Our time series study analyzed the data of 2,560 TB patients as registered with TB Patients Care System in West Azerbaijan Province from early 2001 to 2010. A checklist was prepared for collecting the data and they were then analyzed in SPSS V.16 software. The percentage of male and percentage of female were close to each other (52.2% against 47.8%, respectively). A significant increasing trend of TB rate was found over the years of 2001and 2010 with a pick at 2008 (P<0.001). A Poisson log-linear analysis showed that the most important risk factor of the trend of rate was the level of education so that people with primary level or with illiterate level had a statistically significant TB rate of 5.21 (4.66-5.81), adjusted for years. The next risk factor was type of TB and place of residency, i.e., pulmonary TB cases had higher rate than External pulmonary TB cases (RR=1.67; (1.54-1.80). The last factor with the lowest risk was BCG with RR=1.29 (1.20-1.40) for people who received BCG compared to the people who had not received it. Although the co morbidity of AIDS and TB was not a major problem, it is necessary that special attention be paid to the way of implementing the TB control program based on the demographic risk factors of the study population.

This study aimed to estimate the rate of pressure ulcers in intensive care units (ICUs) and medical and surgical wards of Iranian hospitals and compare the performance of methods of medical record review as well as direct observation for their detection. The research team visited 308 patients in medical and surgical wards of hospitals affiliated with Tehran University of Medical Sciences and a further 90 patients in their ICUs between March 2009 and April 2010. In addition 310 patient records were randomly selected from patients discharged from the ICUs between March 2009 and April 2010. And a further 600 patient records were randomly selected from the patients that were discharged from medical and surgical wards between March 2010 and April 2011. These 910 selected records were retrospectively reviewed to identify pressure ulcers. Data were collected by a structured checklist. In ICUs 24 of 90 patients (26.7%, 95% CI: 17.56 to 35.84) that were directly observed and 59 of 310 patients (19.0%, 95% CI: 14.63 to 23.37) that were studied by retrospective review of medical records had pressure ulcers. In medical and surgical wards, 5 of 308 patients (1.6%, 95% CI: 0.20 to 3.00) that were directly observed had pressure ulcers, but no pressure ulcer was detected by review of 600 medical records. Pressure ulcers are significantly more frequent in ICUs than in medical and surgical wards and a significant proportion of pressure ulcers are not reported.

Exposure to mercury (Hg) as a heavy metal can cause health effects. The objective of this study was to assess occupational exposure to Hg in a chlor-alkali petrochemical industry in Iran by determining of Hg concentrations in air, blood and urine samples. The study was performed on 50 exposed subjects and 50 unexposed controls. Air samples were collected in the breathing zone of exposed subjects, using hopcalite sorbents. Analysis was performed using a cold vapor atomic absorption spectrophotometer (CV-AAS) according to NIOSH analytical method 6009. For all participants, blood and urine samples were collected and then transferred into sterile glass tubes. After micro-extraction with ionic liquid and back extraction with nitric acid, Hg concentrations in blood and urine samples were determined by CV-AAS. The mean concentration of air Hg was 0.042± 0.003 mg/m3. The mean concentrations of Hg in blood and urine samples of exposed subjects were significantly higher than unexposed controls (22.41± 12.58 versus 1.19± 0.95 µg/l and 30.61± 10.86 versus 1.99± 1.34 µg/g creatinine, respectively). Correlation of air Hg with blood Hg, urine Hg and blood Hg-urine Hg ratio were significant statistically (P< 0.05). The values of Hg in blood and urine samples of chlor-alkali workers were considerably high. Correlation coefficients showed that blood Hg and blood Hg-urine Hg ratio are better indicators than urine Hg for assessing occupationally exposed workers in terms of current exposure assessment.

Gastric cancer is the most prevalent cancer among men and the third most prevalent cancer among women in Iran. Its most important reason for death is its belated diagnosis at the advanced stages of the disease. Various factors can be effective on the survival of these patients after surgery, which are the major concern in this study. Data from 330 patients with Gastric cancer who had undergone surgery at Iran Cancer Institute from 1995 to 1999 were analyzed. The Survival Time of patients was determined after surgery and the effect of individual and demographic; clinical and diagnostic; and treatment and post-surgical factors on patients’ survival was studied. For data analysis, Kaplan- Meier, Log-Rank test and Proportional Hazards Model were used. The median of survival time was 16.33 months. The one-year, three-year, and five-year survival rates were, 0.66, 0.31, and 0.21. Based on univariate analysis results of age(P<0.001), metastases(P=0.012), disease stage(P=0.016), and number of renewed treatments(P<0.001), as well as multivariate analysis which was used to investigate the simultaneous effect of influencing variables on patients’ survival showed that age(61-70:HR=1.40,>70:HR=2.08), marital status(HR=0.39), number of renewed treatments(1:HR=0.54,2:HR=0.30,3:HR=0.22), relapse(HR=1.51), type of gastrectomy (Subtotal: HR=1.12, Distal:HR=0.49, Partial:HR=0.94, Proximal:HR=0.52), liver metastases (HR=1.79), distance metastases(HR=1.84), and disease stage(II:HR=1.28,III:HR=2.12,IV:HR=1.90) variables had a significant effect on patients’ survival. Patients who call on doctors in early stages of disease will have a higher survival rate due to early diagnosis whereas disease progression will increase the risk and will decrease the survival. Identifying factors affecting patients’ survival and improving diagnostic methods can prevent disease progression and increase survival rate.

The important role of electronic health as well as importance of health care systems awareness and readiness may lead to develop the essential infrastructures for electronic health especially in developing countries. This study aims to investigate goals, gains, applications, challenges and other important issues related to success performance of electronic health. This research proposed a grounded theory in a qualitative design and a purposive sampling was used to select participants which consisted of 28 hospital managers and staff field managers working in deputy of health and curative affairs of Medical Science Universities in south of Iran. Semi structured interviews were conducted using a topic guide and intended themes derived from the results using Max QDA software during five steps. Nine themes through interviewees` viewpoints were made up as followed: Electronic health definition, necessity and importance of electronic health, electronic health advantages, relationship between electronic health and internet, physicians` opposition to electronic health, prerequisites for electronic health, solutions for applying electronic health plan, factors affecting electronic health acceptance in society and electronic health system challenges. It seems that there are good circumstances in the south medical universities about settlement and implementations of electronic health and their managers are aware of its advantages, importance and necessities. The present findings implicate that these organizations should consider the user friendly and probable resistances of the present clients, in this regard it is suggested that the used technology must be accepted by users, having standard base, inexpensive and simple enough while less vulnerable in response to changes.

Non-syndromic cleft lip with or without cleft palate (nsCL/P) is one of the most common congenital abnormalities of the orofacial region with a multifactorial etiology. The present study aimed to investigate the association of two common polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene (c.677C>T and c.1298A>C) with the occurrence of nsCL/P in an Iranian population. Forty-five nsCL/P patients, 43 mothers of patients, and 101 unrelated controls participated in the present study. Analysis of c.677C>T and c.1298A>C polymorphisms in MTHFR gene was conducted using polymerase chain reaction and restriction enzyme digestions. There was no statistical difference in genotype and allele frequencies for c.677C>T variants between patients or their mothers and the control group. However, differences in the frequencies of alleles and genotypes of c.1298A>C polymorphism were statistically significant between patients and control group (P=0.01 for alleles and P=0.005 for genotypes). The odds ratios (OR) for the CC versus AA homozygotes were 6.1 (95% CI 1.8-20.5) and 4.2 (95% CI 1.1-15.4), in patients and mothers, respectively. We found no association between genetic polymorphism of MTHFR c.677C>T and the risk of nsCL/P in the population studied. Yet the results suggested that c.1298A>C polymorphism of MTHFR gene may be a risk factor for the occurrence of nsCL/P in the Iranian population.

The aim of present study was to investigate the relation between the perception of population on healthy diet and lifestyle related behaviors. As part of national study on Iranian Health Perception, a cross-sectional study was carried out in Iran, 2010. A multistage sampling approach was applied to include a representative sample of population aged between 18 and 65 in the study. To collect data a designed questionnaire was administered. In all 27,883 individuals (50.4% women, 48.8% men) were included in the study. The mean age of participants was 34.6 years (SD = 12.8) and most were married (61%). The findings indicated that Iranian population often pay attention to healthy diet (39.5%), never smoke (74.9%), sometimes were doing exercise (29.5%), felt happy to some extent (39.5%), often care about themselves (47.1%) and rated their health as good (54.5%). Further analysis of the data showed that increased paying attention to healthy diet was associated with reduced smoking, more exercise, more self-care and happiness, and a better self-rated health status. The findings suggest that a healthy diet and other determinants of lifestyle are very integrated into each other. The efforts for changing any components of lifestyle can potentially change all individual related lifestyle behaviors. Indeed, one of effective strategies in fostering healthy diet is fostering other healthy lifestyles. This holistic approach might help decision-makers to design appropriate interventions in order to influence diet behaviors of people.

Yersinia enterocolitica is rapidly emerging worldwide as an enteric pathogen and has become a major cause of diarrhea even in developed countries. The aim of this study was to characterize and genetic diversity analysis among Y. enterocolitica strains isolated from fish and chicken sources. From 44 strains, 55% (24 strains) found to be positive for Y. enterocolitica by colony morphology, biochemical tests and 16S rRNA. We investigate the diversity of Y. enterocolitica by hemolytic activity, antimicrobial resistance, RAPD, ERIC and REP-PCRs PCR, profiling of outermembrane proteins and lipopolysaccarides. Forty one percent of the strains were found to be the producers of haemolysin at 37 ºC but not at 28 ºC. All the isolates were exhibiting multi-drug resistance and found sensitive to chloramphenicol, and resistant to ciprofloxacin and amoxicillin. Eight, eleven and twelve different genotypic patterns were observed in RAPD, ERIC and REP-PCRs respectively. Five isolates have produced high molecular weight protein (HMWP) with a molecular weight of 150 – 220 kDa. Mostly LPS produce identical profiles, 22 strains have produced smooth LPS, while 2 strains have produced the rough LPS pattern. Genotyping tools strongly confirm the co-existence wide genetic diversity among the strains tested. By using any or the combination of these molecular tools, epidemiological investigation on Y. enterocolitica could be elucidated effectively. These results showed that the REP-PCR is more informative and discriminative than other for analysis of Y. enterocolitica diversity.