International Journal of Preventive Medicine
Volume:5 Issue: 8, Aug 2014

Atherosclerosis is the major cause of morbidities and mortalities worldwide. In this study we aimed to review the mechanism of atherosclerosis and its risk factors, focusing on new findings in atherosclerosis markers and its risk factors. Furthermore, the role of antioxidants and medicinal herbs in atherosclerosis and endothelial damage has been discussed and a list of important medicinal plants effective in the treatment and prevention of hyperlipidemia and atherosclerosis is presented. The recently published papers about atherosclerosis pathogenesis and herbal medicines effective in the treatment and prevention of hyperlipidemia and atherosclerosis were searched. Inflammation has a crucial role in pathogenesis of atherosclerosis. The disease is accompanied by excessive fibrosis of the intima, fatty plaques formation, proliferation of smooth muscle cells, and migration of a group of cells such as monocytes, T cells, and platelets which are formed in response to inflammation. The oxidation of low density lipoprotein (LDL) to Ox‑LDL indicates the first step of atherosclerosis in cardiovascular diseases. Malondialdehyde factor shows the level of lipoperoxidation and is a sign of increased oxidative pressure and cardiovascular diseases. In special pathological conditions such as severe hypercholesterolemia, peroxynitrite concentration increases and atherosclerosis and vascular damage are intensified. Medicinal plants have shown to be capable of interacting these or other pathogenesis factors to prevent atherosclerosis. The pathogenesis factors involved in atherosclerosis have recently been cleared and the discovery of these factors has brought about new hopes for better prevention and treatment of atherosclerosis.

Neurotransmitters, such as dopamine and serotonin, play an undeniable role in the incidence of mental illnesses. Almost all humans will experience depression. Furthermore, most humans lack the ability to control and reduce depression, the disorder can lead to physical damage. The main goal of this study was to determine the association between distribution of depression and the climatic conditions in the Iran country. Spatial distribution maps of depression were plotted by using data recorded during 2010 year in the Iran health center registry. The geographical mapping of depression and climatic conditions were then incorporated into a geographic information system to create a spatial distribution model and in this study weused neural network to model the trend of depression and climatic conditions. The spatial distributions of depression diseases in the country, followed by were scattered based on climatic conditions. In fact, common depression was more prevalent in the parts of the country where cold and rainy weather was more abundant. The findings of this study can be useful for psychologists and controlling of this disease, because lack the ability to control and reduce depression, the disorder can lead to physical damage. Data are also important to establish further effects modeling for depression. Moreover, psychologists and health professionals should consider the impact of environmental factors on their patients’ health.

Physical activity (PA) is protective against non‑communicable diseases and it can reduce premature mortality. However, it is difficult to assess the frequency, duration, type and intensity of PA. The global physical activity questionnaire (GPAQ) has been developed by World Health Organization with the aim ofhaving valid and reliable estimates of PA. The primary aim of this study is to assess the repeatability of the GPAQ instrument and the secondary aim is to validate it against International Physical Activity Questionnaire (IPAQ) and against an objective measureof PA (i.e., using pedometers) in both rural and peri‑urban areas of North India. A total of 262 subjects were recruited by random selection from Ballabgarh Block of Haryana State in India. For test retest repeatability of GPAQ and IPAQ, the instruments were administered on two occasions separated by at least 3 days. For concurrent validity, both questionnaires were administered in random order and for criterion validity step counters were used. Spearman’s correlation coefficient, intra‑class correlation (ICC) and Cohen’s kappa was used in the analysis. For GPAQ validity, the spearman’s Rho ranged from 0.40 to 0.59 and ICC ranged from 0.43 to 0.81 while for IPAQ validity, spearman correlation coefficient ranged from 0.42 to 0.43 and ICC ranged from 0.56 to 0.68. The observed concurrentvalidity coefficients suggested that both the questionnaires had reasonable agreement (Spearman Rho of >0.90; P < 0.0001; ICC: 0.76‑0.91, P < 0.05). GPAQ is similar to IPAQ in measuring PA and can be used for measurement of PA in community settings.

Childhood obesity is a world‑wide health problem and development of interventions to prevent or control it is a priority. Obesity is prevalent and on the increase among school‑students in Iran, too. As the first step for development of an intervention, the current study was designed to complete our understanding of ideas, attitudes, beliefs, and preferences of primary school children in Tehran, Iran. Twenty‑seven primary school‑students (11 boys, 16 girls) in grade‑five, most of whom were overweight or obese, participated in four focus‑group discussions (FGDs). All FGD notes were analyzed to find the main themes. Nine themes in three main categories emerged after analysis. The themes in the category of barriers of losing weight included environmental, psychological and physiological barriers. Category of intervention components included nutritionimprovement, physical activity promotion, social support and education. Setting and deliverer of the intervention were included in the intervention conditions category. The children proposed a multi‑component approach for development of an intervention.They mentioned nutrition and physical activity improvement, social support and education as the main elements of an effective intervention. The findings indicate that obese children need to be supported against different barriers of losing weight, mainly social barriers, especially humiliation by the community.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the worldwide. It is associated with chronic disorders such as diabetes and heart diseases. Inflammation is one of the basic causes of metabolic diseases. Several studies have shown that Vitamin D can reduce inflammation. The purpose of this study was to investigate the effect of Vitamin D supplementation on inflammation in patients with NAFLD. This study involved 60 NAFLD patients, divided equally into two intervention and placebo groups. During 10 weeks, patients in the intervention group receive Vitamin D (capsules containing 50,000 IU vitamin D), weekly. Vitamin D levels, C‑reactive protein (CRP), triglyceride (TG), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured at the beginning and end of the study. Data were analyzed using analysis of covariance tests. Analyses were done using SPSS software (version 16) (SPSS Inc., Chicago, USA). P < 0.05 set as significant level. Vitamin D supplementation resulted in an increase of serum 25(OH) D concentrations in inter group (P < 0.05) and intra‑group (P < 0.05) in intervention group. At the end of the study, in the intervention group, TG and CRP reduced significantly compare with baseline (P < 0.05). A significant increase was seen in calcium serum in the intervention group in comparison with baseline (P < 0.05) and compared with the placebo group (P < 0.05). After adjusting for baseline values, level of ALT, AST, TG, and CRP were reduced in the intervention group compared with the placebo group, but this decrease was not significant between the two groups. Vitamin D supplementation had no effect on CRP and other variables in the intervention group compared with the placebo group. Further studies with strong design and more sample must conduct to demonstrate the effect of Vitamin D supplementation on inflammation in patients with NAFLD.

Identifying factors, which influence health behaviors is critical to designing appropriate and effective preventive programs. Human immunodeficiency virus (HIV) transmission is highly related to people behaviors and understanding factors influencing healthy behaviors among Iranian people living with HIVs (PLHIVs)/acquired immunodeficiency syndrome (AIDS) is very important to tailor an effective response to HIV/AIDS epidemic. This study was conducted as a qualitative study by methods of focus group discussion and in‑depth interview in six provinces of Iran with 64 PLHIVs to determine factors influence engagement in positive prevention. Knowledge and education, feelings of responsibility and positive prevention practices were identified as the primary domains of engagement. These domains were found to be influenced by feelings of ostracism and frustration, poverty, barriers to disclosure of HIV status, access to and utilization of drug abuse treatmentservices and antiretroviral therapy, adherence to treatment, age, religiousness, sex work, singleness, and incarceration. Designing new interventions and updating current interventions directed toward the aforementioned factors should be addressed by responsible Iranian authorities in order to have a national effective response on the HIV/AIDS epidemic.

Upon successful experiences of family physician program in the rural regions, Iranian Ministry of Health and Medical Education (MOHME) made a decision to expand this program to urban areas. For this reason a pilot program were designated and some cities have been selected to determine dos and don’ts of performing family physician program in the cities. Various studies were published during this period demonstrating the advantages and disadvantages of family physicians’ care in thesecities. After this process in 2012 and 2013 MOHME announced implementation of family physician program in Tehran. Our study investigated public attitudes, knowledge and practice about the newly introduced program. This cross-sectional study was performed in Tehran during November to December 2012. A telephone survey was carried out using the Random Digit Dialing (RDD) method and data was gathered by a researcher designed questionnaire. A total of 386 residents aged 18 years and over participated in the study. To compare the differences between various groups’ knowledge scores data were analyzed performing Chi-square test, t-test, ANOVA, and logistic regression by SPSS software version17, to find factors that affected individuals’ agreement with the program. Among all samples 214(57.4%) knew about the program and almost 120(85.1%) of these aware people were planning to participate in the program. Television and Radio were the major information resources. After adjusting for Educational status, Access to Internet and Socio Economic Status(SES) those peoplewho didn’t have any kind of health coverage systems(Health insurance) were most likely to accept the program and agree with that[OR= 2.38(1.05-5.38)]. The fact that despite low levels of information, most of aware people intend to enroll in the new program reveals that expanding informative programs would bring more participation and involvement among community.

Hypertension and diabetes are major risk factors for cardiovascular and cerebrovascular disease. Adherence is a primary determinant of the effectiveness of treatment because poor adherence attenuates optimum clinical benefit and paves theway for complications. The cross‑sectional community‑based survey was carried out among men and women aged 30 years and above in the field practice area of a medical college to assess treatment compliance with respect to hypertension and type 2 diabetesmellitus. The study comprised of 426 subjects, already diagnosed with hypertension (287) and type 2 diabetes mellitus (139). During house visits, data were collected by personal face‑to‑face interview using a pre‑tested structured questionnaire. Compliance was determined by indirect methods, which included self‑reportingand interviews with the patients. Compliance to hypertension treatment was found to be 82.2%, while 83.6% of individuals with type 2 diabetes mellitus were on regular medication. Among the individuals on regular medication, 88 (37.3%) of them had controlled blood pressure.Although the compliance was good, blood pressure control was not optimal. Adherence was better among females as compared with males. Literacy status and socio‑economic background were not found to be associated with treatment compliance. High costof treatment for hypertension (39.3%) and diabetes (30.4%) and asymptomatic nature of the disease were the most common reasons cited for not taking regular medications. Adherence to hypertension and diabetes treatment was good. High cost of medications and asymptomatic nature of the disease were the reasons identified among the non‑adherent patients.

Considering the importance of improvement of endothelial function in patients with type 1 diabetes mellitus (DM) and to prevent its related micro‑ and macro‑vascular complications; in this study, the effect of vitamin C administration on improving endothelial function of children with type 1 diabetes was investigated. In this analytic‑experimental study, children with type 1 DM aged 6-18 years and a group of healthy children enrolled. Vitamin C (250 mg/daily) administrated for the two studied groups for 1‑month. Endothelial function evaluated by flow‑mediated dilatation (FMD) and intima‑media thickness (IMT) measurementusing vascular Doppler ultrasonography, before and after trial. In this study, 18 patients with type 1 diabetes (DM) and 19 normal children as the control group were studied. After vitamin C administration IMT reduced in all studied groups (P < 0.05). FMD increased in all studied groups, but it was significant only in the control group (P = 0.02 in the control group and P = 0.07 in patients with DM). Mean differences of IMT 2 – IMT 1, FMD 2 – FMD 1 and left ventricular (LV) mass 2 – LV mass 1 and blood pressure (BP) were not significantly different in two studiedgroups (P > 0.05). Mean differences of IMT 2 – IMT 1, FMD 2 – FMD 1, LV mass 2 – LV mass 1 and BP were not significantly different in patients with HbA1c ≤ 7 g/dl and those with HbA1c >7 g/dl and control group (P > 0.05). The findings of the current study indicated that vitamin C may have a protective effect on endothelial dysfunction, but regarding its effectiveness among the high‑risk population such as diabetic patients with and without appropriate glycemic control the study was not sufficiently powered due to its small sample size.

Tuberculosis (TB) can affect patients’ life even after successful treatment. In this study, we aimed to determine the survival rate of patients with smear positive TB after successful treatment and identify the predictors of mortality. This was a prospective study. The source of data was the TB registry system in Iran and 964 patients were eligible for the study. The life table was used to determine the annual survival rate. Survival curves were estimated using Kaplan–Meier andwere compared using the log‑rank test. In order to determine the predictors of survival, four models of Cox regression, exponential, Weibull and log‑logistic fitted and finally exponential model with minimum akaike information criteria and Bayesian informationcriterion values were selected. Then, variables with significant levels <0.2 in univariate analysis were entered into the multivariate model. Hazard ratios with a confidence interval of 95% were used to measure the association. A total of 149 patients (15.5%) died during the follow‑up period. The median of survival time after successful treatment was 10.5 years and survival probability for 11 years after successful treatment was 70%. Furthermore, previous TB treatment, high age, suffering from kidney failure and cancer were predictors of mortality after successful treatment. This study showed that positive smear pulmonary tuberculosis even after successful treatment has an adverse effect on the patients’ survival and leads to a decrease in their survival rate in the long run. Furthermore, individuals with a history of previous TB treatment had much lower survival rates.

To develop and implement more effective programs of health care delivery to prevent and control diabetes, Iran has developed and implemented the urban phase of the specialized care program for diabetic’s patients. Deeply understanding theviews and experiences of various stakeholders in this program can assist policy makers to identify the program’s strengths and weaknesses and enable them to develop action plans. Hence, the present study aimed to evaluate the planning and establishing ofthis program from the perspective of providers. A qualitative study was applied using documents review and face‑to‑face semi‑structured interviews with the program leads and relevant executive managers of the local medical universities. Thematic analysis was used to analyze the data. Three main themes and nine subthemes were explored, including program planning (the content and the strengths, weaknesses, and corrective measures), implementation (executive mechanisms at the university level, establishment of referral system, collaboration between deputies of health and treatment, information dissemination mechanisms, satisfaction measurement and strengths, weaknesses and corrective measures), and result (implementation results). The urban phase of the specialized care program for diabetic’s patients has been a good base to improve continuity of care, which emphasizes on controlling and prevention of occurrence or progression of chronic complications of diabetes. This model can also be used for better management of other chronicdisease. However, there are still issues that should be considered and improved such as allocation of guaranteed resources, more trained health professionals, and more evidence based guidelines and protocols, better collaboration among medical universities’ deputies, clearer payment system for program evaluation and better information management system.

Protecting households from risk of impoverishment due to out‑of‑pocket costs in health care is a major challenge for health systems. Therefore, this study aimed at evaluating some health expenditure of inpatient and outpatient care as well as assessing the predictors of catastrophic costs for inpatient care in one of central provinces of Iran. In this cross‑sectional study, 760 household were selected by multistage sampling method in Markazi province of Iran and interviewed in order to complete a standard questionnaire. Catastrophic costs were evaluated in a scale that varied from 0 (no money for care) to 100 (spending all income and wealth). Patients who were paid over 20% of household financial sources or 40% of month income were regarded as being exposed to catastrophic costs. Negative binomial model with robust estimator logit function was used for prediction of catastrophic costs. Based on data analysis, 42.6% of hospitalized subjects encountered catastrophic costs. Moreover, 11.2% households faced catastrophic cost among all participated households and 39.3% were reported to need inpatient need care. Multivariate regression model showed that age range 40-59 years and beingin the lower levels of wealth index were significant predictors of facing catastrophic costs (P < 0.05). Lack of money is the most important cause of un‑seeking care. Hospitalizations due to inpatient care needs, household members aged 40-59 years old, especially with chronic diseases and nonrich status of the household were the highestpredictors of facing catastrophic costs. Reducing out‑of‑pocket costs can increase health care utilization.

Magnetic resonance imaging (MRI) is an expensive and commonly used technology with a variety of indications in patient diagnosis and treatments. The aim of this study is to identify a comprehensive list of indications and contraindicationsfor MRI in patients with low back pain (LBP) and to determine the appropriateness of using this technology in these patients on the basis of this list. A cross‑sectional study was conducted in four radiographic centers in Tehran, Iran. A list of MRI indications and contraindications for LBP was developed by review of documents and expert panel. A pre structured checklist was designed andincorporated into a structured form. All 100 consecutive patients referring to four radiographic centers for performing MRI regarding LBP completed the questionnaire. Chi‑square, Fisher’s Exact Test and logistic Regression were used to assess statisticalsignificance. In this study, 187 patients (46.7%) had an indication for MRI, but 186 patients (46.5%) had no indication, 18 patients (4.5%) had indication and contraindication at the same time and nine patients (2.3%) had contraindication. Moreover, 71 patients (17.8%) underwent MRI for LBP during the past 2 years, of which14 (19.7%) had normal results. Patients with complementary private insurance had a history of previous MRI about 20% more than other patients (P = 0.018). There was a statistically significant relationship between complementary private insurance coverageand number of MRI performed (P = 0.006). About half of the patients referring to radiographic centers with LBP for MRI had no indication for this test.

Iron supplementation can decrease the absorption of zinc and influence other antioxidants levels such as vitamin C. This study aimed to investigate the effect of iron supplements alone and in combination with vitamin C on zinc and vitamin Cstatus in iron deficient female students. In a double‑blind randomized clinical trail, 60 iron deficient students were selected from 289 volunteers residing in dormitory. After matching, subjects were randomly assigned into two groups: Group I (50 mg elemental iron supplements) andGroup II (50 mg elemental iron + 500 mg ascorbic acid). Serum ferritin, iron, serum zinc, and plasma vitamin C concentrations were measured by using enzyme‑linked immunosorbent assay, spectrophotometer, atomic absorption spectrometer, andcolorimeter, respectively after 6 and 12 weeks supplementation. Student’s t‑test and repeated measures analysis of variance were applied to analyze the data using SPSS software. Serum zinc levels had no significant differences between 2 groups at the baseline; however, its concentration decreased from 80.9 ± 4.2-68.9 ± 2.7 μg/dl to 81.2 ± 4.5-66.1 ± 2.9 μg/dl (P < 0.001) in Groups I and II, respectively after 6 weeks of supplementation. Continuous supplementation increased serum zinc concentration to baseline levels (79.0 ± 2.9 μg/dl; P < 0.01) in Group I and 70.5 ± 3.1 μg/dl in Group II following 12 weeks of supplementation. Plasma vitamin C increased from 3 ± 0/1-3.3 ± 0.2 mg/dl to 2.7 ± 0. 1-4.2 ± 0.2 mg/dl (P < 0.01) in Groups I and II, respectively.At the end of study, plasma vitamin C significantly increased from 3.3 ± 0.3-4.7 ± 0.3 (P < 0.01) to 4.2 ± 0.2-7.1 ± 0.2 (P < 0.001) in Groups I and II, respectively. Iron supplementation with and without vitamin C led to reduction in serum Zn in iron‑deficient female students after 6 weeks. However, the decreasing trend stops after repletion of iron stores and Zn levels returned to the approximately baseline values after 12 weeks.

The aim of this study was to assess the success rate of nasal intermittent positive pressure ventilation (NIPPV) for treatment of continuous positive airway pressure (CPAP) failure and prevention of conventional ventilation (CV) in pretermneonates. Since November 2012 to April 2013, a total number of 55 consecutive newborns with gestational ages of 26-35 weeks who had CPAP failure were randomly assigned to one of the two groups. The NIPPV group received NIPPV with the initial peak inspiratory pressure (PIP) of 16-20 cmH2O and frequency of 40-60 breaths/min. The CV group received PIP of 12-20 cmH2O and frequency of 40-60 breaths/min. About 74% of newborns who received NIPPV for management of CPAP failure responded to NIPPV and did not need intubation and mechanical ventilation. Newborns with lower postnatal age at entry to the study and lower 5 min Apgar scoremore likely had NIPPV failure. In addition, treatment failure was higher in newborns who needed more frequent doses of surfactant. Duration of oxygen therapy was 9.28 days in CV group and 7.77 days in NIPPV group (P = 0.050). Length of hospital stay in CV group and NIPPV groups were 48.7 and 41.7 days, respectively (P = 0.097). NIPPV could decrease the need for intubation and mechanical ventilation in preterm infants with CPAP failure.

Scrub typhus is an acute, febrile zoonosis caused by an obligate intracellular bacterium Orientia tsutsugamushi. The clinical manifestations of the disease range from subclinical to fatal organ failure. The common symptoms are fever, chills, headache, myalgia, dry cough, lymphadenopathy, and gastrointestinal disturbances. The presentation with complications is usually due to delay in diagnosis and treatment. We report three cases of scrub typhus that presented with features of meningo‑encephalitis, which is very unusual, and all patients recovered with empirical doxycycline treatment.

Vitamin A deficiency (VAD) can cause a range of ocular manifestations, including night blindness, conjunctival and corneal xerosis and keratomalacia. It is an important cause of preventable blindness. Although usually a result of malnutrition, VAD can accompany malabsorption syndrome. We report a case of VAD as manifested by Bitot’s spots and eventually diagnosed to have celiac disease. It is, therefore, important to consider gastrointestinal diseases causing malabsorption in the evaluation of VAD.

The purpose of this study was to investigate the effect of 12‑week of aerobic training on homocysteine, lipoprotein A and lipid profile levels in sedentary middle‑age men. This was a quasi‑experimental study. Subjects of the tudy were 24 men (age 40-60) who participated is the study oluntarily and were randomly assigned in aerobic (n = 12) and ontrol (n = 12) groups. The subjects participated in progressiveaerobic training on treadmill 3 times a week (20 min/session 60% maximum heart rate) to 60 min (75% maximum heart rate). omocysteine, lipoprotein A, triglyceride (TG), cholesterol, ow‑density lipoprotein (LDL) and high‑density lipoprotein (HDL) ere measured before and after 12‑week. Data were analyzed using aired t‑test and independent t‑test statistical methods. Research findings showed a significant decrease in omocysteine (P = 0.002), lipoprotein A (P = 0.003), TG (P = 0.008), holesterol (P = 0.024) and LDL (P = 0.019), significant increase n HDL (P = 0.017) in posttest compared to pretest. Furthermore, esearch findings showed that homocysteine (P = 0.005), ipoprotein A (P = 0.001), TG (P = 0.006), cholesterol (P = 0.015), DL (P = 0.022), and HDL (P = 0.004) levels between the two roups. These findings reveal the 3 sessions/week of erobic training cause reduction of homocysteine, lipoprotein A, nd lipid profile levels in sedentary middle‑aged men and can be ecommended for prevention of cardiovascular disease.

Regarding risk of bacterial meningitis (BM) after Cochlear implantation (CI), it was suggested to receive polyvalent conjugate vaccine. We aimed to estimate the prevalence of BM post CI in child recipients who do not receive polyvalent vaccine. We enrolled 371 children who had received cochlear implants from 2007 to 2010. None of them received pre or post implantation polyvalent conjugate vaccine for BM. We followed all of them for BM for 2 years after implantation. We detected only one female case of BM (0.3% of patients) with the age of 24 months. The mean age of noninfected children was 36.7 ± 23.2 months. The education level of parents was “college level or higher” in less than half of them, and about 65% of patients were products of consanguineous marriage. Our findings indicated that the incidence of BM was not higher in our cochlear implanted children who did not receive immunization than patients from countries in which routine vaccination is done. We suggest that although properimmunization is recommended before surgery, this procedure could be performed without vaccination, especially in developing countries that face financial problems for preparing vaccines.