Journal of Research in Health Sciences
Volume:13 Issue: 1, Winter-Spring 2013

The Body Mass Index (BMI) is widely used to diagnose overweight and obesity. However, there are limitations on the use of BMI and development of alternative measures can be of clinical importance. This study aimed to compare specificity and sensitivity of weight for height (W/H), waist circumference (WC) and waist-to-height ratio (WHTR) with BMI-for-age in diagnosing overweight and obesity in Thai school-age children. This was a cross-sectional study. Children between the ages of 6 and 13 who attended elementary schools were potential participants of the study. BMI, W/H, WC, and WHTR were calculated for each participant. The optimal cut-off points for the diagnosis of overweight and obesity by W/H, WC and WHTR were generated by the receiver operating characteristic curves (ROC). Using BMI cut-off points introduced by WHO, the overall prevalence of overweight and obesity in the study population was 24.6% and 12.9% respectively. W/H, WC, and WHTR all showed acceptable sensitivity and specificity in diagnosing overweight and obesity when compared to BMI-for-age results. W/H had a particularly high correlation with BMI-for-age. Cut-off points of 112% and 125% W/H are validated to determine overweight and obesity in Thai school-aged children.

Tuberculosis (TB) continues to pose a major global health problem and thus intensive action is needed to control and ultimately eliminate the disease. An active case finding (ACF) survey was conducted in the urban slum areas of the R-South Municipal Ward of Mumbai City for a period of two months from June to July 2012. Micro planning for survey was done by District Tuberculosis Officer and Medical Officer of Health of R-South ward. The entire health post staffs of R-South ward were trained to perform the survey. TB suspects were identified by trained community health volunteers during their home to home visit. These suspects were referred to the designated microscopy centers (DMCs) for sputum examination and those diagnosed with TB were put on anti-TB treatment. A total of 278 TB suspects were identified on enquiring on the presence of symptoms suggestive of TB. Out of them 221(79.5%) patients got tested for sputum examination. Sputum positive TB was diagnosed in 29 suspects and the sputum positivity rate was 13.1%, which was slightly higher than the passive case finding norms of 10% as prescribed under Revised National TB Control Program. Active case finding for tuberculosis in the general community was discouraged for several decades because of high costs of implementation. However, results of the survey suggest that periodic ACF should be incorporated in populations wherever tuberculosis incidence / prevalence is high as there was a definite improvement in the case detection rate.

In the past three decades, Tehran has experienced warmer summer so we need to determine heat-related mortality to establish appropriate public health activities during hot summers. The aim of the present study was to detect heat waves during the last decades and then determine excess mortality in immediate and lagged times. An ecological study based on time-series model was conducted in Tehran for recent decade using generalized linear lagged model (GLLM) with Poisson regression. Maximum daily temperature was heat exposure for death outcome on the same day (lag 0), 3 (lag01) and also 7 (lag02) -day moving average. Relative risk with 95% confidence was reported to quantify for increasing of daily mortalities for 1°C risen exposure. Air pollutants considered as confounders in final model. Total excess mortality during 17 heat waves was 1069 (8.9 deaths/Heat wave days). All non-external cause of death increased significantly during heat waves (3-9%) and after adjusting for ozone and PM10, raised. Cause-specific deaths (especially circulatory disease) and death among elderly increased during heat waves (especially in the hottest wave). The largest positive lagged effect of hot temperature although seen during hottest waves for all mortalities. Three waves had the most harvest effect for all categories of mortalities. Study showed excess mortalities resulted from hot temperatures and exacerbated with air pollutants in Tehran in the context of climate change. Forward displacement mortality and lagged mortalities as well as were seen, but our results were not conclusive about the displacement pattern of mortalities.

Peritoneal dialysis is one of the most prevalent types of dialysis prescribed to the patients suffering from renal failure. Studies on the factors affecting the survival of these patients have mainly used log-rank test and Cox analysis. The present study aimed to investigate the risk factors affecting short- and long term survival of patients on continuous ambulatory peritoneal dialysis (CAPD) using cure model. The data obtained retrospectively from 20 medical centers in Iran, between 1996 and 2009. All patients with renal failure who had been treated by CAPD and followed at least 3 months were included in the study. The STATA (11.0) software and CUREREGR module were used for survival analysis using cure model. Totally 2006 patients were included in this study. The major reasons for renal failure were hypertension (35.4%) and diabetes (33.6%). The median of survival time was 4.8 years with a 95% confidence interval of 4.3 to 5.6 years. The percentage of long-lived patients surviving was 40% (95% CI: 32%, 47%). The analysis showed that the effect of diabetes, serum albumin level, age, diastolic blood pressure, and medical center was significant on the long-term survival of the patients. In addition, in short-term survival the effects of age, albumin, and medical center were significant. By improving the quality of medical care in centers, nutritional status, controlling co-morbidities can help the patients on CAPD with better health and increase their short and long term survival.

The objective of this work was developing a simple and stable time-based on-line setup for assessing the potential of mercury (Hg) vapor adsorption of the commercial sorbents used in air sampling and control operation followed by cold vapor atomic absorption spectrometry (CVAAS). A special designed separation chamber was used where reduction of the injected Hg (II) solution took place. Purge gas passes through this chamber resulting to a prompt release of mercury vapor, purging into the adsorbent that regulated at the desired adsorption temperature. After sorbent saturation, in order to study the adsorption parameters of sorbents (activated carbon and bone char) such as breakthrough time (BTT), and adsorptive capacity, mercury gas stream was passed through the sorbents, directly transport to the CVAAS. Preliminary experiments concerning the reductant solution showed that SnCl2 offers higher stability than NaBH4. Around the loading range 0.125-2.5 ml min−1 of 100 µg l-1 Hg(II) solution, a linear calibration curve with the equation peak area=0.134; loading flow=-0.017 and a correlation coefficient r=0.996 was obtained, and the detection limit was improved up to cL=1µg l-1. The relative standard deviation of five measurements of lowest flow loading of Hg (II) was RSD=2.8%. The significant differences were observed in the breakthrough time and mercury adsorptive capacity between activated carbon and bone char (P=0.010). This novel setup is suitable for an on-line study of elemental mercury adsorption, determination of breakthrough time and adsorption capacity, and because of its stable performance during all experiments; it can be applied to the time based studies.

Various reasons accounted for the infection of infants kept at Neonatal Intensive Care Unit (NICU). Expressed breast milk may be regarded as a source of infection in infants. This study investigated the source of bacterial contamination and the impact of educational interventions on the contamination of mothers’ expressed breast milk (EBM) level whose infants are hospitalized at NICU. Fifteen mothers used to express breast milking their infants admitted at NICU, involved in this study was conducted during October 2011-March 2012. Samples taken from hands, breast, pumps, breast milk, and milk storage containers and therefore 244 samples were prepared by sterile cotton swab and cultured on Blood Agar and EBM. After presenting enough training to mothers, cultures of the same positions were carried out again. Only those samples proved infected that number of their bacterial colonies exceeded 104 cfu / ml or even there was a growth of pathogenic organism. Before intervention 80% of mothers had infected by at least one sample that reduced to 36% after the intervention. Before intervention 25.4% of samples were contaminated; however after intervention, it reduced to 8.2%. The main source of contamination was milk containers and pumps; moreover, Pseudomonas, E-coli, and Klebsiella were among the most common bacteria of samples’ contamination. The possibility of EBM contamination was relatively high but educational interventions might reduce the risk of prevalence.

High Cesarean section rate is a major health problem in developing countries. This study was established to evaluate the effectiveness of Iranian Ministry of Health and Medical Education protocols on Cesarean section rate trend. Through a non-concurrent controlled quasi-experimental study, Cesarean section rate in Shohada-e-Tajrish and Taleghani hospitals in Tehran was compared during 2008-2009. Intervention group included 578 participants hospitalized because of premature rupture of membranes, prolonged pregnancy, pre-eclampsia, intra-uterine growth retardation, vaginal bleeding and premature labor in first and second trimester underwent interventions based on MOHME new protocol. On the other hand 594 cases as control group were selected during the same time before the intervention and underwent routine treatments. Descriptive statics, t-test, chi square and univariate analysis were used when appropriate. Basic characteristics in two groups had no statistically significant difference. Cesarean section applied for 360 (67.8%) women in case group and on the other hand, 270 (48.8%) Cesarean sections were done for control group (P<0.001). There was 19 % difference between intervention and control groups. Complication of pregnancies had increased by 6% in intervention group (P<0.001). Mortality rate in the study was zero in both groups. Applying clinical practice guidelines does not guarantee decreasing Cesarean section rate. Providing appropriate service may increase the ability of service providers to find more indications for Cesarean section.

In recent years, proficient treatment of wastewaters containing recalcitrant and toxic compounds such as phenol has been a challenge. This study introduced and evaluated an efficient option for treating such wastewater. This experimental study was performed on phenol removal as a recalcitrant and toxic compound in aqueous solutions in 2011. The pumice stone was collected from a local mine. Collected samples were crushed and granulated using standard sieves (mesh size of 20). CuSO4 was used to modify prepared samples. The chemical composition and the surface area of the modified pumice were evaluated using X-ray fluorescence and N2 gas via Brunauer-Emmett-Teller isotherm and Belsorb software. Different parameters including of pH (3-12), contact time (20-120 min), phenol concentration (25-400 mg/L) and adsorbent dosage (0.25-1 g/L) were examined in a batch reactor. 93.5% of the phenol was removed under optimum experimental conditions of pH 3 and a 0.5 g/L adsorbent dose after 60 min contact time. The experimental adsorption isotherm the best fit with Freundlich equation model. The maximum amount of phenol adsorption onto modified pumice (MP) was 15.8 mg/g. Modified pumice is effective adsorbent for the removal of phenol from aqueous solution. Accordingly, it is feasible and promise adsorbent for treating polluted phenol streams.

The main objective of this study was to assess the malnutrition and some socio-economic related factors based on three ethnic groups among primary school children in north of Iran in 2010. This cross-sectional study was carried out through multistage cluster random sampling on 5698 subjects (2505 Fars-native, 2154 Turkman, and 1039 Sistani) in 112 schools. Well-trained staffs completed the questionnaire and measured students'' weight and height. Malnutrition estimated the Z-score less than -2SD for underweight, stunting and wasting were calculated using the cutoffs from WHO references. Generally, malnutrition was observed in 3.20%, 4.93% and 5.13% based on underweight, stunting and wasting respectively. It was more common in girls than in boys and in Sistani than in other ethnic groups. The correlation between malnutrition based on underweight and stunting and ethnicity was statistically significant (P=0.001). Results of logistic regression analyses showed that the risk of malnutrition was in rural area 1.34 times more than urban area, in girls 1.17 times more than boys, in Sistani ethnic group 1.82 times more than Fars-native ethnic group, in low economic families 2.01 times more than high economic families. Underweight, stunting and wasting are the health problems in primary school children in north of Iran with a higher prevalence in girls, in rural areas, and in Sistani ethnic group.

Injuries are the first leading but predictable, avoidable and preventable cause of death among under five-year children worldwide. The present study aimed to identify the factors associated with mothers'' beliefs and practices concerning injury prevention in under five-year children. This cross-sectional study was conducted from August to October 2011 in Hamadan County, the west of Iran, enrolling 580 mothers with at least one under five-year child. The data collection instrument was a questionnaire including 85 questions regarding demographic characteristics; knowledge; practices; Health Belief Model (HBM) constructs; and history of injury occurrence among the children. The reliability of the questionnaire was evaluated by a pilot study using Cronbach''s alpha coefficient. Data had been collected through interview with mothers, by trained interviewers. Almost 22.59% of mothers reported at least one injury in their under five-year children. Of 131 injuries occurred, 85 cases were mild, 23 cases were moderate, and 23 cases were severe. About 52.67% of injuries occurred in boys, 37.41% in less than one-year children, 73.28% at home, and 61.07% when the children were playing game. Fall (24.28%), burn (20.61%) and poisoning (14.50%) were the common causes of injuries. There was a positive correlation between mothers'' practices and knowledge, perceived benefits, cues to action and self-efficacy and a negative correlation between mothers'' practices and perceived susceptibility, severity, and barriers. Knowledge, perceived severity, perceived barriers, cues to action, and self-efficacy of mothers toward the injuries in children were among the most important predictive constructs, which may be used for planning educating programs.

Volatile organic compounds (VOCs) are human-made chemicals widely spread in the environment and produced by petrochemical industries and petroleum refineries. The aim of this research was to evaluate the distribution of VOCs in the ambient air of Mahshahr Petrochemical Complex, Iran. This study was a cross-sectional research performed in 2009. We used the method numbered 1501, 1500, 2000, 1003, 1005, 1010, 2555, 1300 and 1400 of the National Institute of Occupational Safety and Health (NIOSH) for the sampling and analysis of compounds in the air. A total of 204 samples were analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) and a Gas Chromatography-Flame Ionization Detector (GC-FID). The mean of concentrations of the pollutants in the winter is less than in summer and a strong variation occurred among the sampling site, attributed to the change in meteorology. The results indicated high concentrations of benzene in most factories. In addition, a significant difference occurred between the concentrations of the compounds in the ambient air inside and outside the factories in both seasons (P<0.050). It seems that the atmospheric conditions of the workplace affect the spreading of the pollutants, causing the concentration of the pollutants in the summer to be higher than in the winter. In addition, the frequent prevailing wind speed in the region plays a major role in the distribution of the pollutants from Mahshahr Petrochemical factories.

The prevalence of antimicrobial resistance among Enterobacteriaceae is increasing worldwide. Identification of pathogens and their resistance to antimicrobials is mandatory for successful empiric antibiotic treatment. The aim of this study was to investigate the prevalence of antimicrobial resistance of Enterobacteriaceae isolated from hospital-acquired and community-acquired infections. In a descriptive-comparative study, during 2010, all clinical isolates of Enterobacteriaceae and their antibiograms from laboratories of Sina and Bessat Hospitals, Hamadan, west of Iran were included. Hospital-acquired infections were identified by records from infection-control units. A questionnaire containing information about demographic characteristics, source of specimen, kind of Enterobacteriaceae and their antimicrobial resistance was filled for each patient. Data were analysed using SPSS. A total of 574 samples were collected, out of which the most prevalent pathogens were Escherichia coli and Klebsiella pneumoniae. Almost all isolates of Enterobacteriaceae were resistant to ampicillin (98.8%), and the least resistance was to piperacillin (3.7%). In addition, most isolates were resistant to cefazolin, cefixime, and co-trimoxazole. Among third generation cephalosporins, the highest resistance to ceftriaxone and the least resistance to ceftizoxime were observed. 19.3% of isolates were resistant to imipenem. In terms of fluroquinolones, nosocomial infections and community acquired infections were resisitant to ciprofloxacin 33% and 4.1% respectively. The rate of resistance in nosocomial infections was higher than that of community-acquired infections. The prevalence of multidrug resistant Enterobacteriaceae is increasing both in community-acquired and hospital-acquired infections. Because of propable increasing resistance to fluoroquinolones and newer betalactams, reassessment of resistance of Enterobacteriaceae must continue in future years.

Self-medication has increased in the last decade in Iran; can be followed several complications. The aim of this study was to determine the prevalence and factors influencing self-medication based on health belief model. A cross-sectional study was conducted among 1400 Hamadan Province pharmacies visitors, during spring and summer 2012 which was randomly selected with the proportional to size among different pharmacy at Hamadan for participation in this study. A structured questionnaire was applied for collecting data, which were analyzed by SPSS version 16 using bivariate correlations and logistic regression statistical tests. 35.4% of the participants had self-medication. Pain medication (10.6%), antibiotics (7.3%) and anti-cough and cold medications (4.5%) had the largest consumption. The main reasons of self-medication among participants were previous use of medication, symptoms improve and similar prescribed. The best predictor for self-medication was perceived severity with odds ratio estimate of 0.790 [95% CI: 0.694, 0.900]. It seems that designing and implementation of educational programs to increase seriousness about side effect of self-medication may be usefulness of the results in order to prevent of self-medication.

Cryptosporidium is a protozoan parasite causes cryptosporidial diarrhea, which is typically a short-lasting benign infection, but can become severe and non-resolving in immunocompromised individuals. The aim of the present study was to determinate the prevalence of Cryptosporidium infection in livestock and humans that were in contact with livestock in Hamadan district, Iran. In this cross sectional study a total of 660 fecal specimens were collected; 228, 195 and 237 from humans, whom raising livestock, their calves and lambs/goats, respectively in spring 2012. Samples were concentrated by formalin-ether concentration technique and examined using cold modified Ziehl-Neelsen staining method. Two (0.87%) out of 228, 25 (12.8%) out of 195 and 6 (2.5%) out of 237 fecal samples of humans, calves and lambs/goats were positive for Cryptosporidium oocysts, respectively. There was no significant relationship between the infection to Cryptosporidium and demographic variables of humans. However, Cryptosporidium infection rate was higher in diarrheic calves (OR=3.81; 95% CI: 1.30, 11.21; P=0.010). Despite studies conducted in some regions of Iran that resulted in a relatively high rate of infection in humans in contact with livestock, our results showed low prevalence and low carrier status in the asymptomatic persons in Hamadan region. Because the infection in calves and lambs/goats was relatively high, these animals could be probable reservoir of infection for humans in this area.

Physical activity regularly is one of the important aspects of healthy lifestyle, which has an essential role in reducing the burden of disease and death. Diabetes is a typical general health problem. The aim of this study to determine the effect of education based on social cognitive theory on promoting physical activity among women with diabetes II in Iran. In this randomized control study, 82 diabetic females were randomly selected then were assigned into two groups: intervention (n=41) and control (n=41). Educational intervention was planned then performed during 7 sessions of 60-min in accordance with social-cognitive theory (SCT). The participants were asked to fill in the questionnaires in educational evaluation before and immediately after intervention and the follow up (10 weeks later). The data were analyzed through Repeated Measures ANOVA, Friedman, independence t and Mann-Whitney tests. The mean age among the participants was 48.37±5.67 yr also the body mass index was 28.69±3.95. In the intervention group, light physical activity and sedentary behavior reduced from 56.1% (23 individuals) to 14.6% (6 individuals) in the following up stage. There was significant improvement across time in the mean of minute''s physical activity (P=0.042). There were significant differences in the mean''s constructs of the Social-cognitive theory (SCT) (P<0.05). Design and execution of training program based on social cognitive theory can lead to promote physical activity among women with diabetes II through changes in the theoretical constructs.

Age-related macular degeneration (AMD) is one of the leading causes of visual loss among people aged 65 yr and older. The pathophysiology of AMD is poorly understood. The purpose of this study was to evaluate the relationship between serum lipid concentrations and age-related macular degeneration. In this case-control study, total cholesterol (TCH), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride (TG) of 32 patients with AMD were compared with 32 subjects without AMD that were matched for age. Data were analyzed using Independent t and Chi-Square Tests. TCH, LDL, and TG serum concentrations were significantly higher in AMD patients compared with control group (P<0.001, P<0.001 and P<0.017 respectively). There was no difference in HDL concentration between two groups (P=0.781). High level of total cholesterol, TG and LDL were associated with increased risk of AMD. Results of this study suggest further research to better understand the underlying biological mechanisms of AMD related to serum cholesterol.