Journal of Research in Health Sciences
Volume:15 Issue: 1, Winter 2015

The aim of this study was to describe the coverage for cervical cancer screening among the visitors of a food exhibition in Brussels, Belgium and to describe the factors that affect their participation in the screening programs. The participants aged between 25 and 64 years were recruited during a food exhibition at the Brussels Exhibition Centre from 6 until 21 October 2012. Their participation to the cervical cancer screening was recorded as well as their medical history and health related parameters. After adjustment for age and region, 66% of the 408 participants have had a cervical cancer screening during the past three years. In univariate analysis, no participation in the cervical cancer screening was related to hypertension, high body mass index (BMI), and low self-reported health. There was no adherence to breast cancer screening. Age, systolic blood pressure, abdominal circumference and BMI of the participants who did not adhere to cervical cancer screening were significantly higher as compared to the participants who did adhere. A multivariate analysis confirmed the relationship between not adhering to the screening and older age (OR=0.56; 95% CI: 0.44, 0.73) and having a high body mass index (OR=0.63; 95% CI: 0.47, 0.85). Participation to the screening was related to having a tetanus vaccination (OR=1.67; 95% CI: 1.05, 2.63) and adhering to breast cancer screening (OR=3.9; 95% CI: 2.09, 6.84). Our study revealed an association between not having had a cervical smear in the last three years and not having had a mammography, older age, not having had a tetanus immunisation recently and having a higher BMI.

Obesity and underweight are both a public health concern worldwide. Being overweight, and obesity are primary risk factors for the development of chronic conditions including hypertension. Data on obesity and the underweight as well as their association with hypertension in Thai children, specifically, are scant. This study was aimed to assess the relationship between obesity or underweight status and hypertension in Thai school children. Anthropometric data were collected from 3991 students (mean age of 9.5 yr) in Ongkharak district, central Thailand. The sex as well as the age-specific BMI criteria of the WHO were used to define what is overweight, obesity, underweight and severe underweight status of children. In order to calculate the odds ratio and the association between one''s nutritional status and hypertension logistic regression was used. Obese and overweight children have a higher prevalence of hypertension compared with children with an average weight (49.5% and 26.5% versus 16.2%, respectively). The risks of developing hypertension is also high in obese children (OR 5.15; 95%CI: 4.27, 6.22), overweight children (1.87; 95% CI: 1.50, 2.32) and overweight/obese children (OR 3.30; 95% CI: 2.82, 3.86. Additionally, underweight children were not associated with an increased risk of hypertension (OR 1.04; 95% CI: 0.72, 1.42). Rates of hypertension in overweight and obese children are high in central Thailand and, as a result, this increased body weight is a risk factor for hypertension. Larger, multi-centric studies are required to evaluate the correlation between hypertension and obesity amongst children at the national level.

Population Attributable Fraction (PAF) is one of the most practical measures for estimating the burden of risk factors with some challenges in its calculation. Cardiovascular disease (CVD) is the first cause of death worldwide and the estimation of accurate PAFs for CVD risk factors is of great importance in conducting preventive strategies. Our aim was to estimate the PAFs of CVD risk factors via direct, i.e. based on regression models, and indirect, i.e. using related equations, methods. Participants (3200 males and 4245 females aged ≥30 yr) without history of CVD were selected from the population-based cohort of Tehran Lipid and Glucose Study (TLGS). Hazard ratio (HR) and Odds ratio (OR) of conventional risk factors were calculated for CVD events after ten yr of follow-up. Levin’s and Miettinen’s equations were applied to indirectly estimate the PAFs and average PAF was directly derived from logistic regression model. The sum of PAFs resulted from indirect estimations reached to more than 100% (around 200% and 150% based on Levin’s and Miettinen’s formula respectively). The direct estimation attributed 80% and 86% of burden of CVD events to conventional risk factors in men and women respectively. The rank and pattern of PAFs of risk factors was somehow different among different methods. Estimating priorities of risk factors may differ in different methods for calculating PAF. This study provides evidence on the more expediency of direct method over indirect ways when individual data is available through a population-based cohort.

Hepatitis B (HB) is a major global mortality. Accurately predicting the trend of the disease can provide an appropriate view to make health policy disease prevention. This paper aimed to apply three different to predict monthly incidence rates of HB. This historical cohort study was conducted on the HB incidence data of Hamadan Province, the west of Iran, from 2004 to 2012. Weighted Markov Chain (WMC) method based on Markov chain theory and two time series models including Holt Exponential Smoothing (HES) and SARIMA were applied on the data. The results of different applied methods were compared to correct percentages of predicted incidence rates. The monthly incidence rates were clustered into two clusters as state of Markov chain. The correct predicted percentage of the first and second clusters for WMC, HES and SARIMA methods was (100, 0), (84, 67) and (79, 47) respectively. The overall incidence rate of HBV is estimated to decrease over time. The comparison of results of the three models indicated that in respect to existing seasonality trend and non-stationarity, the HES had the most accurate prediction of the incidence rates.

Association between the vitamin D deficiency and metabolic syndrome (MetS) has previously been noted and reported to be controversial. The aim of this study was to determine the association of serum 25 (OH) D Level and Vitamin D dietary intake with MetS among Iranian population. This analytical study was conducted on 122 patients with MetS based on the ATPIII criteria and 128 subjects without MetS as control from September 2010 to April 2011. Serum levels of calcium, phosphorus and 25(OH) D were compared between the two groups. A food frequency questionnaire (FFQ) was used to calculate dietary intake. Data were analyzed using Chi- square test, t-test, Mann-Whitney U test and logistic regression analysis. Serum concentrations of 25 (OH) D, calcium and phosphorus and calcium intake were significantly lower in subjects with MetS compared to the subjects without MetS. 98.4% of subjects with MetS and 88.3% without MetS had Vit. D deficiency and this difference was statistically significant (P=0.005). In regression analysis, lower concentration of serum 25 (OH) D, calcium and phosphorus and lower calcium and diary intake were predictors of MetS. Serum 25 (OH) D Level, calcium and phosphorus and calcium intake are associated with metabolic syndrome. However, the mechanism of this association requires further studies.

lack of access to health services has been mentioned as one of the main causes of health inequity in health system. The aim of this study was to measure horizontal inequity in access to outpatient services in Shiraz. This household survey was conducted among 1608 participants above 18 years in Shiraz in 2012. Four-stage sampling was used. According to high amount of zero-valued of outpatient services utilization, Zero inflated regression model was established. We computed concentration index (CI) for determining actual (CIM) and indirect standardized utilization (CIIS) of outpatient services in order to compute horizontal inequity index (HII). The results were analyzed using Stata software, version 8. The CIM was not statistically significant (-0.016, 95% CI: -0.097, 0.066). But the CIIS was statistically significant and favored the rich (0.06, 95% CI: 0.010 to 0.001). The horizontal inequity index was -0.076. There was no inequality in actual amount of outpatient utilization, maybe High subsidization to health care by government in public sector, high insurance coverage, low prices of health services in the public sector, quality of services and opportunity cost of high income groups were the reasons for our results.

Substance abuse is one of the most complicated social problems. Understanding socio-demographic characteristics of those who abuse substances could help deal with this problem more efficiently. The main objective of this study was to determine socio-demographic characteristics associated with alcohol drinking, cigarettes smoking and drug abuse among a sample of male medical university students in Iran. This cross-sectional study was conducted in 2014 among 425 male medical college students randomly selected with the proportional to size among different faculties in Isfahan and Kermanshah medical universities in Iran. A self-report written questionnaire was applied to collect data. Data were analyzed by the SPSS-20. Mean age of the respondents was 19.9 yr (ranging from 18 to 22 yr). About 19.4%, 3.9%, and 10.1% of the respondents had history of cigarette smoking, drug use, and alcohol drinking during the past three months, respectively. Logistic regression showed that mother’s educational level, living place, economic status, and parents’ divorce were the most influential predictive factors on substance abuse. Considering the high prevalence of substance abuse (especially smoking and alcohol drinking), it seems essential to design educational interventions to prevent substance abuse, paying attention to predictive factors mentioned above, among college students.

Osteoporosis is one of the most common metabolic bone diseases. The purpose of this study was to investigate the effect of a prevention program based on health belief model on osteoporosis among women. In this quasi-case study, 120 patients (60 cases and 60 control), registered under the health centers in Fasa City, Fars Province, Iran were selected in 2014. A questionnaire consisting of demographic information, Health Belief Model (HBM) constructs was used to measure nutrition and walking performance for prevention of osteoporosis before, immediately after the intervention and six months later. Bone mineral density (BMD) was recorded at the lumbar spine and femur before and six months after intervention. Data were analyzed using SPSS19 via chi-square test, independent t-test, and Repeated Measures ANOVA at significance level of 0.05. Immediately and six months after the intervention, the case group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, internal cues to action, nutrition and walking performance compared to the control group. Six months after the intervention, the value of lumbar spine BMD T-Score in the case group increased to 0.127, while in the control group it reduced to -0.043. The value of the Hip BMD T-Score in the intervention group increased to 0.125 but it decreased to -0.028 in the control group. This study showed the effectiveness of knowledge, walking and diet on bone mass by HBM model. Hence, these models can act as a framework for designing and implementing educational interventions for the osteoporosis prevention.

Most studies evaluated the vaccine coverage, but the time of vaccination is important as coverage. This study was conducted to evaluate the Expanded Program of Immunization (EPI) in outskirt of Iranian cities regarding to incidence of delay vaccination among children less than 4 years. This cross sectional descriptive study was conducted among children 24-47 months old, living in the suburbs of five metropolises of Iran. Totally, 3610 eligible children selected with proportioned cluster sampling method and data of vaccination card extracted after interview with child parents. Delayed incidence rate reported and predictive factors assessed by Chi square test and Multivariate logistic regression. Overall, 56.6% to 93.2% vaccines were administered out of time. Delayed vaccination incidence with more than one-week delay varies from 5.5% to 74.9% for polio at birth and MMR2 at 18 month, respectively. Mother’s educational level and birth order were the most important predictors of delayed vaccination. Incidence of delayed vaccination was enlarged by increasing birth order and decreased in lower educated mothers.Incidence rate of delayed vaccination is more than expectation. Regarding to high coverage vaccines in Iran, heath officers and health policy makers should attempt for on-time vaccination beside of high immunization coverage especially in slum areas with more concentrated immigrants due to low literature and crowded families.

Interleukin (IL)-8 plays important roles in the recruitment and activation of immune cells during visceral leishmaniasis (VL). Genetic variations in IL-8 modulate the expression of IL-8 protein and may be associated with VL. This study aimed to evaluate polymorphisms at the IL-8 −251 position in VL patients. This cross-sectional study was performed on three groups: Leishmania-seropositive patients with clinical symptoms of VL (n = 91), seropositive patients without clinical symptoms (n = 104), and healthy controls (n = 110). Polymorphisms at the IL-8−251 position were analyzed using allele-specific polymerase chain reaction (PCR). Anti-Leishmania antibody titers were assessed by immunofluorescence. IL-8−251 polymorphism was significantly associated with VL (P<0.002). The IL-8−251 T/T genotype was significantly higher in group 1 than in groups 2 and 3 (P<0.002). The validity of the data was analyzed using Hardy-Weinberg equilibrium and one-way analysis of variance (ANOVA), as well as χ2 tests. IL-8−251 polymorphism was significantly associated with impaired immune responses in VL and might be considered a risk factor for disease development.

Few studies have focused on syndromic data to determine levels of alarm thresholds to detection of meningitis outbreaks. The purpose of this study was to determine threshold levels of meningitis outbreak in Hamadan Province, west of Iran. Data on both confirmed and suspected cases of meningitis (fever and neurological symptom) form 21 March 2010 to 20 March 2012 were used in Hamadan Province, Iran. Alarm threshold levels of meningitis outbreak were determined using four different methods including absolute values or standard method, relative increase, statistical cutoff points and upper control limit of exponentially weighted moving average (EWMA) algorithm. Among 723 reported cases, 41 were diagnosed to have meningitis. Standard level of alarm thresholds for meningitis outbreak was determined as incidence of 5/100000 persons. Increasing 1.5 to two times in reported cases of suspected meningitis per week was known as the threshold levels according to relative increase method. An occurrence four cases of suspected meningitis per week that equals to 90th percentile was chosen as alarm thresholds by statistical cut off point method. The corresponding value according to EWMA algorithm was 2.57 i.e. three cases. Policy makers and staff of syndromic surveillance systems are highly recommended to apply the above different methods to determine the levels of alarm threshold.