Iranian Journal of Public Health
Volume:48 Issue: 8, Aug 2019

Obesity is recognized as an important global health problem that increases the risk of all-cause death. It is a major risk factor for various cardiovascular and metabolic diseases. We conducted this review through searching the related literature plus internet links. Recently, many researchers have been applying various efficient alternative exercise paradigms for treating obesity, such as high-intensity interval training, whole-body vibration training, and hypoxic therapy. Compared with moderate-intensity continuous training, high-intensity interval training involves a shorter exer-cise time but higher energy expenditure and excess post-exercise oxygen consumption via a higher exercise in-tensity and is effective for treating obesity. Whole-body vibration training effectively reduces the rate of fat production and accumulation through passive vibration of the whole body and improving the body composi-tion, muscle function, and cardiovascular function of the obese population. Hypoxic therapy has been reported to improve obesity and obesity-related diseases through appetite loss, reduced dietary intake, increased energy consumption, improved glycogen storage and fatty acid oxidation, angiogenesis and left ventricle remodeling, decreased mechanical load, and reduced sarcopenia progression due to aging. The new therapeutic exercise modalities, namely, high-intensity interval training, whole-body vi-bration training, and hypoxic therapy, are practical, useful, and effective for improving obesity and various met-abolic and cardiovascular diseases induced by obesity.

The monotherapies of statin and ezetimibe had not successfully achieved their objectives in the management of lipid levels of dyslipidemia patients. We aimed to compare the effects of combined low-dose simvastatin and ezetimibe versus high-dose statin on the lipid-lowering treatment of dyslipidemia patients. We searched five databases published before May 2018, namely PubMed, EMBASE, Cochrane, Web of Science, and Clinicaltrials.gov. Completely published randomized controlled trials (RCTs) comparing the effect of high-dose statin (S) with ezetimibe/simvastatin (10/10 mg; E/S) on the management of dyslipidemia patients were included. A total of ten RCTs met the inclusion criteria, including 1,624 patients (E/S:691, S:933). Six out-comes underwent pooled analysis, including weighted mean difference (WMD) from baseline in total choles-terol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high sensitivity C-reactive protein (hs-CRP), triglyceride (TG), and non-high-density lipoprotein cholesterol (non-HDL-C). No significant gap was found between high-dose statin and ezetimibe/simvastatin (10/10 mg) in LDL-C (-1.55; 95% confidence interval [CI]:-4.42~1.31, P=0 .29), HDL-C (1.05; 95%CI:-0.21~2.3, P=0 .1), TG (4.03; 95%CI:-4.53~12.58, P=0.36), and hs-CRP (0.14; 95%CI:-0.50~0.78, P=0.67). However, there was significant difference found between the two lipid-lowering treatments in TC (-0.45; 95%CI:-9.07~-0.83, P=0.02) and non-HDL-C (-4.97; 95%CI -8.46~-1.49, P=0.005). Ezetimibe co-administered with simvastatin (10 mg) and high-dose statin monotherapy may show similar effects in reducing LDL-C, TG, and hs-CRP levels and in increasing HDL-C levels. However, the results suggest that there was greater TC and non-HDL-C lowering through high-dose statin monotherapy as compared with ezetimibe/simvastatin co-administration.

Mobile technologies are widely used in healthcare. The purpose of this study was to compare the effectiveness and cost-effectiveness of fixed computed tomography (CT) and magnetic resonance imaging (MRI) with the mobile ones. In this systematic review, PubMed, Cochrane Library, Scopus and CRD database were searched from 1995 to 2015. The data on safety and effectiveness of technologies were extracted from included studies. Be-cause the review showed no significant differences in the performance of mobile CT and MRI compared to the fixed ones, then a cost minimization approach was used to explore the cost-effectiveness of three scenarios. Twenty two articles were included in the review that showed no statistically significant differences in the performance of mobile MRI and CT scan compared to the fixed ones. The cost minimization approach showed that the third scenario based on purchasing a common mobile MRI and CT scan; and using it by two or more hospitals that are in rational distance from each other is associated with the lowest costs, so it is the most cost-effectiveness strategy. The performance of Mobile CT and mobile MRI is comparable to the fixed ones; and using a combined mobile CT and MRI by two or three hospitals is the most cost-effective approach.

Despite our awareness of the significant effect of Social Determinant of Health (SDoH) such as Socio Economic Status (SES), income and education on breast cancer survival, there was a serious lack of in-formation about the effect of different level of these factors on breast cancer survival. So far, no meta-analysis has been conducted with this aim, but this gap was addressed by this meta-analysis. Main electronic databases such as PubMed, Web of Science, and Scopus were investigated up to Jan-uary 2019. Epidemiological studies focusing on the association between SDoH and breast cancer were singled out. Q-test and I2 statistic were used to study the heterogeneity across studies. Begg's and Egger's tests were applied to explore the likelihood of the publication bias. The results were reported as hazard ratio (HR) with 95% confidence intervals (CI) through a random-effects model. We identified 7,653 references and included 25 studies involving 1,497,881 participants. The HR esti-mate of breast cancer survival was 0.82 (0.67, 0.98) among high level of SES, 0.82 (0.70, 0.94) among high level of income and 0.72 (0.66, 0.78) among academic level of education. The SES, income, and education were associated with breast cancer survival, although the associa-tion was not very strong. However, there was a significant association between the levels of these factors and breast cancer survival.

The aim of the present study was to assess the level of satisfaction of dentists working in primary healthcare (PHC) with a Distance learning (DL) course in pediatric dentistry offered by the TeleHealthRS cen-ter, and to the investigate possible associations between the variables indicative of their satisfaction and their performance on the questionnaires applied before and after the course. The course was offered in 2015 by the Federal University of Rio Grande do Sul (UFRGS) together with the TeleHealthRS center in Brazil. Data were collected on the participants’ personal and professional pro-file, their pre- and post-course knowledge about pediatric dentistry, and their satisfaction with the course. Stu-dent's t-test and the ANOVA test were used to assess the possible associations between the variables indicative of their satisfaction and their performance on the questionnaires applied before and after the course. Overall, the participants were satisfied with the course, however, no statistically significant association was found between the variables indicative of their satisfaction and the grades they earned on the pre- and post-course questionnaires. The available pediatric dentistry course received positive evaluations from the participants, consti-tuting a possible strategy for the qualification of primary care dentists. Future studies are warranted to further investigate the expectations of DL course participants, aiming to enhance the quality of future editions of this learning modality for pediatric dentistry contents.

We aimed to investigate the efficacy of paclitaxel combined with kanglaite injection in the treat-ment of bone metastases of lung cancer in mice. Human lung cancer cell line A549 was inoculated into 100 C57BL/6 mice to establish bone metasta-sis model of lung cancer. Eighty successful modeling mice were randomly divided into four groups: Kanglaite (group A), Paclitaxel (group B), Paclitaxel combined with kanglaite (group C) and 0.9% sodium chloride solu-tion (control group), 20 in each group. The mice started taking drugs on the 5th day after inoculation. The treatment lasted for 21 days, and the changes of body weight were observed. Evaluation of the efficacy of drug therapy was performed by comparing the pain behavior of the treated mice with that of the control mice. The physical improvement rates in group A and group B were lower than that in group C (P<0.05). The bone metastasis area and tumor weight in group A, group B and group C were significantly lower than those in control group after 21 days of treatment (P<0.05). The tumor area and tumor weight in group C were significantly lower than those in group A and group B (P<0.05). Paclitaxel combined with kanglaite is more effective than paclitaxel or kanglaite alone in improving bone metastasis of lung cancer and has an important significance in clinical treatment of bone metastasis of lung cancer.

Supply, processing, and distribution (SPD) model is sparingly used in hospitals in China. We evaluated its effects on the management efficiency, quality control, and operating costs of medical consumables (MCs) in the clinical nursing surroundings in a single Chinese hospital-Anhui Provincial Hospital from 2014 to 2015. Amount-based packages (ABP) and procedure-based packages (PBP) models were created. They were introduced the use of quick response (QR) code scanning for using in clinical nursing departments (CNDs). Questionnaires were prepared by referring to previous literature and using Delphi method repeatedly, further discussed and formalized. Partial results of the formal questionnaire were analyzed using SPSS. Frequency of MCs claims reduced without any requirements of MCs in 70% of CNDs. Average time spent on the inventory per week decreased and the time required to procure MCs reduced. Moreover, the aver-age satisfaction score with MCs management increased, reaching 100%. Average space occupied by MCs de-creased significantly, reducing by 1.2444m3. Overall, 100% of the respondents concluded that the management of MCs improved effectively and the inventory turnover rate had accelerated. The cost of MCs decreased by 15% with more than 10% increase in in-hospital amount, and the average daily cost of MCs also showed de-crease. SPD can improve the efficiency of MCs management in CNDs, reducing medical risks and dis-putes, saving hospital operating costs, and decreasing capital occupation.

To investigate the treatment efficacy of radioactive iodine therapy on patients after total thy-roidectomy and its effect on the quality of life. A retrospective analysis of clinical data of 120 thyroid cancer patients admitted to Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China from February 2014 to February 2017 was performed. According to different treatment methods, they were divided into observation group of 62 cases and control group of 58 cases. Both groups were treated with total thyroidectomy. The control group was treated with anti-infection and prevention of complications after operation, the observation group with radioactive iodine therapy. Treatment efficacy, quality of life score, recurrent laryngeal nerve injury and post-operative survival rate were compared between the two groups. The total effective rate of treatment in the test group was 98.39%, significantly higher than 72.41% in the control group, with a statistically significant difference (P<0.05). Compared with the control group, the fatigue score of the test group was lower, but the score in the area of emotion function and the overall health status score were higher, with a statistically significant difference (P<0.05). There was no significant difference in the recurrent laryngeal nerve injury between the two groups of patients. The postoperative survival rate of the test group of patients was 96.77%, significantly higher than 86.21% of the control group. The effect of radioactive iodine therapy after total thyroidectomy is remarkable, which can signif-icantly improve the clinical treatment efficacy and postoperative quality of life of patients, worthy of clinical application.

Suicide/suicide attempt, as a major public health problem, has been included among anti-social behaviors. We aimed to investigate the epidemiology of suicide and some associated individual, family, and so-cial factors. A historical cohort study was conducted among all cases (748 persons) reports related to sui-cide/suicide attempt that register in hospital reporting system and health care center in Gonabad and Bajestan, Iran, from 2009 to 2014. The required data were extracted through a checklist. Descriptive (mean and standard deviation) and analytic statistics (t-test, Chi-square, and logistic regression) applied to analyzed data. All data were analyzed using SPSS software. Of the 748 reported suicide attempters, 17 cases (2.3%) had completed suicide. The annual average incidence rate of suicide was 110.03 per 100,000 populations. The mean age of suicide attempt had significantly decreased during the time (P=0.007). Furthermore, a significant association was observed between outcome of suicide and place of residence (P=0.019), history of physical illnesses (P=0.002), and method of suicide (P=0.001). Due to trend of age among suicide attempters, considering intervention programs of suicide pre-vention for school pupils and university students especially individuals residing in rural areas, as well as individ-uals suffering from physical illness would be effective to reduce the rate of suicide.

We aimed to investigate the reliability and validity of the Iranian version of the short form social well-being scale. After linguistic validation, the Iranian version of social well-being scale was completed by 715 partici-pants, aged ≥18 yr between Jan and Sep 2015. Concurrent validity was examined by calculating the Pearson’s correlation coefficient between the dimensions of social well-being and social support. Internal consistency, Cronbach’s alpha coefficient, confirmatory and explanatory factor analyses were also examined. The internal consistency as measured by Cronbach’s alpha coefficients was 0.72 for total score. No ceiling and floor effect was found in total score or any of the subscales. The concurrent correlation coefficients between social well-being and social support ranged from good to excellent agreement. Exploratory factor analy-sis supported mainly comparable results with the original US English dialect version. The results of the confirm-atory factor analysis for 5-factor models indicated acceptable fit for the proposed research models. The findings support the initial reliability and validity of the Iranian version of the social well-being scale in the research and community settings in Iran.

Despite constant decrease in rate of neonatal mortality, the rate is still higher than that of other under-five children. One of the first steps towards reduction of neonatal mortality is to identify its determi-nants using health production function. The aim of the present study was to estimate neonatal health produc-tion function for Iran. In this cross-sectional study, Iranian Multiple Indicator Demographic and Health Survey (Ir-MIDHS) 2010 was used. Four categories of socioeconomic, mother, neonatal demographic and healthcare sys-tem factors were entered into the Binomial Logistic Regression model to estimate neonate health production function. Households’ economic status was constructed using principal component analysis. History of abortion/stillbirth had the highest significant positive impact on odds of neonatal mortali-ty (odds ratio=1.98; 95 % CI=1.55-2.75), indicating that neonates of mothers with such a history had 1.98 times higher chance of death compared to other neonates. Moreover, odds ratio of neonatal death for the poorest quintiles was 1.70 (95 % CI=1.08-2.74), indicating that by moving from the poorest quintile to the richest one, the odds of being alive for neonates increased up to 70%. However, skilled birth attendant de-creased the chance of death up to 58% (odds ratio=0.58; 95 % CI=0.36-0.93). Considering the most significant inputs of neonatal health production function in Iran, im-provement of economic status of households, provision of appropriate care services for mothers, and im-provement of delivery care provided by trained personnel, could be priorities for health policymakers to act and reduce neonatal mortality in Iran.

Zinc, an essential trace element, plays a key role in many biological human body functions. Se-rum zinc concentration is the most widely used indicator of zinc status for general populations. Considering the limited data available on seasonal fluctuation of serum zinc concentration, we aimed at determining seasonal variations in serum zinc concentrations of Tehranian adults. The current study was conducted within the framework of the Tehran Lipid and Glucose Study, on 4698 subjects, aged ≥20 years. Serum zinc samples of subjects were obtained from all four seasons over three years (from 2009 to 2011); samples of similar seasons over three years were placed in one group and the geo-metric means of serum zinc concentration of four seasons were compared to determine possible seasonal varia-tions. Participants with mean age 46.3 yr and geometric mean of serum zinc concentration 116.3 μg/dl, were studied for almost three years through four seasons. Serum zinc concentrations in spring and summer were significantly higher than those in autumn and winter (112.2 and 114.4 vs. 106.7 and 104.8 μg/dl; P<0.001, re-spectively). Moreover, monthly serum zinc concentration of all subjects differed, with the lowest and highest levels found in October and August (98.5 vs. 122.7; P<0.001). This study demonstrates the difference in serum zinc concentration in Iranian adults of both gen-ders in different months and seasons during the year.

An essential requirement exists for a single exhaustive source of anthropometric databank in Iran. Available information about Iranian bodily dimensions is not applicable to the general population due to the sample of people investigated. This study aimed to present the first Iranian anthropometric databank by estima-tion. After a systematic review, 24 relevant sources of information were found and included. No time limit was considered. The method of Rapid Anthropometrics Scaled for Height was used. Overall, 36 bodily dimensions were estimated, for which the seven percentiles of 1st, 5th, 25th, 50th, 75th, 95th, and 99th were calculated, stratified by sex. The resulting tables can be claimed as the most representative anthropometric databank for Iranian general 20-64 yr population now. Data are suitable for practical purpose and are applicable in both occupational and community setting.

Research in source of inequality and enhance of knowledge can be reducing the inequalities in the coming decades. Therefore, we aimed to ascertain effects of income inequality measured by Gini-coefficient to death from suicide in Iran. This is an ecological study on the relation of Gini-coefficient and suicide death in Iran. Data were obtained from Iranian Urban and Rural Household Income for Gini-coefficient and Expenditure Survey and Iranian Forensic Medicine Organization for suicide. Concentration Index was used to determine of inequality by Gini-coefficient in suicide death and prediction model was applied by Stata software. Significant level considered less than 5%. A Gini-coefficient between 0.2523 and 0.3755 (mean, 0.3092) was observed. The overall concentration index CI was -0.10 (95% CI= -0.19 to -0.01), therefore our results confirmed a positive inequality in incidence suicide rate result from income inequality in Iran. Our results showed a positive inequality due to Gini-coefficients in suicide death. This study could be a start for investigation of inequality source in geographical units and at the individual level in all provinces

Parasitoses are among the most important problems of most countries especially developing countries. We aimed to detect the situation of intestinal parasitic infections in the Farashband district in Fars Province South of Iran and identify influential factors in the escalation of parasitic diseases and to reduce them. Overall, 1009 participants from the age of 6 months to 90 years were selected from 3 cities and 15 villages of Farashband district, Fars Province South of Iran from 2015 to 2016. Parasitological methods such as the direct assay method, formalin-ether concentration method, and zinc sulfate flotation were used for diagnosis of worm eggs, cysts, and protozoa trophozoite. Susceptible and protozoan positive samples were stained using the Trichrome stain-ing method. The modified acid-fast staining procedure was conducted for diarrheal samples and the results were used for diagnosis of coccidia. Overall, 313 subjects were infected with at least one intestinal parasite (pathogenic and nonpathogenic). Helminthes infection and protozoan infection were observed in 9 (0.9%) and 304 (30.13%) participants, respectively. Fecal samples of 34 patients with diarrheal feces were used to prepare smears for further examinations using the Ziehl-Neelsen staining method. Examinations showed no infection with coccidia. Helminthes infection has decreased drastically but protozoan infection is still considered a health issue in this region. It is possible to reduce parasitic infections through proper measures such as increasing public aware-ness and education the public, especially children on health problems with education courses.

We report a case to provide an improved air quality index (AQI) based upon association between individual health risk and Particulate matter (PM2.5) exposure. A Poisson sampling distribution model was used to quantify the health risk, in which the coefficient of exposure-response was derived from a simple Meta-analysis. The result shows that the old people are the most vulnerable population while exposing to PM2.5, for which they are advised to reduce intensity of their physical activities. It is expected that this study is insightful to create a nexus between air quality information and public communication, which help publics take appropriate actions on health protection.

We report a human case of Hymenolepis diminuta infection in Guilan Province, northern part of Iran in 2017. The patient was a 15-month-old boy with gastrointestinal symptoms. In stool examination, eggs of H. diminuta was found based on morphological characteristic. The infant was successfully treated with a single oral dose of praziquantel, and then completely recovered. For the first time, we report human infection with this species in north of Iran.