Journal of School of Public Health and Institute of Public Health Research

Prevalence of neonatal hearing impairment in province capitals

H Eftekhar Ardebili

Background and Aim: Hearing impairment is one of the most common congenital defects. Unfortunately there have been no studies so far on the prevalence of various degrees of neonatal hearing, loss in Iran. As accurate determination of prevalence is crucial in estimating disease burden and planning subsequent interventions, we carried out this study to determine the prevalence of neonatal hearing impairment.

Materials and Methods: In this study, we assessed the prevalence of hearing loss among the newborns in province capitals and also looked at the role of some putative risk suggested by the Joint committee on Infant Hearing (JCIH). In this research, 76500 newborns who had undergone audiologist-administered screening tests were assessed by a special questionnaire designed specifically for this study.

Results: After trapshooting the overall prevalence of hearing loss was estimated and then cases were classified as moderate (40 - 65 db HL), severe (65 - 90 db HL), or profound (>90 db HL) hearing loss. Among the newborns examined, a total of 362 were diagnosed with hearing loss and hence the overall prevalence was estimated at 4.7 per thousand 168 cases had moderate (2.2 × 10 -3), 114 cases had severe (1.5 × 10 -3) and 80 cases had profound (1.1 × 10 -3) hearing loss.The prevalence rate ranges from 2-3 × 10 -3 (in Hamedan and Mazandaran) to 7-8 × 10 -3 (in Yazd and Chaharmahal-Bakhtiari). In newborns with a family history of sensory-neural hearing loss the prevalence was 16 × 10 -3, compared to 18 × 10 -3 in those requiring blood transfusions, 15 × 10 -3 in newborns with a history of admission to neonatal intensive care units, 17 × 10 -3 in those with craniofacial anomalies, and 19 × 10 -3 in newborns with birth weights below 1500 grams. The sample included 39376 boys and 37124 girls 193 boys (5 × 10 -3) and 169 girls (4.6 × 10 -3) were affected. The stratified prevalence in males (193) was 477 × 10 -3 for intermediate, 311 × 10 -3 for severe and 202 × 10 -3 for profound deafness. The rates in the female population were 437 × 10 -3 for intermediate, 320 × 10 -3 for severe and 273 × 10 -3 for profound hearing loss.

Conclusion: The results confirm the need for extensive neonatal screening programs, and the significant difference in prevalence between high-risk groups and the normal population provides justification for continuous audiologic screening in this group of newborns.

Participation in Tehran University of Medical Sciences

SH Nedjat

Background and Aim: In the past few years publications in the field of medicine have increased considerably in Iran and knowledge production in this country shows the greatest growth rate in the entire Middle East region. Considering the fact that 12% of all faculty members in the health and medical sector in Iran are employed by Tehran University of Medical Sciences, this university is regarded as the country's leading research institution. This study is focused on the behavior of the researchers in this university in terms of collaboration in research and factors that affect such behavior.

Materials and Methods: Our samples included all research projects in Tehran University of Medical Sciences that had obtained grants from inside and outside the university in 2004, had registered their contracts, had been finished by the time of this study (October 2006- March 2007) and whose final reports had been submitted (315 projects). The data collecting forms were filled for 301 files. The researcher's questionnaire was sent to the principal investigators of the projects and eventually 208 questionnaires were collected. We used the SPSS software package and the usual statistical tests (frequency ratio, chi square, analysis of variance and multiple linear regression with the Enter method) to assess the factors affecting the participation scores of individuals. Based on the data gathered from the forms, we used the UNICET software to analyze the 'cooperation network' between project directors and their principal co-workers and the relationship between different sections of the university.

Results: Only in 2.2 percent of the projects whose contracts were arranged in 1383 there has been some cooperation between the project director/principal coworkers and non-academic organizations. This ratio reaches 2.5% for collaboration with other universities. Among all projects, health system research programs show a better status of collaboration. Linear regression analysis showed that another important factor affecting the participation score is the "method for choosing the research topic". University-affiliated research centers only collaborate with the Schools of Medicine and Public Health, while in the School of Rehabilitation and Physical Medicine all projects are defined within the School's own structure, with virtually no collaboration with any other sections of the university.

Conclusion: The present study showed that research programs in this university include little collaboration with organizations outside the university or with other universities. Part of this is related to the current structure of the research sector in the country, which is largely financed by the government with hardly any participation by the private sector. Current potentials within the University make it possible to embark upon joint research initiatives with other academic institutions. As the possible effect of intervention on health system research has been shown, policies can be implemented to promote effective collaborative research at university and national level.

Motives for cigarette smoking in 13- to 15-year-old boys: A qualitative study

S Nedjat

Background and Aim: Cigarette smoking is a global problem, but is decreasing in most developed countries. Reports from the East Mediterranean show that unlike the 5 other WHO regions, cigarette smoking has not decreased in this particular zone. There is a vital need to address the problem, especially in the adolescent population. This qualitative study looks at the motives behind the smoking tendency in boys aged 13-15.

Materials and Methods: The study consisted of 6 focus group discussions performed in Tehran orientation (intermediate) schools participants were male students aged 13 to 15 years. Purposeful sampling was used to draw in participants who were willing and able to take part in the group discussions. Each group was composed of 6-8 students, whose voices were recorded to determine themes and subthemes.

Results: Family and social factors have a more prominent role in creating the smoking tendency compared to individual factors. The most important elements are family history of smoking, having friends who smoke, poor parental control, conflicts at home, divorced parents, failure to consult with parents, easy availability and relative cheapness of cigarettes, and lack of information.

Conclusion: Serious attention must be paid to the social and family factors in the initiation of the smoking habit. Social and political institutions must come up with effective programs to control the social and family factors that have a role in creating the smoking tendency.

The relationship between nutritional factors and breast cancer in women attending Imam Hospital

M Shokoohi

Background and Aim: Breast carcinoma is the most common type of cancer in women. It has been estimated that 8-9 percent of all women will develop breast cancer during their lifespan. According to The Iranian Ministry of Health and Medical Education, the incidence of breast cancer in Iran has risen between 1984 and 1988 and the current mortality rate from this kind of cancer ranks fifth in the country.

Materials and Methods: In this case-control study, 110 patients with breast cancer (ages 20-60 yrs) were compared with a similar number of age- and sex-matched women hospitalized for other reasons. Cases were women with histologically confirmed in situ or invasive breast cancer diagnosed no more than 1 year before the interview and with no previous diagnosis of cancer at other sites. Controls were drawn from either patient relatives or from women with no history of cancer admitted to Imam Hospital for acute, non-neoplastic, non-gynecologic conditions unrelated to hormonal or digestive tract disease or to long-term diet modifications. We calculated odds ratios and performed Mantel-Haenzel as well as logistic regression tests to control for potential confounding factors.

Results: Odds ratios [with 95% confidence intervals] for total fat, saturated fatty acids, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA) and cholesterol were 1.97 [1.062-3.67], 1.19 [0.64-2.14], 2.2 [1.17-4.13], 4.11 [2.2-7.65] and 0.45 [0.25-0.83], respectively. After adjusting for energy, macronutrients, weight, age at first full-term pregnancy and the socioeconomic status, it emerged that the intake of PUFA (OR=6.38 and 95%CI: 1.95-20.83) had a positive association with breast cancer while cholesterol (OR=0.22 and 95%CI: 0.09-0.55) showed a negative relationship, though the latter finding only applies to menopaused women.

Conclusion: Undoubtedly, dietary factors involved in the etiology of breast cancer take many years to cause any pathologic changes in any organ. Nonetheless, one-year frequency of lipid intake is a good measure of individual's dietary habit throughout his/her adult life. Based on this, the present study suggests that increased PUFA intake- probably due to its high pro-oxidant potential- can be considered as a key factor in the rising incidence of breast cancer in Iran.

Mental Health Survey on Shift Work Nurses in Shiraz Province, Iran

H Kakooei

Background and Aim: There are no occupational health data concerning the prevalence of mental disorders in Iranian hospital nurses. Such information may be a prerequisite for efficient occupational mental health interventions. The aim of this study was to determine mental health status among shift work hospital nurses.

Materials and Methods: This paper reports the findings of a cross-sectional survey that was part of a larger quasi-experimental study. We selected and evaluated 1195 nurses in 12 general hospitals in Shiraz (capital of Fars Province), using the 28-item version of the General Health Questionnaire (GHQ). We used structured observations in accordance with an occupational health checklist to assess working environment during the work period.

Results: Results indicated that 28.7% of nurses were in poor mental health. Mental disease was more common among females than males (p<0.05). Prevalence rates for anxiety and somatic symptoms were 42.2% and 35.5% respectively. The prevalence of depression was 11.9% and social dysfunction, 79.5%. There was a significant relationship between shift work and anxiety as well as sleep disorders (p< 0.05). Associations were also found between marital status and depression and between gender and social dysfunction (p< 0.001).

Conclusion: Prevalence figures for mental disorders are similar to those from nationwide surveys but it seems that social dysfunction and anxiety disorders are more common in nurses compared to the general population aged 15 and over. More attention must be paid to the health of shift work nurses (especially female staff). This can take the form of shift work health education programs, occupational health counseling, and periodic examinations.

Bacteriology and antibiotic sensitivity patterns of burn wound infections in Emam Reza Burn Care Center, Mashhad

K Ghazvini

Background and Aim: Superinfection of burn wounds is a major cause of mortality and morbidity in hospital burn units. It is crucial for every burn center to determine the pattern of microbial colonization in burn wounds and the antimicrobial sensitivity profiles. This study was carried out on patients admitted to the Burn Unit of Emam Reza University Hospital, Mashhad, with the aim of verifying the pattern of microbial colonization of burn sites and determining the antimicrobial sensitivity of the isolated bacterial species.

Materials and Methods: In this study a total of 344 samples were obtained from 126 burn patients. After isolation and identification of bacteria, we used an agar diffusion method to determine sensitivity against 14 common antibiotics.

Results: Our results showed that 27.7% of the wounds were sterile at the time of the first dressing, but the rate of contamination increased with time so that only 5% of wounds were sterile by the third week Pseudomonas aeroginosa was the most frequently isolated species (31.7%). Most of bacteria were resistant to amoxicillin ciprofloxacin and imipenem emerged as the most effective antibiotics.

Conclusion: The common occurrence of gram-negative bacilli and staphylococci together with the sensitivity patterns show that we are far from eradication of wound infections, so there is an urgent need for improved infection control practices and policies.

Evaluating the Microbial Content of the Drinking Water in Rural Areas of Tehran Province

R Nabizadeh

Background and Aim: The scattered state of the rural populations- in terms of both the distance between villages and the distance between residential units within a single village- has made the task of supply, distribution and monitoring the quality of water a difficult one. In this study we looked at the bacteriological quality as well as access to safe potable water in selected villages of Tehran Province. This research started in February 2006 and ended in July the same year.

Materials and Methods: In this cross-sectional field study, sampling points were specified on the basis of the populations of the villages served by the Tehran Rural Water and Wastewater Company. After systematic sampling, the specimens were transferred to the laboratory for testing. Data were analyzed using the SPSS and Microsoft Excel software packages.

Results: Drinking water contamination with E. coli was observed in 5.99% of the villages. The degree of contamination was highest in the districts of Pakdasht, Savojblagh and Damavand, with rates of 33.34, 13.69 and 13.32 percent respectively. For 99.36% of the Tehran rural population the turbidity was lower than the standard value of 1053 set by the Iranian Institute of Standards and Industrial Research. Values in Savojblagh and Varamin were relatively higher, with rates of 96.51% and 99.30% respectively. Given the standard value of 1053, the residual chlorine levels were unacceptably low for 92.39% of the rural residents, with figures in the districts of Pakdasht, Damavand and Robatkarim reaching 75.67, 85.45 and 83.98 percent respectively.

Conclusion: Based on WHO guidelines concerning the microbial quality of water published in 2006, the average indicator for lack of E.coli in rural water of Tehran was 94.01%, i.e. at an excellent level. Levels were good for Damavand and Savojblagh, low in Pakdasht and excellent in all other districts.

Physical and chemical quality of the drinking water in Ahvaz

J Savari

Background and Aims: In this study we measured the quality, corrosiveness, Ryznar stability index, and heavy metal leakage in the drinking water distribution networks of Ahvaz.

Materials and Methods : A total of 76 sampling sites were selected for this purpose the sites included inlet and outlet points in water treatment plants as well as consumers taps. We collected 456 samples in six stages and over a period of six month, following the procedures outlined in the Standard Method. Data were analyzed using the SPSS 11.5 software package.

Results: The average values obtained from the specimens were as follows: temperature (19 0C), turbidity (1.97NTU), pH (7.31), pHs (7.88), EC (1678µs/cm), TDS (1006mg/l), Alkalinity (129mg/l), Calcium (109mg/l), DO (6.78mg/l), Cl- (293mg/l), SO4-- (264mg/l), Ryznar stability index (8.43). Average heavy metal levels in tap water were as follows: Pb (8.48µg/l), Cd (0.972 µg/l), Zn (3.18 mg/l), Cu (0.168 g/l), Fe (0.257 mg/l), and Mn (0.031mg/l).

Conclusion: The results showed that the water quality has been affected in such a way as to cause corrosiveness, heavy metal leakage and aesthetic problems. We also showed that in comparison with USEPA and Iranian standards, the quality indices of the drinking water in Ahvaz were at an acceptable level, with the notable exception of a few indices such as TDS, EC, and hardness. The Ryznar stability index indicated that the drinking water in Ahvaz has corrosive properties and this could be one of the reasons behind the high rates of heavy metal leakage detected in this area.