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

Vitamin D status of type-2 diabetic patients as compared to healthy subjects

Mahmoud jalali

Background and Aim: Vitamin D deficiency is highly prevalent in Asia, including the Middle East. Vitamin D deficiency has been found to have an inverse relationship with occurrence of type-2 diabetes mellitus (DM). In this study we assessed the vitamin D and calcium status in type-2 diabetic patients and compared it with that of healthy subjects in Tehran, Iran.

Materials and Methods: This cross-sectional study included 180 Tehrani individuals, including 95 DM patients, selected randomly from among the members of Iranian Diabetes Association, and 85 healthy subjects in Tehran, Iran. Age and gender were adjusted between the two groups. Serum levels of 25(OH)-vitamin D, calcium, phosphorous, and Parathormone (PTH), as well as weight, height and body mass index (BMI) were measured.

Results: The mean and SD age and BMI of the diabetic patients were 51.26 ± 11.18 years and 26.22 ± 9.30 kg/m², respectively the corresponding figures for the healthy subjects were 51.55 ± 13.39 and 26.26 ± 4.55. The prevalence of calcium deficiency was close in the 2 groups, it being 55.8% in the diabetic, and 57.0% in the healthy, subjects. The data also showed that while 26.3% of the patients suffered from a poor vitamin D status, only 18.6% of the healthy subjects had this problem.

Conclusion: Vitamin D deficiency is highly prevalent among both type-2 diabetic and healthy subjects and should be considered a public health and nutritional problem in Tehran city, Iran.

Organizational justice and responsiveness in selected private and public hospitals of Isfahan, Iran

Marzieh Javadi

Background and Aim: Responsiveness is of extreme importance in every health system, especially for policy-makers and health managers. Responsiveness relates to how the health system responds to legitimate expectations of the patients regarding non-clinical aspects of health care. Furthermore, justice in an organization requires fair treatment of the patients on the part of the health personnel. In other words, organizational justice relates to how to treat the personnel so that they feel they are treated fairly. The objective of this study was to investigate the responsiveness of hospital as perceived by patients and nurses and the relationship between the responsiveness rate and organizational justice as perceived by nurses in the hospitals.

Materials and Methods: This was a descriptive-analytical study aiming at determining the correlation between responsiveness and organizational justice in 8 elected hospitals (4 private and 4 public) in Isfahan, Iran. The study population was patients and nurses. A total of 320 individuals (160 patients and 160 nurses), selected by stratified random sampling, participated in this study. Two questionnaires, namely the adjusted WHO Responsiveness Questionnaire (for patients and nurses) and the Equity Questionnaire (for nurses), the validity and reliability of both of which had been determined, were used to collect data. The software used for data analysis was SPSS

Results: The overall score (out of 4) of organizational justice was 1.9 0.77, while the mean score of responsiveness as perceived by the nurses and the patients was 2.32 0.54 and 2.48 0.58, respectively. There was no statistically significant difference between the 2 groups with regard to responsiveness, but there was a positive association between responsiveness and organizational justice as perceived by nurses (r = 0.2, p = 0.03).

Conclusion: The variables in the hospitals studied are generally at an intermediate level and there are no statistically significant differences between private and public hospitals. There is no difference in organizational justice between private and public hospitals, but responsiveness is higher in private hospitals as compared to public ones. Thus, the public sector needs to attempt to create more incentives in health professionals in the health sector in order to guarantee higher-quality services and better responsiveness.

Factors influencing self-management behavior in type-2 diabetes patients: A strategy proposed to be adopted when planning theory/model based interventions

Davoud Shojaeezadeh

Background and Aim: Diabetes mellitus is a widespread disease. Diabetes patients should be fully familiar with the different dimensions of this chronic disease and possess the skills required for self-management and self-care. They should realize that each patient is a different case. It is to be noted that promoting self-management behavior is an essential component of case management in type-2 diabetes mellitus. The objective of this study was to assess self-management behavior of type-2 diabetes patients in Isfahan, Iran and determine factors influencing it.

Materials and Methods: This was a 6-month cross-sectional study conducted in 2011. The study population was type-2 diabetes patients consulting an outpatient diabetes center in Isfahan, Iran. The sample included a group of 350 patients selected by the continuous sampling method. The self-management behavior of the patients was assessed using a diabetes self-management instrument (DSMI), containing questions on 5 domains. The responses were rated on a 5-point Likert scale and SPSS software, version 11.5 was used for analyzing the collected data.

Results: The response rate was 88%. The majority of the patients were 50-60 years (55.52 ± 8.42) old and 54.3% of them demonstrated borderline metabolic control according to the World Health Organization criteria. Mean scores of self-integration, self-regulation, interaction with health professionals and other influential persons, self-monitoring blood glucose, and adherence to recommended regime were 33.67±6.36, 29.09±5.9, 27.08±4.81, 11.71±3.91 and 11.46±2.9, respectively. On the whole, the global diabetes self-management behavior seemed to be not quite desirable (the score was at an intermediate level). Further analysis of the data revealed that self-management behaviors (at 3 levels, namely, desirable, intermediate, and undesirable) had significant associations (p<0.001) with demographic (age, gender, marital status, education level) and health-related (duration of diabetes, diabetes-related diseases, diabetes complications, general health, type of treatment, family income, and serum HbA₁C level) variables. Self-management behavior had no association with disease history

Conclusion: Empowerment of patients afflicted with diabetes and, more generally, non-communicable diseases, which are quite prevalent and on the increase, in the area of self-management at the individual and community level will be a vital step towards promotion of health of the population.

Determinants of breastfeeding promotion as perceived by health personnel

Effat Sadat Merghati Khoie

Background and Aim: Demographic, physical, social and psychological factors make breastfeeding and its maintenance complex. Despite extensive breastfeeding promotion programs, no progress has been achieved. As breastfeeding is a phenomenon embedded in culture and folk perceptions, identification of its key determinants is essential when designing policies and implementing programs.

Materials and Methods: In this qualitative study, data were collected from 35 health professionals through a 4-day group interview using a structured questionnaire (open-end questions). The participants were purposefully recruited from among the health professionals attending a 4-day breastfeeding promotion workshop.

Results: The determinants of breastfeeding were categorized into 2 main domains, namely, people's perception of breastfeeding phenomenon and approaches employed in its promotion. The former domain was described by beliefs, demographic characteristics, social variables, and indigenous theories, and the later by practice in the cultural and social context, policies, interactions and practical skills.

Conclusion: From the participants' perspective, misperceptions of people can determine the degree of success or failure of a breastfeeding promotion program. Our findings confirm that people's perceptions are deeply influenced by their demographic characteristics, folk theories and social variables. As regards the breastfeeding promotion domain, the barriers are social-cultural factors rooted in the local beliefs and folk theories. The participants listed the breastfeeding promotion determinants as lactation policies and health providers' performance related to their skill in effective communication with mothers. Our findings also indicate that wrong beliefs, maternal and child diseases, caesarian section, and mothers' employment were believed to be deterrents in promoting breastfeeding in the community and that pediatricians, obstetricians and other health professionals can play key roles in the field. Based on our findings, we can further conclude that the phenomenon of breastfeeding and its maintenance are deep-rooted in social structure and cultural diversity. When designing and implementing breastfeeding promotion programs, local variables and determinants should be taken into consideration.

Shift work and its related health problems in petrochemical industries

Ahmad Soltanzadeh

Background and Aim: Shift work may induce adverse effects such as health problems on human life. The purpose of this study was to investigate shift work-related health problems and their associated risk factors among workers of petrochemical industries.

Materials and Methods: This cross-sectional study was carried out in 21 petrochemical companies affiliated to the National Petrochemical Industries Company, Iran. The study population consisted of 3580 workers (44.2% shift- and 55.8% day-workers). Data were collected on demographic characteristics, shift schedules, and health problems using anonymous questionnaires. Statistical analyses and modeling were performed using SPSS version 11.5.

Results: The mean age of the day-workers with a job tenure of 8.87±7.22 years and of the shift-workers with a job tenure of 8.22±7.02 years was 34.56±8.19 and 33.15±7.73 years, respectively. Analysis of the data showed that prevalence of health problems among shift-workers was higher than that of day-workers. Furthermore, based on multiple linear regression analysis, it was revealed that, in addition to shift-working itself, other variables such as long working-hours, type of employment, age, job tenure, education, and job title also had a role in creating problems.

Conclusion: Although in the shift-working system the main risk factor associated with health problems among the workers is the work itself, there are also other risk factors, such as demographic and occupational variables.

Prevalence of female genital mutilation and factors associated with it among women consulting health centers in Ravansar City, Iran

Fereshteh Majlesi

Background and Aim: Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia for non-medical reasons.The World Health Organization has estimated that 100 to 140 million girls and women worldwide are currently living with the adverse consequences of FGM. Two of the major incentives for FGM are traditions and social pressure, and the practice is mostly carried out by traditional circumcisers. Not only FGM has no health benefits for girls and women, but it has immediate and long-term complications. The objective of this study was to determine the prevalence of female genital mutilation and factors associated with it among women consulting health centers in Ravansar City, Iran

Materials and Methods: A cross-sectional study was conducted on 348 women consulting 5 health centers in Ravansar City, Iran. Data were collected using a structured questionnaire and SPSS.16 was used for data analysis.

Results: The prevalence of FGM was 55.7% and the mean age of the women undergoing FGM was 9.2±14.2 years. The prevalence increased with age. Almost in all cases the operation had been performed by traditional local circumcisers. The data also showed that 96.2% of the mothers and 87.6% of the sisters of the subjects had also been mutilated. There were statistically significant associations between FGM and several independent variables as follows: the mutilated women's age (0.001) and education level (p<0.001) their mothers' education level (p=0.006) and their awareness of, and attitude towards, mutilation (p<0.001).

Conclusion: FGM is prevalent among Ravansar women. Religious leaders and health personnel should attempt to discourage FGM. Promoting public awareness of FGM and its undesirable consequences is essential. Research shows that if a community itself decides to abandon FGM, the practice can be eliminated rapidly.

Effect of genistein isoflavone on glucose lipid profile and paroxonase enzyme activity in diabetic rats

Mohammad Hassan Eftekhari

Background and Aim: It is known that oxidative stress plays an important role in the pathogenesis of diabetes. Consequently, use of antioxidant for treating and preventing complications of this disease is believed to be beneficial. Considering the antioxidant effects of soy isoflavones, this study was initiated to determine the effects of genistein, one of the isoflavones in soybeans, on serum glucose, lipid profile, and paraoxonase activity in diabetic rats.

Materials and Methods: Thirty-six male Sprague Dawley rats were divided randomly into three groups, in 2 of which diabetes was induced by intravenous injection of 60 mg/kg body weight stereptozotocine dissolved in a 0.05 mol/liter citrate buffer the criterion for diabetes was a plasma glucose level above 250 mg/dl. All the 3 groups were fed a standard diet for 3 weeks, genistein (95% purity) being added to the diet of one of the diabetic groups at a level of 600 mg/kg diet. Fasting blood samples from the tail were taken at baseline and at the end of the period for measuring glucose, lipids, and paraxonase activity. The statistical test used for data analysis and inter-group comparisons was ANOVA.

Results: Supplementation with genistein had no statistically significant effects on the serum paraxonase activity or glucose level, but it brought about significant decreases in the serum triglyceride and total, HDL- and LDL-cholesterol levels.

Conclusion: Genistein can potentially have a beneficial effect on diabetes-induced dyslipidemia

Application of multiple imputations in medical and epidemiological research

Kourosh Holakouie Naieni

Data missing, which occurs for different reasons, is an unavoidable problem in epidemiological studies. It is quite widespread and, therefore, it is considered as a challenge in research design and data analysis by many methodologists. Complete case analysis is often used in studies with missing data however, this approach may result in inaccurate estimates and inferences due to bias associated with missing data. It is possible to obtain more accurate results through data repairing methods. Ordinary, simple strategies, such as single imputation methods, have drawbacks and limitations in practice. It has, however, been demonstrated that using modern imputation techniques can, despite their complexity, reduce bias dramatically in many situations, if used appropriately and properly. In this review, application of multiple imputations, as a novel technique for handling missing data in health and epidemiological research, is briefly discussed