Journal of School of Public Health and

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Background and Aim: In this study, we compared a latex agglutination test (KatexR) with the direct agglutination test (DAT) for the diagnosis of human visceral leishmaniasis (HVL) in an area with a high prevalence of zoonotic visceral leishmaniasis (ZVL) in Iran.
Materials and Methods: The validity of the KatexR (Kalon Biological Ltd, England) for detection of urinary Leishmania antigens in HVL was compared with standard direct agglutination test on 92 visceral leishmaniasis patients (29 were acute and 65 were chronic phase) and 90 healthy controls over a period of one year.
Results: We detected a sensitivity of 82.7% and a specificity of 98.9% in the acute phase. As for the chronic phase, the test showed a sensitivity of 6.15% and a specificity of 98.9% at a 1:3200 cut-off titer. Concordance between KatexR and DAT was 94 .9% in the acute phase and 59. 3% in the chronic phase. As the rapid, noninvasive Katex does not require much expertise or elaborate equipment.
Conclusion: It can be used for screening and diagnosis of human visceral leishmaniasis in remote endemic foci.

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Background and Aim: As the population of the world increases, it is essential that food production keep pace. It will be necessary not only to produce more food, but also to maintain this food so that it is safe and wholesome for human consumption. The purpose of this study was to investigate the rate of Coliform, Staphylococcus aureus, Mould, Yeast and other aerobic and mesophilic bacteria as contaminats of milk and milk products in Yazd province.
Material and Methods: In this study a total of 198 different samples including Milk (24.2%), Yoghurt (21.2%), Cream (12.1%), Cheese (18.2%), Ice cream (12.1%) and dairy powders (12.1%) were investigated by culture method and biochemical tests. Then obtained data were analyzed by SPSS and χ2 programs.
Results: On the basis of our findings, of the total samples, 136 cases (68.7%) were desirable, 48 cases (24.2%) acceptable and 14 cases (7.1%) undesrable. Microbial contaminants of undesrable samples were coliform (7.1%), Staphylococcus aureus (6.1%) and yeast (6.1%). Meanwhile, the results of χ2 Statistical analysis test, showed significant different between contamination rate and kind of Milk products (df = 5, χ2 = 17.75, P<0.005(.
Conclustion: It seems that despite the efforts, which have been done for prevention of food contamination in Yazd province, it is still considered as a threat for people Health.

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Background and Aim: Patients who consult hospital due to physical or mental damages have legal rights. Observation of patients' rights will result in patient satisfaction, which will help to improve hospital services. The aim of this study was to determine awareness and observation of patient's right in hospitals affiliated with medical universities in Tehran.

Materials and Methods: This was a cross-sectional study conducted in 2009 in hospitals affiliated with medical universities in Tehran. A total of 601 patients were randomly selected from 11 hospitals affiliated with three medical universities in Tehran. Data were collected using a 50-item questionnaire the validity and reliability of which had been confirmed. Chi-square and Kruskal-Wallis tests were used for statistical analysis. The software used was SPSS.17.

Results: The mean age of the patients (59% females and 41% males) was 43.3 (SD=18.5) years and the average length of hospitalization 7.1 (SD=7.4) days. Data analysis showed that the proportions of the patients with a poor, intermediate and desirable patients' rights awareness were 71.5%, 22.0% and 5.8%, respectively. Observation of patients' rights was good in 13.8% of the cases, medium in 82.9% of the cases and poor in 3.3% of the cases. There was a significant statistical relationship between observation of patients' rights on the one hand and the hospital ward and length of stay on the other hand (p=0/007). Further analysis of the data showed that the strongest and the weakest observed rights were patient awareness right and the right of making objections and lodging complaints, respectively.
Conclusion: The results of this study showed that patients are not well aware of patients' rights and that observation of patient's rights is not at a desirable level. We recommend organizing public educational programs including components on patients' rights and follow-up of patient' rights violations, as well as passing a comprehensive act to ensure observation of patients' rights and specific programs designed for monitoring and supervising it.

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Background and Aim: Multiple sclerosis (MS) is considered as a common inflammatory disease of the human central nervous system (CNS). 4 amino pyridine (4-AP), a potassium channel blocker, is used widely in MS treatment to reduce fatigue and cachexia often experienced by the patients. The objective of this study was to get a better understanding of the mechanism of action of this drug, using the cell culture model. More specifically, we attempted to determine the effects of the drug on 1. The profileration of, and its cytotoxicity on, the neurons, and 2. The activity of MMP-9 in the neurons.

Materials and Methods: Considering the available reports on the wide range of 4-AP effects, we designed this study to investigate its possible role in proliferation or cytotoxicity of the MS cellular model, i.e. astrocytoma U373-MG, using the MTT assay technique. We also analyzed the effect of 4-AP on cell functionality as assessed by matrix metalloproteinase-9 (MMP-9) zymography.

Results: The results showed that while 4-AP at a concentration of 0.1 and 1 mM has no significant cytotoxic effects on the treated cells, it has remarkable MMP-9 inhibitory effects (p<0.01). The proliferation analyses confirmed the stability of 4-AP effects on cell functionality.

Conclusion: On the whole, the results of the present study show the desirable effect of 4-AP on MMP-9 activity at non-cytotoxic doses, promising its further therapeutic applications.

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Background and Aim: Length of stay (LOS) in a hospital is one of the best hospital indicators that can be used for various purposes. In this survey, we studied the hospital LOS and its associated factors in Tehran University of Medical Sciences Women's Hospital (a teaching hospital) in Tehran using the Cox proportional hazards semi parametric model and compared the results with the results obtained using the multiple linear regression.

Materials and Methods: This was a descriptive-analytical study in which we reviewed 3421 files of inpatients hospitalized in, and those discharged from, the oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatient interviews. A P<0.05 was considered statistically significant.

Results: The median of patients' LOS in the hospital was 50.8 hours, that in the obstetrics, surgical and oncology units being 48.5, 54.4 and 94.2 hours, respectively. Of all the patients, 2632 (76.9%) had been discharged with a recovery status and the rest (23.1%) with a no-recovery status. Results of the Cox proportional hazards model showed that the following variables had increased LOS: a distance longer than 200 km between a patent's residence and the hospital, hospitalization in the surgery and oncology units, admission on a Thursday, admission by an internist, hospitalization for neoplastic, endocrine, nutritional, or genitourinary system diseases (P<0.005), as well as a high number of diagnostic laboratory tests, radiographies or sonographies (P<0.001). Patients admitted and hospitalized as an emergency case had a shorter LOS (P<0.001) than others. On the other hand, based on the multiple linear regression model results, some occupations (being a worker, a farmer, a stockbreeder, or a retired spouse) admission on a Thursday, (The first day of the weekend in Iran), suffering from a neoplastic disease, and a high number of diagnostic tests or radiographies or sonographies increased, and admission by a resident decreased, patients' LOS (P<0.05).

Conclusion: Considering having censored data, the Cox proportional hazards model is a more suitable model than the multiple linear regression models for identifying factors influencing patients' LOS in a hospital. From among the LOS Cox model's associated factors as identified in this study, policy-makers and managers can only change admission days and the number of diagnostic tests. That is to say, they should try to prevent admission on a Thursday (unless emergency cases) and also perform the required primary diagnostic tests before admitting a patient into the hospital, which would lead to a more effective utilization of hospital beds and other resources.

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Background and Aim: Specific and unique characteristics of nanoparticles may entail specific and unique hazards. In addition, they may also exhibit toxicity under certain conditions. This study was conducted to investigate the toxicity of phenol-exposed and phenol-unexposed nano-TiO2 and nano-Fe/TiO2 particles.
Materials and Methods: Stock solutions of the afore-mentioned nanoparticles were prepared at different concentrations and a sample of each was exposed to phenol. This was followed by exposing Daphnia Magna to the phenol- and non-phenol-exposed nanoparticles. LC50, NOEC and the concentrations at which mortality rates were 100% were determined 12 to 96 hours after exposure, while for the determination of the mortality rate of Daphnia the Probit model in SPSS version16 software was used.
Results: The results revealed that (1). The 48-hr LC50 values for phenol-unexposed nano-TiO2 and nano-Fe/TiO2 particles were 2705 and over 15000 mg/m3, respectively. The corresponding values for the phenol-exposed samples were 414 and 1253. (2). The 48-hr NOEC values for the phenol-exposed TiO2 and FeTiO2 were 41 and 789, respectively, the corresponding values for unexposed samples being 1253 and over 15000 mg/m3. (3). In addition, the 48-hr 100% mortality rates for phenol-unexposed nano-TiO2 and nano-Fe/TiO2 particles were, respectively, 1253 and over 15000 mg/m3, while for the phenol-exposed samples the corresponding rates were 1090 and over 2108.
Conclusion: With regard to 48-hr LC50, the findings show that the toxicity of both nano-Fe: TiO2 and TiO2 increases as a result of exposure to phenol, the increase being 12-fold for the former and 6.5-fold for the latter. In general, however, based on LC50, it can be said that the toxicity of Fe:TiO2 nanoparticles, which has better catalytic characteristics, is lower in comparison to TiO2 nanoparticles. Thus, using Fe:TiO2 in preference to pure TiO2 should be investigated further, as it will be less hazardous to the environment.

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Background and Aim: Visceral leishmaniasis is a systemic parasitic disease with a high fatality rate in under-5-year-old children. The disease is endemic in some parts of Iran, particularly in the north-west region. In 2001 a visceral leishmaniasis (VL) surveillance system was established for children aged ≤ 12 years in the primary health system in Meshkin-Shahr District, Ardebil Province, situated in the north-west of Islamic Republic of Iran.

Materials and Methods: All cases with clinical signs and symptoms of VL and confirmed positive by the direct agglutination test (DAT) were referred for physical examination and treatment.

Results: The mean annual incidence of VL decreased significantly from 1.88 per 1000 children before (1985-2000), to 0.77 per 1000 child population after (2001-07), the intervention. In the control area with no surveillance, it increased from 0.11 to 0.23 per 1000.

Conclusion: Early detection of VL using serological tests and timely treatment of cases can decrease the mortality and morbidity rates of VL in endemic areas.

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  Background and Aim: Women perceive menopause differently. Beside biological changes, women experience menopause based on the cultural scenarios. The qualitative research presented here is about how Iranian women perceive menopause within cultural scenarios.

  Materials and Methods : Data was collected during 4 focus group sessions and 6 individual in-depth interviews of women aged 40 years and older. Informants were selected from the Tehran University of Medical Sciences. The sessions were facilitated by using a semi-structured inventory focus group. Content analysis was adopted using combined free and analytical coding to reduce data, to extract meanings, to categorize domains and to obtain themes .

  Results: We categorized our findings into four main domains: gender role, the changes in socialization, social interactions and supporting resources. Descriptions of the later domain are going to be reported in subsequent manuscript.

  Conclusion: The women's understandings of menopause are shaped based on the specific cultural scenarios. Menopause recognized as a factor which changes women’s life line. Meanings as 'Loosing femininity' and 'changes in women's roles in the community' describe women's gender role, social interactions and changes in the socialization throughout the menopause years. The women’s misconceptions, accumulated myths, and ignorance about femininity were evidenced based on narratives. The majority of women raised ‘role change’ as an important determinant in social interactions. Gender role changes as well as women's socialization patterns have forced women to accept loosing femininity as a reality. Developing comprehensive and culturally sensitive health services to address women's needs in the climacteric years is suggested .

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  Background and Aim: Health-risk behaviors are socially constructed and influenced by the given culture. Therefore, the health-risk behaviors are prioritized differently in diverse cultures. In this study, we aimed to explore the priority of health risk behaviors among high school students in Tehran.

  Materials and Methods : In this qualitative study using rapid assessment approach, we interviewed 130 individuals who voluntarily participated in the focus group discussions (FGDs, n=17). They were students (n=9 FGDs), the parents (n=5 FGDs), and the teachers (n=3 FGDs). Four of the principals were individually interviewed. Interviews focused on (1) perceptions about and description of healthy or unhealthy behaviors (2) priority of health risk behaviors in adolescents (3) perceptions and beliefs about the formation of the risk behaviors among adolescents. All sessions were embarked on the public schools located in the area five in West Tehran. After obtaining a written consent form from the participants, primary investigators and three of the trained facilitators (male and female) conducted the sessions. We employed content analysis to extract the major themes and sub-themes. The rigor of the data was obtained.

  Results : Addiction, risky sexual behavior, and social misconduct ion (aggression) were identified as the main concerns for the boys. Risky sexual behavior, early marriage, eating unhealthy habits, physical motionless, and fear of the future (job, education, marriage) were identified as the main health-risk behaviors for the girls.

  Conclusion : According to our findings, health risk behaviors are classified differently for boys and girls. However, sexual risk behaviors are common findings for both groups. The adolescents' risky behaviors are formed throughout their socialization and seriously influenced by the given culture. Understanding of gender schema was identified as an important factor in the way participants do priority health-risk behaviors of young people. Comprehensive and holistic health education and promotion programs targeting adolescents as well as training programs for parents are suggested.

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Background and Aim: To succeed in study and deliver service to community, training spiritual and related skill is urgent need in public health students. The aim of study was to explore spiritual needs and related skills in public health students of Kurdistan University of medical sciences.

Materials and Methods: This research was done through content analysis approach in Kurdistan university of medical science in 2015 year. Public health 15 students’ needs and perspective investigated via purposeful sampling. Inclusion criteria were including willingness to participate in the study, public health students, and ability to speak fluently. Data was gathered using individual and group in-deep sim-structural interviews and field note. Interviews recorded, typed, and analyzed using content analysis method. credibility, dependability, confirmability and transferability were employed to rigor and trustworthy of data.

Results: from Analysis of data were extracted 4 main categories: “individual interaction with superior existence”, “individual’s interaction with surrounding”, “strengthen individual characteristics”, and “improvement of study”. 

Conclusion: the results of the study showed that acquiring of spiritual and life skills is an urgent need for students. Earning these skills not only is not an individual factor but also is multi-factorial and this is regarding to educational organizations, ministries, universities and families.

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Background and Aim: The role of physical activity in prevention of non-communicable diseases is now well known. The purpose of the present study was to find any possible association between physical activity and bone mineral density (BMD) in the hip and lumbar spine areas in women in postmenopausal years. 

Materials and Methods: This was a cross-sectional study including 254 postmenopausal women aged 46 to 78 years. Body composition and BMD were determined using the bioelectrical impedance analysis (BIA) and DEXA methods, respectively, and for physical activity measurement the International Physical Activity Questionnaire (IPAQ) was used.

Results: The distribution (%) of  the subjects according to the level of physical activity ─  inactive, moderate and active ─ was 39.7%, 47.6% and 12.5% respectively. There was a positive association between physical activity level and lumbar spine BMD (P = 0.03) in the 55-year-old or younger women. No association was found between physical activity level and the hip BMD(P>0.05).

Conclusion: Based on the findings it may be concluded  that physical activity level can be used as a predictor of bone mineral density in the lumbar spine area in women in postmenopausal years (≥55 years old). 

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Background and Aim: Considering the protection of, and safeguarding, the health of industrial workforce, this study was conducted to determine the prevalence of overweight and obesity in the personnel of Abadan oil refinery in the south-west of Iran and factors related to it.

Materials and Methods: The study included 721 oil refinery staff members randomly selected based on the yearly occupational health examination records. The information recorded included anthropometric measurements and blood test results; in addition, Breslow lifestyle and Global Physical Activity (GPAQ) questionnaires were completed for each subject.

Results: The mean body mass index (BMI) was 28.2 for men and 27.5 for women. The prevalence of obesity and overweight were 29.8% and 48.7%, respectively. Further analysis of the data showed that the prevalence rates were different between men and women; while 48.6% and 30.24% of the men suffered from overweight and obesity, respectively, the corresponding proportions among women were 50% and 15%. Overweight and obesity were associated with age, fasting blood glucose level, lipid profile and hypertension (in all cases    p < 0.001).

Conclusion: The prevalence of overweight and obesity among Abadan oil refinery staff is higher as compared to the mean values in the general population in Iran or to personnel of other industries globally. Development and implementation of public educational programs with particular emphasis on high-risk individuals, such as middle-aged people and those with a low socioeconomic status, and focusing on healthy lifestyle and rotation shift workers can be effective, resulting in improvements in physical and general health of the personnel.

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Background and Aims: Cutaneous leishmaniosis (CL) is a neglected tropical vector-borne disease. As other vector-transmitted diseases, its transmission is sensitive to the physical environment. The purpose of this study was to investigate the relationship between El Niño-Southern Oscillation (ENSO) and annual incidence of CL in Iran.

Materials and Methods: The data of ENSO were obtained from the National Oceanic and Atmospheric Administration (NOAA) Climate Prediction Center for the period 1977-2011(34 years), and the annual data on CL incidence in Iran from WHO. To determine the association between the ENSO annual fluctuations and annual CL incidence we used crosstab analysis and tow-tailed independent t-test to find any possible differences among the annual CL incidence according to different phases of the Southern Oscillation Index (SOI: El Niño, warming phase; La Niña, cooling phase; neutral phase).

Results: Analysis of the data showed that, as compared with the years when El Niño and La Niña were dominant, the annual incidence of CL in Iran was lower in the years when neutral phases of SOI were dominant. The highest incidence was found to have occurred during the years with an intermediate La Niña dominance. During the years when La Nina was dominant the incidence of CL was, on the average, 15-20% higher than that in the years with a neutral phase, while the difference between the annual CL incidence in neutral years and El Niño years was not statistically significant.

Conclusion: The findings reveal that in general the mean incidence of cutaneous leishmaniosis during the years with a neutral ENSO index is lower than that during the years with dominant El Nino or La Nina, although there is no difference between incidence in the neutral years and the El Nino-dominant years.

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Background and Aim: Gastric cancer is one the most common gastrointestinal tract cancers in Iran, with East-Azerbaijan Province ranking second in the country. The objectives of this research were to determine the feasibility of using cure models in survival analysis and factors affecting short-term and long-term patient survival rates using the mixture cure cox model.

Materials and Methods: We used the available information on 184 patients diagnosed with gastric cancer in East-Azerbaijan Province cities referring to medical centers during the period 2009-2010 and followed up for 5 years.

Results: The median of survival time was 8.33 months (95% CI = 5.9-10.6). Fitting the univariate and final cox cure models showed that in the short-term survival the effect of the chemotherapy factor was statistically significant (Hazard ratio =0.49, 95% CI = 0.34, 0.69, p-value <0.001).

Conclusion: If the population under study consists of two groups of susceptible and non-susceptible individuals for the intended incident, the mixture cure models can be used for the discrete analysis of long-term and short-term survival of patients diagnosed with gastric cancer and identification of variables affecting the two survival rates.

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Background and Aim: The practice of breastfeeding among mothers is affected by their knowledge of, and attitude to, it. Therefore, this study aimed to determine the effect of intervention, using the transtheoretical model (TTM), on the knowledge, attitude and practice of exclusive breastfeeding among pregnant women in the third trimester referred to Golestan University of Medical Sciences in hospitals in 2021.
Materials and Methods: This quasi-experimental intervention was conducted on 120 pregnant women in the third trimester of pregnancy randomly assigned to an intervention (n = 60) or a control (n = 60) group using the permuted block randomization. The data collection tools were a two-part questionnaire to collect data on demographic and obstetric characteristics and a researcher-made questionnaire based on the TTM. Due to the coronavirus Epidemic the education was conducted partly face-to face in five 30-minute sessions three times a week observing the health protocols and partly virtually via WhatsApp and Telegram messenger (audio file, video tutorial, electronic pamphlets and posters). The data collected one and six months after the intervention were analyzed using the SPSS software version 16, the tests being descriptive and inferential tests.
Results: The mean scores of knowledge, attitude, practice and the TTM constructs were not statistically significant between the intervention and control groups before the education intervention. One and six months after the intervention the mean scores of knowledge, attitude and practice and the TTM constructs, as well as perceived barriers and benefits in decision-making and self-efficacy were found to be significantly different between the intervention and control groups (p< 0.001).
Conclusion: Based on the findings it seems that breastfeeding education of pregnant women based on the transtheoretical model can improve their knowledge, attitude and practice as regards exclusive breastfeeding.