Analysis of Papers Submitted to “Iranian Journal of Public Health” during 2013-2016

Life Style and Sustainable Development Please provide alternate text for this image to ensure accessibility for users with text-only browsers or assistive devices

Background: We aimed to elucidate the association between fat mass and obesity associated gene (FTO) polymorphism and the risk of polycystic ovary syndrome (PCOS) by meta-analysis.

Methods: We searched PubMed and Embase databases to find the relevant studies. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were used for pooled analysis. Statistical analyses were carried out by using R 3.12 software. Heterogeneity was assessed using I² and Q statistics. I²>50% or P<0.05 was considered as heterogeneity statistically, and random effects model was used for pooled analysis. Otherwise, fixed-effect model was used.

Results: Twelve eligible studies that published from 2008 to 2015 were included in this meta-analysis. The pooled analyses showed that rs9939609 polymorphism of FTO gene was significantly associated with risk of PCOS under A vs. T, AT vs. TT, AA vs. TT, AA vs. AT+TT and AA+AT vs. TT genetic models. However, for rs8050136 and rs1421085, significant association was only found under recessive genetic model.

Conclusion: rs9939609 variation of FTO gene is significantly associated with risk of PCOS. However, the association between rs8050136, rs1421085, and PCOS is still unclear and needs further confirmation.

Background: The current study was conducted to estimate the integrated mean of Quality Of Life (QOL) of the general population of different countries around the world and to compare them on the grounds of the Human Development Index (HDI).

Methods: Well-known international databases such as Medline, Scopus, Science Direct, Google Scholar & Google, and domestic databases including SID, IranMedex, Irandoc & Magiran were searched in 2015. The data were analyzed with the Random Effect Model, using Stata 11 software.

Results: Ninety-seven studies were selected for the final analysis. The overall QOL mean in the very high HDI subgroup was 74.26 (CI=72.40-76.12), which was the highest value. The lowest mean score was observed in the psychological domain (M=67.37; CI=66.23-68.52). In the high HDI subgroup, the highest mean was observed in the social relationships domain (M=64.16; CI=61.99-66.34), and the lowest mean was observed in the environment domain (M=58.76; CI=56.50-61.03). In the medium HDI subgroup, the highest mean was calculated for the overall QOL score (M=62.62; CI=56.35-68.92), and the lowest mean was estimated for the environment domain (M=56.98; CI=53.54-60.43). The highest mean in the low HDI subgroup was observed in the physical health domain (M=68.17; CI=67.43-70.52), and the lowest mean was calculated for the environment domain (M=53.14; CI=51.57-54.72). There was considerable heterogeneity in all the subgroups and domains; the values reported here are the weighted means of QOL for different countries.

Conclusion: Overall, the highest means of various QOL domains were observed in the very high HDI subgroup.

Background: The extremely low-frequency electromagnetic field (ELF-EMF), mainly emitted by electric transmission lines and household electronic appliances, is becoming a worldwide health risk. It is imperative to investigate the biological impacts of ELF-EMF and to identify products that are resistant to the radiation from 50 Hz ELF-EMF. In this study, we investigated the biological impacts of apoptosis caused by 50 Hz Power line ELF-EMF and the protective effects of Vit C and Vit E.

Methods: We conducted this study in Beijing, China in 2013. B_95-8  and Balb/c-3T3 cells were divided into a sham group, an expo group and 3 expo groups in which the cells were preincubated with various concentrations of Vit C and Vit E. Then, all of the cells were exposed to 50 Hz Power line ELF-EMF and examined for apoptosis. The cells were collected for apoptosis detection after exposure.

Results: The percent of cells that undergoing apoptosis and preincubated with various concentrations of Vit C and Vit E were significantly lower than in the Expo group.

Conclusion: Vit C and Vit E exert significant protective effects from 50 Hz ELF-EMF radiation. The optimal protective concentrations of Vit C and Vit E are 10 μmol/L and 25 μmol/L, respectively. The protective effect of vitamins was more apparent for Balb/c-3T3 cells than B_95-8 cells.

Background: Precise diagnosis of disease risk factors via efficient statistical models is the primary step for reducing the heavy costs of breast cancer, as one of the most highly prevalent cancer throughout the world. Therefore, the aim of this study was to present a recently introduced statistical model in order to assess its proficiency for model fitting.

Methods: The information of 1465 eligible Iranian women with breast cancer was used for this retrospective cohort study. The statistical performances of exponential, Weibull, Log-logistic and Lognormal, as the most proper parametric survival models, were evaluated and compared with 'Model-based Recursive Partitioning' in order to survey their capability of more relevant risk factor detection.

Results: 'Model-based Recursive Partitioning' recognized the largest number of significant affective risk factors, whereas, all four parametric models agreed and unable to detect the effectiveness of 'Progesterone Receptor' as an indicator; 'Log-Normal-based Recursive Partitioning' could provide the paramount fit.

Conclusion: The superiority of 'Model-based Recursive Partitioning' was ascertained; not only by its excellent fitness but also by its susceptibility for classification of individuals to homogeneous severity levels and its impressive visual intuition potentiality.

Background: To identify and analyze factors that influence the grading and zoning management model of emergency triage as a first step in the improvement of the system.

Methods: Questionnaires were used to extract data from clinical histories of 286 patients who attended the Emergency Department of Binzhou Central Hospital (Binzhou City, Shandong Province, China) from September to November of 2015. Through logistic regression analysis, influencing factors for unreasonable (≥ 2h) emergency department retention times were identified.

Results: Analysis of general characteristics of patients including gender, method of payment or assigned medical department did not result in any statistically significant differences between patients with a time to discharge longer than 2 h and those with a shorter time to discharge (P＞0.05). Older age, higher income, lower or higher education degree, admission time from 17:00-7:59, and lack of understanding of zoning management and of condition severity grading resulted in a retention time greater than or equal to 2 hours (P < 0.05). According to the Logistic regression model: age, income level, education degree, admission time, degree of understanding of zoning management and condition severity grading were all independent risk factors affecting the time to discharge from the emergency department (P＜0.05).

Conclusion: Countermeasures need to be developed in order to minimize the influence of patients’ factors and promote reasonable average retention times lower than 2 hours in the emergency department.

Background: To study the influence values of self-management program intervention on efficacy of emotion regulation for patients suffering from chronic obstructive pulmonary disease (COPD).

Methods: Eighty-six diagnosed chronic COPD patients in stable phase in Linzi District People's Hospital, Zibo Shandong Province, PR China from June 2014 to June 2015 were selected in succession. They were divided into control group and observation group randomly with 43 cases in each group. In control group, conventional out-of-hospital continued nursing mode was used while strengthened self-management program guidance was used in observation group (including seven modules that included disease knowledge, breathing exercises, emotion management, home oxygen therapy, medicine intake technique, healthy life behaviors, and action plans in deterioration stage) to compare their differences of results.

Results: For follow-up visits of 6 months, self-management behaviors of patients in two groups had increased, including physical fitness training, cognitive symptom management practice and medical care scores, and the increase range in observation group was more obvious and differences were of statistical significance (P < 0.05); self-efficacy of emotion regulation in two groups is increasing, including positive affect, despondency/distress, anger/irritation and total scores, furthermore, the increase range in observation group is more obvious and differences are of statistical significance (P < 0.05).

Conclusion: Self-management program intervention can improve self-management behaviors of COPD patients and it is significant in terms of improving efficacy of emotion regulation and prognosis.

Background: To extract utility values of diabetic retinopathy on a perfect health and perfect vision scales for Iranians with both types diabetes.

Methods: In this investigation, 150 untreated patients with diabetic retinopathy consecutively were examined and interviewed in Farabi Eye Hospital, Tehran, Iran, a tertiary referral center in the Iranian health care system. Utility values based on patients-reported outcome measures, standard gamble, time trade off and visual analogue scale approaches, were estimated.

Results: Considering all three utility elicitation methods were valid, diabetic retinopathy patients, on average reported the 0.95 (±0.03), 0.85 (±0.15) and 0.80 (±0.30) standard policy scale utility according to standard gamble, TTO and VAT respectively. In all three-studied approach, diabetic retinopathy had more disutility in higher levels of disease and had more disutility in the presence of both maculopathy and vasculopathy compared with one of them. Evidence show that share of macular edema in imposing disutility was maximum in early stage and exponentially decreased with advancing the severity of diabetic retinopathy.

Conclusion: Study indicated utility scores in DR-experienced Iranian patients were highest with the SG and lowest with the VAT method. The proffered utility-elicitation method in Iranian patient populations could be the TTO approach. The novel model we employed for DR takes the effects of diabetic macular edema and vascularization into account separately, and can provide a better estimate of the QoL for these patients.

Background: The fertility experience in Iran suggests that the family planning programs had an effective role in the fertility reduction. This study aimed to specify patterns of marriage in Iran and especially in a northern city of Iran and to investigate the association between patterns of marriage and contraceptive use before first pregnancy and current contraceptive use.

Methods: In this cross-sectional study, following the implementation of an expert panel in order to investigate marriage patterns, 880 women aged 15-49 yr old, were selected by multistage cluster sampling and completed the “reproductive practices” questionnaire in Babol City, northern Iran, in 2013. The data were analyzed using IBM SPSS ver.16 and descriptive and analytical parameters.

Results: There are three patterns of marriage in the northern part of Iran: Traditional, Mixed and Modern marriage and between different patterns there is no statistically significant difference in the contraceptive use.

Conclusion: According to the lack of significant relationship between patterns of marriage and the contraceptives use, which is one of the proximate determinants of fertility, the policy makers should pay attention to other determinants of fertility in order to manage the problems and implications of population decline in the country.

Background: Hearing loss (HL) is the most frequent neurosensory impairment. HL is highly heterogeneous defect. This disorder affects 1 out of 500 newborns. This study aimed to determine the role of DFNB2 locus and frequency of MYO7A gene mutations in a population from west of Iran.

Methods: Thirty families investigated in Shahrekord University of Medical Sciences in 2014, genetic linkage analysis via four short tandem repeat markers linked to MYO7A was performed for two consanguineous families originating from Hamedan (family-13) and Chaharmahal-Bakhtiari (family-32) provinces of Iran, co-segregating autosomal recessive HL and showed no mutation in GJB2 gene in our preliminary investigation. All 49 coding exons and exon- intron boundaries of the MYO7A gene were amplified by PCR and analyzed using direct DNA sequencing.

Results: Two of families displayed linkage to DFNB2. Family-13 segregated a homozygous missense mutation (c.6487G>A) in exon 48 that results in a p.G2163S amino acid substitution in C-terminal domain of the myosin VIIA protein. While family-32 segregated a homozygous nonsense mutation (c.448 C>T) in exon five, resulting in a premature truncation at amino acid position 150 (p.Arg150X) in the motor domain of this protein.

Conclusion: Mutation frequency of MYO7A gene in different populations of Iran as well as cause of HL in most cases are still unknown and more extensive studies have to be done.

Background: One of the key issues in determining the quality of water in rivers is to create a water quality control network with a suitable performance. The measured qualitative variables at stations should be representative of all the changes in water quality in water systems. Since the increase in water quality monitoring stations increases annual monitoring costs, recognition of the stations with higher importance as well as main parameters can be effective in future decisions to improve the existing monitoring network.

Methods: Sampling was carried out on 12 physical and chemical parameters measured at 15 stations during 2013-2014 in Haraz River, northern Iran.

Results: The results of the measurements were analyzed using multivariate statistical analysis methods including cluster analysis (CA), principal component analysis (PCA), factor analysis (FA), and discriminant analysis (DA). According to the CA, PCA, and FA, the stations were divided into three groups of high pollution, medium pollution, and low pollution.

Conclusion: The research findings confirm applicability of multivariate statistical techniques in the interpretation of large data sets, water quality assessment, and source apportionment of different pollution sources.

Background: We determined the levels of subjective and observer drowsiness and facial dynamics changes.

Methods: This experimental study was done in the virtual reality laboratory of Khaje-Nasir Toosi University of Technology in 2015. Facial dynamics changes like changes in eyes, mouth and eyebrows were surveyed on twenty-five drivers in 2015byKSS (Karolinska Sleepiness Scale) and ORD (Observer Rating of Drowsiness). ANOVA Repeated Measure and MANOVA Repeated Measure tests were used for data analysis. Also, neural network and Viola-Jones were used to detect facial characteristics. PERCLOS (Percentage of Eye Closure), blink frequency and blink duration were inspected for eyes parameters. The size of open mouth during drowsiness was inspected for mouth parameter. During the inspection of eyebrow, the number 50 denoted eyebrow in normal position. For eyebrows above the normal position, a range of 50 to 55 was specified; in addition, 45-50 was found as the specified range for eyebrows under normal position.

Results: Descriptive statistics of the dynamic changes in mouth and eyes illustrated that during the driving process, the level of sleepiness increased as well as changes of eyes and mouth. However, statistical findings during car driving revealed that dynamic changes in eyebrows had clear expression with a constant trend. Similar studies on data obtained from KSS and ORD showed that both of these parameters simultaneously increased as well as the level of drowsiness. In addition, a significant relationship existed between facial expression and drowsiness.

Conclusion: This research would be an effective and efficient tool for timely alarming and detecting the drowsiness quickly and precisely.

Background: Salmonella enterica serovar Typhi, as causative agent of typhoid fever, is one of the most important endemic pathogens. Non-typhoidal Salmonella serovars, including Typhimurium, Infantis, and Enteritidis are amongst the most prevalent serotypes worldwide and in developing areas such as Iran. The aim of this study was to apply a uniplex PCR for rapid detection of Salmonella spp., and a multiplex PCR for the simultaneous detection of the four most common Salmonella serovars in Iran.

Methods: Current research was done in 2010 at Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. For detection of Salmonella spp a pair of primers was used to replicate a chromosomal sequence. Four other sets of primers were also designed to amplify the target genes of four Salmonella species including S. typhi, and three non-typhoidal Salmonella spp (S. enteritidis, S. infantis, and S. typhimurium). The assay specificity was investigated by testing 15 different Salmonella serovars and 8 other additional non-Salmonella species.

Results: The Salmonella genus-specific PCR yielded the expected DNA band of 404 bp in all Salmonella spp., strains tested. The uniplex and multiplex PCR assays produced also the expected fragments of 489 bp, 304 bp, 224 bp, and 104 bp for serovars Typhi, Enteritidis, Typhimurium, and Infantis, respectively. Each species-specific primer pair set did not show any cross-reactivity when tested on other Salmonella serovars or other non- but related- Salmonella strains.

Conclusion: Both uniplex and multiplex PCR protocols had a good specificity. They can provide an important tool for the rapid and simultaneous detection and differentiation of the four most prevalent Salmonella serovars in Iran.

Background: Galactosemia is a congenital metabolic disorder that can damage the health of a newborn. Screening is an important step to prevent and treat this condition. Due to increasing health care costs and limited financial resources of health systems, the most suitable economic analysis tool should be applied. The aim of this study was to analyze the cost-utility of neonatal screening program for diagnosing galactosemia in Fars province, Iran.

Methods: In this cross-sectional study and cost-utility analysis in the cost of screening for galactosemia and its financial effects, decision tree model and society’s viewpoint were used. The population of study was 81837 infants referred to Neonatal Screening Laboratory (Nader Kazemi Clinic) affiliated to Shiraz University of Medical Sciences (SUMS), Iran, in 2010. Quality of life in two groups of patients was evaluated by using the time trade-off. The best intervention option was selected by using the Incremental Cost-effectiveness Ratio.

Results: The estimated cost of diagnosed through screening and without screening were 43519911 and 130011168 Iranian Rails (4222.00 $ and 12615.00 $), respectively. Therefore, there was a saving of 201443240.99 Iranian Rails (19641.00 $), for each patient annually.

Conclusion: The screening program can improve both the qualitative and quantitative lifestyle of people and increase savings in health care system. Policymakers could use the results to design new policies based on the necessity of screening.

Background: Diabetes mellitus is one of the most important causes of morbidity and mortality all over the world. Chronic high blood glucose is the root cause of developing future micro and macro vascular complications. In current study, we analyzed poorly controlled patients’ information by clustering method in order to find more homogenous sub-groups of patients for planning for further interventions.

Methods: This study was conducted based on medical records of diabetic patients admitted to 23 health care centers in four cities of Iran from 2010 to 2014. Demographic data and physical and biochemical measurements were extracted and analyzed using two-steps cluster analysis method.

Results: Three distinct clusters were derived from 2087 eligible cases. Cluster 1 totally consisted of men without any apparent risk factors. Members of clusters 2 and 3 were illiterate women with obesity. Dyslipidemia was a prominent characteristic in members of cluster 2.

Conclusion: Masculinity would play the main role in diabetes control. Meanwhile, aggregation of obesity, illiteracy and/or dyslipidemia in diabetic women predispose them to poor control condition. Based on these findings, we will be able to plan interventions that are more appropriate for identified groups.

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