Residential segregation and infant mortality: a multilevel study using Iranian census data

There is a great amount of literature concerning the effect of racial segregation on health outcomes but few papers have discussed the effect of segregation on the basis of social, demographic and economic characteristics on health. We estimated the independent effect of segregation of determinants of socioeconomic status on infant mortality in Iranian population. For measuring segregation, we used generalized dissimilarity index for two group and multi group nominal variables and ordinal information theory index for ordinal variables. Sample data was obtained from Iranian latest national census and multilevel modeling with individual variables at level one and segregation indices measured at province level for socioeconomic status variables at level two were used to assess the effect of segregation on infant mortality. Among individual factors, mother activity was a risk factor for infant mortality. Segregated provinces in regard to size of the house, ownership of a house and motorcycle, number of literate individual in the family and use of natural gas for cooking and heating had higher infant mortality. Segregation indices measured for education level, migration history, activity, marital status and existence of bathroom were negatively associated with infant mortality. Segregation of different contextual characteristics of neighborhood had different effects on health outcomes. Studying segregation of social, economic, and demographic factors, especially in communities, which are racially homogenous, might reveal new insights into dissimilarities in health

[Needle sticks injuries among health care workers in emergency medical centers in Tehran University of Medical Sciences Hospitals [2007-2010]]

Today, Needle Stick Injuries [NSI] are very important occupational hazards experienced by healthcare workers lead to exposure to blood-borne viruses especially hepatitis B, hepatitis C and HIV. The aim of this study was to determine needle sticks injuries among health care workers in emergency medical centers in Tehran University of Medical Sciences hospitals [2007- 2010]. In this descriptive study 991 health care workers worked in emergency wards in Tehran University of Medical Sciences hospitals were followed for needle stick events from 2007 to 2010. Sampling method was census. Data were collected by a researcher-made questionnaire consisted of 32 questions included demographic variables and NSI included the event that leads to needle stick injuries. Content and face validity and also test-retest reliability [r = 0/71] were measured and data was analyzed by SPSS 16. The study population reported 167 needle stick injuries during the study period [167 health care workers exposure group, 554 health care workers not exposure group]. Incidence rate of NSI was 16/85%. Majority of subjects in exposure group were female [50/89%], married [52/69%] and nurse [53/2%] and also the mean age was 35/3 +/- 6/4. In most cases, needles [55/08%] and vein catheter [22/75%] were responsible for injuries. IV access [24/7%] and recapping of needles [23/3%] were most common action resulted to exposure. There weren't statistically significant different in demographic variables except working experience between exposure groups and not exposure group. According to the results of this study, incidence rate of NSI among HCWs worked in emergency wards in TUMS less than other studies in different countries. This might be an indication of inadequate reporting. It is suggested that, NSI in hospitals should be managed through obtaining an appropriate reporting system and organizing blood and body fluid exposure surveillance system

[ ten-year study of oral squamous cell carcinoma cases in the Guilan province]

Oral carcinoma is among the most common cancers and one of the top-10 causes of death worldwide. Oral squamous cell carcinoma [OSCC] has the highest incidence and the lowest survival rate among oral cancer cases. The study of OSCC epidemiology, incidence rate, and its association with age and gender among the patients could provide the oral and maxillofacial specialists as well as health officials and policy workers with valuable information. Analysis of OSCC incidence rate and its association with sex and age among the oral cancer patients in the Guilan province during the 1378-87 period. This descriptive and prospective study was done by reviewing 12686 files of the cancer patients recorded by the Guilan Cancer Registry Center during 1377-87. Medical information including age, gender, the type of cancer, and anatomical location of the tumor were extracted from the patients' records. Data analysis was performed using SPSS software and chi-square test and Kruskal-Wallis. Among the total number of files studied, 2364 [18.6%] were diagnosed as head and neck carcinoma cases, of which 1152 [48.7%] were recorded as SCC, with a male to female ratio of 1.7:1 and a mean age of 63.41 +/- 15.41 years.The most involved areas were tongue with 35.2% cases and buccal region with 24.4% cases. The 70-80 year age group had the largest number of 37patients [28%] with OSCC. Our results show that the incidence of OSCC is significantly higher in the 8th decade of life. We also found that the most common risk site of the tumor in young patients is the tongue

assessment of relations between socioeconomic status and number of complications among type 2 diabetic patients

The prevalence of diabetes mellitus among Iranian aged 25-64 estimated to be about 7.7%. The aim of current study was the assessment of socioeconomic status of diabetic patients and their complications. A cross sectional study was conducted on type 2 diabetic patients with complications in four major teaching hospitals affiliated to Tehran University of Medical Sciences [TUMS] during July 2009 to March 2010. All patients [530] were interviewed through a questionnaire with 85% response rate [450 patients]. Skilled nurses were assigned as responsible for data collection. Collected data analyzed by Exact Fisher and x2 tests using SPSS version 11.5. The majority of patients had experienced one or more complications. Findings revealed that 50%, 33.6% and 16.4% of the patients suffered from one, two, and three complications of type 2 diabetes, respectively. Patients with cardiovascular complications included 22.2%, with both cardiovascular and eye complications [12.7%], and with cardiovascular, eye and foot ulcer together 14% of the respondents. Frequency of complications demonstrated significant relation with sex, age, educational level, type of occupation, duration of diabetes [P 0.001] and social class [P=0.002]. The majority of patients [54.2%] belonged to low income group. It seems patients with low socioeconomic status face more challenges in their social environment together with less psychological support. Health care systems are responsible to empower them to control their illness and feel a better life to live

Leukocyte antigen [HLA] class ii allele frequencies in female patients with breast cancer: a case control study

The study aimed to examine the association between human leukocyte antigen [HLA] class II allele frequencies and breast cancer in Iranian women. A total of 100 patients with pathologically proven breast cancer who referred to Cancer Institute were randomly selected and compared with a group of age matched healthy blood donors [n = 80]. HLA class II alleles were determined by amplification of DNA followed by HLA-typing using sequence-specific primer [SSP] for each allele. The frequency of HLA-DQA1 0301 [P=0.001, OR=3.4] and HLA-DRB11303 [/M].02, OR=2.3] among breast cancer patients was significantly higher than those in control group. HLA-DQA 10505 [/M].003, OR=0.4], HLA-DRB11301 CP=0.002, OR=0.12] and HLA-DQA10101 [P=0.01, OR=0.21] alleles showed negative association with breast cancer. The findings suggest that HLA-DQA10301 allele is mainly associated with increased risk of breast cancer in Iranian female patients. HLA-DQA 10505 and HLA-DRB11301 alleles are suggested as protective genetic factors against breast cancer. The findings confirm that specific alleles of HLA class II influence breast cancer risk

Ecology of malaria vector Anopheles culicifacies in a malarious area of Sistan va Baluchestan province, south-east Islamic Republic of Iran

A study was done of the bionomics, insecticide susceptibility and irritability status of Anopheles culicifacies in Sistan va Baluchestan province. Sampling was performed to determine the following parameters: species identification, seasonal activity, adult and larval susceptibility tests, irritability tests, anthropophily index and sporozoite rate. An. culicifacies adults were susceptible to all tested pyrethroid insecticides. An. culicifacies started to appear indoors in late May, showing 2 peaks in June and September. Fenitrothion, cyfluthrin and permethrin had the least irritancy effect and DDT the highest. Only 2/860 females tested were infected with Plasmodium spp. [sporozoite rate: 0.25%]. EL1SA testing of 250 blood meals derived from night-biting collections of female mosquitoes from humans and cows revealed that only 12.5% were human-fed

Testicular cells apoptosis in opium-addicted rats: [short report]

Apoptosis is a physiological mechanism of cell death and it can be triggered by a variety of internal and external stimuli. It has been shown that some opium derivatives promote cell apoptosis. This study was designed to examine the influence of opium addiction on testicular cell apoptosis in Wistar rats. This experimental study was performed on 7 opium-addicted as case group and 7 normal rats as control group. In the case group, animals treated with peritoneal injections of opium twice a day at 8 a.m and 8 p.m for 8 days based on the following regimen; at the first day 30 mg/kg, second day 60 mg/kg, third day 90 mg/kg, fourth day 120 mg/kg, and from fifth to eighth day 150 mg/kg. The control group received only normal saline. Apoptosis was then evaluated by TUNEL and DNA fragmentation assays. The results of this study showed that the rate of testicular cells apoptosis in opium-addicted rats were significantly higher than the normal rats [p<0.001]. These results indicated that opium addiction may play an important role in testicular cells apoptosis and as a result can cause testicula dysfunction and reduced testosterone production which may culminate in infertility

[To determine the prognostic factors in esophageal cancer using log-logistic regression model in Iran]

Each year almost 400,000 people are diagnosed with oesophageal cancer worldwide. Wide variation in incidence has been reported both between countries and in different ethnic groups and populations within a country. The area with the highest reported incidence for oesophageal cancer is the so-called Asian 'oesophageal cancer belt', which stretches from eastern Turkey through north-eastern Iran, northern Afghanistan and southern Russia to northern China. In the high risk area of Gonbad in Iran, world age-standardised rates are more than 200 per 100,000 and the male/female ratio is reported as 0.8:1.0.This study aimed to assess the risk factors and demographic factors influencing survival of patients with esophageal cancer in north of Iran using weibull and log-logistic regression models. Demographic and clinical data of 359 patients with confirmed diagnosis of esophageal cancer from Babol Cancer registry utilized for our model. parametric and weibull models were employed to analyze the data. The Akaike information criterion [AIC] was also considered as a criterion to select the best model[s]. All p values as 0.05 were considered as statistically significant. The sample study consisted of 62.7% men and 37.3% women. Estimated survival rates in 1, 3, and 5 years following diagnosis were 23%, 15%, and 13% respectively. According to AIC criterion, the hazard rate of non-monotonic and rejection proportional hazards assumption [p<0.05], log-logistic model was more efficient than weibull model. Family history of having cancer in patients showed a significant difference in both models. It is concluded that early detection of people with a family history of cancer can be effective as an important factor in reducing the risk of death in patients with esophageal cancer

[To evaluate of efficacy of education based on health belief model on knowledge, attitude and practice among women with low socioeconomic status regarding osteoporosis prevention]

Osteoporosis is major public health concern affecting millions of adults particularly older adults and women worldwide. Designing effective educational intervention is principle in any health promotion program. The purpose of this study was to evaluate the efficacy of an educational intervention based on health belief model on knowledge about, attitudes toward and practice of prevention osteoporosis among women with low socioeconomic status in Isfahan. The study population consisted of 14 women with low socioeconomic status and under 60 years old. A valid and reliable questionnaire developed and used as measurement tool for initial and final assessments in this program. In addition calcium intake and vitamin D, physical activity and exposure to the sun were assessed. The mean age of the participants were 40.8 +/- 10.52 years. The mean score of all parts of health belief model [except for perceived barriers], knowledge, sun exposure, and physical activity after educational intervention compared to before intervention, were increased significantly. There was no statistically significant difference between daily calcium and vitamin D intake before and after intervention. It is concluded that the HBM Model- based educational program on Knowledge and belief regarding Osteoporosis prevention seems practical and effective. However more research should be done to find out more effective intervention regarding optimal calcium and vitamin D intake

Treatment of synthetic wastewater containing reactive red 198 by electrocoagulation process

Discharge of textile colored wastewater industries without providing enough treatment in water bodies, is harmful for human and aquatic organisms and poses serious damages to the environment. Most of conventional wastewater treatment methods don't have enough efficiency to remove textile dyes from colored wastewater; thus in this research the efficiency of electrocoagulation treatment process with aluminum electrodes for treatment of a synthetic wastewater containing C.I. Reactive Red 198 in batch reactor was studied. The experiment conducted in a Plexiglass reactor with a working volume of 2L that equipped with 4 aluminum electrodes. The effects of operating parameters such as voltage, time of reaction, initial dye concentration and interelectrode distance on the color removal efficiency, electrical energy consumption and electrode consumption were investigated. in the optimum operational condition electrocoagulation, is able to remove color and COD as high as 99.1 and 84.3% in aluminum electrode in 75 minutes at 20 volt and 2 cm interelectrode distance, respectively. Under this condition, operating cost was 2986 rails per cubic meter of treated wastewater. Increase in the interelectrode distance and initial dye concentration, lead to the decrease in efficiency of dye and COD removal. While as the voltage and time of reaction increased, energy consumption, electrode consumption, final pH and color removal, increased too. electrocoagulation process by aluminum electrode is an efficient and suitable method for reactive dye removal from colored wastewater

Expected survival using models of life table compared with survival of gastrointestinal tract cancer patients in north of Iran

Northern regions of Iran have been encountered to dominate malignancies of gastrointestinal [GI] tract. We came to examine the total excess mortality due to the GI cancer in Mazandaran province. Socio-demographic and clinical data of 484 patients with GI cancer collected during the years 1990-1991were available from Babol Cancer Registry. Patients were followed up for 15 years by the year 2006. Using the West Coale-Demeny life table model, a number of five life tables for men and four for women, corresponding to each birth cohort, were constructed. Observed survival was obtained using the Kaplan-Meier method and compared with the Expected survival calculated using the direct adjusted method represented by STEIN et al. The sample of subjects encompassed 66.3% men and 33.7% women with mean age 58.26 +/- 10.90, and endoscopy was the general method for cancer detection. Esophagus accounted for 74.2%, and stomach and colorectal accounted for 22.7% and 3.1% of GI cancers, respectively. Survival rate in 15 years following diagnosis was nearly 6%. Comparing patient and expected survival curves showed a significantly reduced survival for patients of each GI cancer over the whole period and especially during the first two years after diagnosis. Patients experienced reduced survival associated with the development of GI cancers. Considering individuals in a population come from different cohorts, adjustment by constructing distinct life tables for different birth cohorts is recommended. The West model is recommended as a first choice to represent mortality in countries whose registration systems are exposed to various errors

[Disease-free survival of postoperative gastric cancer patients: a competing risks analysis]

Many researchers have studied survival [time to death] of gastric cancer patients. Although gastric cancer diagnosed in early stages can be cured by surgery, chance of relapse still exists after operation. Hence, we should consider both events, that is, relapse of the disease and death, in order to be able to make a more precise estimation for survival of the patients. The purpose of this study was to use the competing risks method to estimate the cumulative incidence functions [CIF] of the relapse of disease and death and consequently to estimate the postoperative disease-free survival. A total of 330 patients admitted to Iran Cancer Institute and operated between March 1995 and March 1999 were enrolled in the study. They were followed up for at least 5 years to estimate their 5-year disease-free survival. Information on their demographic, clinical, and therapeutic characteristics, as well as on the type and time of occurrence of the first event [relapse of disease or death] after surgery was collected from their medical records. The direct parametric method was applied to estimate CIFs of relapse of the disease and death, while to adjust the effects of some covariates the parametric regression model was used. Data analysis was done using the R software and a p-value <0.05 was considered statistically significant. The findings were compared with the results obtained on the basis of data analysis in which the competing events were not considered. The median follow-up time was 37.9 months. Of all the patients 13% experienced relapse and 60.9% death as the first event after surgery. The CIFs of relapse of disease and death 5 years after operation, with due consideration of covariates, were estimated at 11.0% and 68.6%, respectively. Age, stage of disease, and complementary treatment were statistically associated with the CIF of death, while only complementary treatment was related to the CIF of relapse. Older patients and those in more advanced stages of disease were more likely to die after operation. Moreover, while complementary treatment after operation decreased the CIF of relapse of disease, it increased the CIF of death. The disease-free survival of patients 5 years after surgery was 20.4% [considering the effects of some covariates]. The competing risks method is recommended for analyzing survival data because of its capability in considering different events and, therefore, making it possible to make more precise estimations. By using this method, considering smaller variance estimates for model parameters and also narrow confidence intervals for the cumulative incidence functions of competing events, it is expected to obtain more precise results. Unfortunately, the results have revealed that the disease-free survival of gastric cancer patients is low in Iran

Effect of breastfeeding on cognitive performance in a British birth cohort

This cohort study investigated the effect of early life nutrition on later performance in developmental milestones and cognitive tests. Structural equation modelling was carried out on follow-up data from a national birth cohort of 5362 children born in 1 week of 1946 in Britain. Children who were breastfed longer showed earlier developmental milestones. After adjusting for sex, social group and milestones, those children scored higher in verbal tests. Path analysis showed that breastfeeding may have an effect even into adult life. The chain of path coefficients from breastfeeding to developmental milestones at early ages, to cognitive scores at ages 8-15 years, to reading tests at age 26 years and to memory and visual tests at age 43 years were significant in females but not in males

[ survey on testosterone blood levels in male irritable bowel syndrome patients in comparison with a control group]

Irritable bowel syndrome [IBS] with chronic abdominal pain and changes in bowel habits in the absence of any organic cause is identified as the most common known gastrointestinal disorder. IBS affects both sexes and can occur at any age. Diagnosis of this disease in younger patients and women is more likely. In the pathophysiology of IBS, hereditary, environmental, visceral, psychological factors, emotional stress and to a lesser degree, brain factors and hormones, have been discussed. Cortricotropin releasing factor [CRF] has a strong relationship with stress. This factor plays a role in the production of several steroid hormones, including testosterone. During stress, CRF and its receptors' activities increase. This may play a role in some digestive system disorders such as IBS. This study was undertaken from December 2009 to June 2010 on 32 men diagnosed with IBS from a GI clinic, Iran as cases and 23 healthy men who were employees of Ali-Ebn-Abitaleb Hospital, as the control group. Serum testosterone levels were measured by ELISA. Demographic data and laboratory results were analyzed by SPSS version 15. The t-test compared serum testosterone levels of the two groups. Testosterone levels of the IBS cases were 5.73 +/- 3.5 ng/dl and the control group was 1.84 +/- 0.67 ng/dl in this study, which was statistically significant [P < 0.05]. Testosterone may play a role in the pathogenesis of IBS. More extensive studies should be done to discover the pathogenesis of IBS and role of this hormone

Metaplot: a novel stata graph for assessing heterogeneity at a glance

Heterogeneity is usually a major concern in meta-analysis. Although there are some statistical approaches for assessing variability across studies, here we present a new approach to heterogeneity using "MetaPlot" that investigate the influence of a single study on the overall heterogeneity. MetaPlot is a two-way [x, y] graph, which can be considered as a complementary graphical approach for testing heterogeneity. This method shows graphically as well as numerically the results of an influence analysis, in which Higgins' I2 statistic with 95% [Confidence interval] CI are computed omitting one study in each turn and then are plotted against reciprocal of standard error [1/SE] or "precision". In this graph, "1/SE" lies on x axis and "I2 results" lies on y axe. Having a first glance at MetaPlot, one can predict to what extent omission of a single study may influence the overall heterogeneity. The precision on x-axis enables us to distinguish the size of each trial. The graph describes I2 statistic with 95% CI graphically as well as numerically in one view for prompt comparison. It is possible to implement MetaPlot for meta-analysis of different types of outcome data and summary measures. This method presents a simple graphical approach to identify an outlier and its effect on overall heterogeneity at a glance. We wish to suggest MetaPlot to Stata experts to prepare its module for the software

Species identification and strain typing of candida isolates by PCR-RFLP and RAPD-PCR analysis for determining the probable sources of nosocomial infections

Since the incidence of nosocomial Candida infections have been increasing in parallel with the raising in the number of patients involving in predisposing factors, determining the sources and the ways of acquisition of infection is necessary as an efficient strategy for controlling the diseases. The aim of this study is identification and strain typing of Candida strains isolated from hospitals to facilitate tracing the sources of infections in hospitalized patients in addition to assess the discriminatory power of some random primers by using RAPD analysis. Samples were collected from patients who were hospitalized in oncology, intensive care unit [ICU], and organ transplants wards of the Shohadaye-Tajrish Hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran, and their environments. The yeasts were isolated on CHRO Magar Candida. Species identification was performed by PCR-amplification of ITS1-5.8SrDNA-ITS2 region followed by restriction digestion with the enzyme MspI. To determine the probable origin of Candidia infections, in case of each patient whose the clinical and relevant environmental isolates were identified as the same species, a set of eight primers namely number 1 to 8, were applied in RAPD-PCR to find out the possible homogeny or variation within the isolated strains. One hundred and four Candida strains were identified. The most common species was C. albicans [57.5%] followed by C. tropicalis [13.5%], C. glabrata [12.5%], C. parapsilosis [8.65%], C. famata [3.8%], C. krusei [1.9%], C. guilliermondii [0.96%]. and C. lusitaniae [0.96%]. While the source of infection for three patients were not determined by RAPD analysis, interpretable results from RAPD-typing of Candida species isolated from 8/18 of cases implied that the infections might originate from the exogenous sources. Moreover, according to the function of each primer, primer No. 1 was determined as a best primer for typing of Candida albicans strains. The species of yeast isolates were determined by PCR-RFLP. It was found that RAPD assay can point out the genomic variability within the Candida species. Besides, the method could show a probable relationship between acquired infections and their sources

[Developing appropriate criteria for benign prostatic hyperplasia surgery using RAND Appropriateness Method [RAM]]

Results of different studies show that a relatively large number of healthcare services offered are inappropriate or unnecessary. Benign prostatic hyperplasia is a benign enlargement of the prostate gland. Clinical features of this disease are one of the most common problems encountered by elderly males. The aim of this study was to assess the appropriateness of benign prostatic hyperplasia surgery. In this qualitative study which was conducted in 2008-9, in Tehran University of Medical Sciences, the RAN/UCLA method was used, which was designed in 1980 by the RAND institute and the University of California in Los Angeles. Regarding the stages of our method, scenarios and indications for benign prostatic hyperplasia surgery were chosen from the latest approved scientific resources and subsequently sent to urology specialists, who were chosen as members of the specialized panel. Panel members gave scores ranging from 1 to 9 to each indication and scenario based on scientific resources, clinical experiences and patient's condition in two separate panel sessions. After compilation, the indications were finally grouped as appropriate, equivocal, and inappropriate so that they could be used to determine appropriateness of benign prostatic hyperplasia surgery in hospitals. In this study, the most suitable and most approved clinical guidelines related to benign prostatic hyperplasia, the Guidelines Evaluation and Research Appraisal [AGREE] were used.The selected guidelines were used as scientific resources for choosing the indications of benign prostatic hyperplasia surgery. SPSS version 16 and kappa weighted value were used in analysis process of the study. Out of 282 scenarios grouped as 9 conditions related to benign prostatic hyperplasia surgery, which were extracted from scientific sources, 73 cases [25.9%] were considered as appropriate, 14 cases [5%] as equivocal and 7 cases [2.5%] were considered as inappropriate. Also 22 cases [7.8%] were considered as appropriate indications for drug therapy and none were found to be suitable for waiting and watching. There were 94 scenarios related to surgery that 75 scenarios [80%] were grouped in appropriate and 8 scenarios [8.5%] identified inappropriate. At the present time, due to the lack of scientific evidence for suitable decision-making in providing health services, methods based upon agreement, including the one used in the present study, and the use of treatment standards derived from similar studies, are amongst the most important measures taken to improve the standard of hearth, provide suitable health services, and to reduce unnecessary costs. In addition, RAM appropriateness method could be an ideal method in determining the appropriateness of health care and in reducing the rate of inappropriate services provided. The similarity of results derived from other studies performed by the RAND method in determining the appropriateness of benign prostatic hyperplasia treatment with the current study shows the validity and reliability of this method

[Effect of risk factors associated with myocardial infarction among military persons in Tehran]

Acute myocardial infarction [AMI] is prevalent and has serious consequences including re-infarction and death. Although the risk factors for AMI have been extensively studied in Western countries, they are less well documented in Iran. To determine the risk factors for AMI. We performed a case-control study in Military men patients hospitalized for AMI in Military hospitals. Risk factors were assessed in 150 consecutive patients with a first AMI [age 40 years old; and higher than 40], who were admitted to 502 hospital, and in 300 age-and sex-matched hospital-based controls. Family history OR=6.37; Cl [4.03- 10.07], current smoking OR=3.46; Cl [1.92 - 6.23]; PAR = 38%, Hypertension OR=1.75; Cl: [1.16 -2.63] PAR = 17%, diabetes OR=2.2; Cl: [1.2 -4.02] PAR = 29%, hypercholesterolemia OR=2.99; Cl: [1.63 -5.51] PAR = 29%] and non physical activity OR=3.0 Cl: [1.68 -5.38] PAR = 38% were all independent risk factors for AMI. Family history, current smoking, Hypertension, diabetes, non physical activity, and hypercholesterolemia are associated with AMI in Military men patients