Knowledge, attitude, and practice among staff associated with Human Papillomavirus Vaccine of young children in Iran.

INTRODUCTION: This study aimed to evaluate knowledge, attitudes, practice associated with Human Papillomavirus (HPV) Vaccine for Young Children among lecturers and health staffs of Shahid Beheshti University of Medical Sciences (SBMU). METHOD: This was a cross-sectional study with 220 adults from five different specialties, randomly selected. Data was collected using 45-item questionnaire on knowledge (12- item), attitude (18-item) and practice (15-item) (KAP) about HPV. The demographic questionnaire included information on age, gender, level of education, occupation, and marital status. Content validity was calculated by content validity ratio (CVR) and content validity index (CVI). Reliability was evaluated using test-retest and by Cronbach's Alpha coefficient, internal consistency was calculated values >0.81 which considered as satisfactory. RESULTS: The mean age of the studied population was 37.70± 8.07 (23-67) years. Of the 220 participants, 80 (36.4%) were males and 140 (63.6%) were females. In evaluating KAP in the men and women, the mean and standard deviation of knowledge were estimated at good level and one-way ANOVA analysis showed significant differences between women and men (p=0.019). There was no significant difference in men and women related to attitude (p=0.92) and practice (p=0.38). CONCLUSION: The KAP about HPV among participants was significantly higher at good levels compared to average levels. Women's knowledge was significantly higher than men. Attitude and practice could have been higher because there was consensus to the usage of vaccine among the specialists to prevent HPV.

Local versus international recommended TSH references in the assessment of thyroid function during pregnancy.

The aim of this study was to compare the prevalence of subclinical and overt hypothyroidism based on local population-specific reference intervals versus arbitrary cutoffs that are not specific for the population studied or the assay used, during pregnancy in an area of iodine sufficiency. We tested a total of 203 pregnant women in the first trimester of pregnancy, and followed their status in the second and third trimesters. Serum samples from women were assayed for levels of total T4 and T3, FT4I, TSH, TPOAb, and TgAb. Of the 203 women based on our national trimester specific reference ranges of serum TSH and FT4I, 153, 157, and 157 were euthyroid in 3 consecutive trimesters of pregnancy. Accordingly, a total of 23, 12, and 13 had subclinical hypothyroidism in the first, second, and third trimester, respectively. Overt hypothyroidism was detected in 4, 5, and 1 women in the first, second, and third trimesters of pregnancy, respectively. The prevalence of subclinical hypothyroidism was 49, 31, and 34 in each of the trimesters respectively, when TSH>2.5 mIU/l was considered for definition of hypothyroidism in the first trimester, and over 3 mIU/l in the second and third trimesters. Our results showed that using arbitrary cutoff values for TSH instead of population-specific reference intervals may inappropriately increase the rate of subclinical hypothyroidism.

Presenting a practical model for governmental political mapping on road traffic injuries in Iran in 2008: a qualitative study.

OBJECTIVES: This study was conducted to assess political mapping in relation to road traffic injuries (RTIs) management and prevention to present a practical model for RTIs. DESIGN: A phenomenological qualitative study was developed to identify stakeholders on RTI in Iran in 2008. SETTING: The designed questions were discussed by systematic discussion with the relevant specialists. After receiving written consent from the main responsible stakeholders, the questionnaire was filled in by trained experts. Themes were determined and content was analysed in each part. PARTICIPANTS: Main responsible stakeholders. MAIN OUTCOME MEASURES: By comparing other countries' political mappings which were found in the library and by Internet searching, political mapping of RTI in Iran was suggested. RESULTS: Subjects were 26 experts from governmental and non-governmental organizations. The main proposed leading agencies were traffic police and presidency (13% each). Findings showed that only 31% of our political mapping was formed according to the World Health Organization (WHO). In 94% of cases, the involved organizations had unspecified roles; the reason was poor monitoring for RTI in 39% of organizations. Lack of adequate authority and suitable legislation, appropriate laws and tasks definition were 94% and 18%, respectively. The most essential policy to overcome problems was defined as appropriate legislation (21%), and the most frequent type of support needed was mentioned as adequate budgeting (25%). CONCLUSION: Traffic police can play the leading agency role by government support, with strong leadership, appropriate legislation, defined tasks and adequate budget.

Neonatal thyroid status in an area of iodine sufficiency.

BACKGROUND: Iodine deficiency constitutes a public health problem in many countries worldwide. Fetal neurodevelopment is affected by maternal iodine intake. The aim of present study was to assess urinary iodine excretion (UIE) in the 3 trimesters of pregnancy and evaluate its association with newborn thyroid function in Tehran, an area of iodine sufficiency. METHODS: Based on median urinary iodine in 3 trimesters, 138 pregnant women were divided into 2 groups with UIE<150 (group I) and UIE ≥ 150 µg/l (group II). Cord blood samples of their newborns were evaluated for serum concentrations of TSH, T3, T4, free T4 (FT4), and thyroglobolin. Quartiles of UIE were also determined. Correlations between mothers' UIE and newborns' thyroid function in both groups were investigated. RESULTS: Fifty-two pregnant women (38%) had median UIE<150 µg/l and 86 had (62%) UIE ≥ 150 µg/l. Median UIE in groups I and II in the 1st, 2nd, and 3rd trimesters were 125 and 212 µg/l, 97 and 213 µg/l, 93 and 227 µg/l, respectively. No significant difference was seen in thyroid function of newborns in the 2 groups. Mean concentrations of T4, T3, FT4, and TSH of newborn did not show significant difference in median UIE of mothers in various quartiles. CONCLUSION: This study shows that newborns, irrespective of mothers' UIE, in an area with a sustained iodine supplementation program, may not be at risk of alterations in thyroid functions.

Association between mandatory seatbelt laws and road traffic injuries in Iran.

This study investigated the efficacy of mandatory seatbelt legislation on traffic injuries and intensity of road traffic injuries (RTIs). We carried out a before- after interventional study. Data regarding road traffic accidents and injuries one year before and one and two years after the implementation of mandatory seatbelt legislation were obtained from the traffic police database. Traffic accident mortality was 13.0% of all RTIs during the year prior to implementation. This decreased to 9.7% and 11.4% during the first and second years after implementation, respectively (p < 0.001). The mortality rate was not consistent for seatbelt use since there was a slight increase in the mortality rate in second year after implementation of mandatory seatbelt use although this level was lower than the pre- implementation rate. Our findings suggest mandatory seatbelt use reduces the intensity of RTIs and reduces the crude number of RTIs.

Prevalence of metabolic syndrome during menopausal transition Tehranian women: Tehran Lipid and Glucose Study (TLGS).

OBJECTIVE: This study was conducted to assess the prevalence of metabolic syndrome (MetS) in Tehranian women during menopausal transition. DESIGN: In this cross sectional study 2182 subjects, pre-menopausal (pre-M) n=537, menopausal (M) n=311 and post-menopausal (post-M) n=1334 were selected from 15005 participants of the TLGS and assessed for MetS risk factors. All MetS components were evaluated following age adjustment according to the ATPIII criteria. RESULTS: The mean ages of post-M, M and pre-M women were 61.0+/-4.3, 53.0+/-4.0 and 47.0+/-1.9 years, respectively. The prevalence of MetS in subjects was 63% (53%, 54% and 69%) in pre-M, M and post-M women respectively. HDL-c levels was significantly higher in post-M women in comparison to pre-M women (p<0.001). TG levels, FPG and waist circumference was significantly higher in post-M women in comparison to pre-M women (p<0.05). The most frequent markers of MetS were low HDL-c and high diastolic blood pressure in post-M women. CONCLUSION: It is concluded that the frequency of MetS is significantly higher in post-M women as compared to pre-M women; low HDL-c and high diastolic blood pressure is the most frequent feature in comparison to other factors.

Women, occupation and cardiovascular risk factors: findings from the Tehran Lipid and Glucose Study.

OBJECTIVE: To investigate the relationship between occupation and cardiovascular risk factors in women in Tehran. STUDY DESIGN AND METHODS: A cross-sectional study of 566 working women and 561 age-matched housewives selected from among the 15005 Tehran Lipid and Glucose Study (TLGS) participants. All cardiovascular risk factors were assessed. RESULTS: The means of body mass index, waist circumference, waist to hip ratio, systolic and diastolic blood pressures, triglycerides and total cholesterol were significantly higher in housewives as compared to working women (P<0.05). Nine percent of working women and 17% of housewives had 4-6 cardiovascular risk factors; 1% of housewives had 7-8 cardiovascular risk factors. CONCLUSION: An increase in some cardiovascular risk factors was seen in housewives as compared to working women, and the percentage of housewives with 4-6 risk factors was found to be twice that of working women.

Changes in calcium, 25(OH) vitamin D3 and other biochemical factors during pregnancy.

INTRODUCTION AND AIMS: Calcium and vitamin D play major roles in calcium homeostasis and skeletal development, especially during pregnancy. This study was conducted to determine changes in calcium, 25 hydroxy [25(OH)] vitamin D3 and other biochemical factors (PTH, osteocalcin, alkaline phosphatase, magnesium, phosphorus) related to calcium homeostasis and bone turnover during pregnancy and compare the values to those of non-pregnant women. MATERIALS AND METHODS: In a cohort study, 48 pregnant women, in their first trimester of pregnancy (12+/-2.7 weeks), from 5 prenatal care centers, and 47 non-pregnant women randomly selected from the Tehran Lipid and Glucose Study (TLGS) population were enrolled. These pregnant women were followed in their second (26+/-1.9 weeks) and third trimesters (37+/-3.2 weeks) of pregnancy. Samples were drawn from June 2002 to March 2003. Including criteria were healthy women with no background of disease. Women using photo protection and calcium and vitamin D supplementation were excluded. A questionnaire was used to obtain demographic information for both groups. Venous blood samples were taken after 12-14 h of overnight fasting to measure serum calcium, phosphorus, magnesium, alkaline phosphatase, PTH, 25 (OH) vitamin D3 and serum osteocalcin levels. The repeated measures analysis of variance and t-test were used for statistical analysis. Data were matched for age and weight in both the case (in the first trimester) and control groups. RESULTS: Significant differences were found in the mean serum levels of osteocalcin and alkaline phosphatase between the three trimesters of pregnancy (p< 0.001). Osteocalcin was significantly higher in the first trimester as compared to second and third trimesters of pregnancy. Alkaline phosphatase was significantly lower in the first trimester as compared to the second and third trimesters of pregnancy and their controls. There was also a significant difference in osteocalcin in the second and third trimesters and alkaline phosphatase in the first and third trimesters of pregnancy in comparison to the control group. The mean values of osteocalcin were 12.7+/-8.5, 8.1+/-6.9, 5.6+/-5.0 and 13.9+/-7.9 ng/ml, respectively, and mean values for alkaline phosphatase were 115+/-38, 125+/-37, 174+/-61 and 134+/-35.0 Iu/l, respectively. In the first trimester, alkaline phosphatase was lower and osteocalcin was higher than in the second and third trimesters. In the first trimester of pregnancy, 20 and 40% of women had 25(OH) vitamin D3 < 10 and < 20 ng/ml, respectively, and 19% of women had serum calcium levels < 8.6 mg/dl. CONCLUSION: 60% of women in the first trimester, 48% in the second and 47% in the third trimester had either severe or moderate vitamin D deficiency. It is recommended that the importance of calcium supplements with vitamin D in pregnant women be stressed for these individuals.

Coronary heart disease risk factors and menopause: a study in 1980 Tehranian women, the Tehran Lipid and Glucose Study.

OBJECTIVES: The menopause is associated with an increased incidence of coronary heart disease (CHD). Assessing CHD risk factors in menopausal women can shed more light on the pathogenesis of accelerated atherosclerosis after the cessation of ovarian function. DESIGN: In this study, 1980 women aged 44-69 years were selected from among 15 005 participants in the Tehran Lipid and Glucose Study (TLGS) and assessed for CHD risk factors. They were classified into three groups: premenopausal women (n = 483), aged between 44 and 50 years, without any history of menstrual irregularities; menopausal women (n = 310), with permanent cessation of menses for at least 12 months and a duration of less than 3 years; and postmenopausal women (n = 1187), with at least a 3-year history of cessation of menses. Demographic information including waist size, height, weight and systolic and diastolic blood pressures was recorded, and body mass index, low-density lipoprotein/high-density lipoprotein ratio (LDL/HDL) and waist/hip ratio were calculated. Serum total cholesterol, triglycerides and HDL were measured and an oral glucose tolerance test was performed. The LDL level was calculated using the Friedwald formula. RESULTS: Mean systolic blood pressures were 121 +/- 18, 125 +/- 20 and 136 +/- 23 mmHg (p< 0.001) and mean diastolic blood pressures were 80 +/- 10, 81 +/- 11 and 82 +/- 11 mmHg (p< 0.001) in premenopausal, menopausal and postmenopausal women, respectively. For premenopausal, menopausal and postmenopausal women, mean cholesterol levels were 215 +/- 42, 238 +/- 45 and 245 +/- 46 mg/dl (p< 0.001), respectively. HDL and LDL levels were 44 +/- 11, 48 +/- 12 and 47 +/- 11 mg/dl and 138 +/- 38, 156 +/- 41 and 161 +/- 42 mg/dl (p< 0.001) for premenopausal, menopausal and postmenopausal women, respectively. Mean LDL/HDL ratios were 3.4 +/- 1.4, 3.5 +/- 1.3 and 3.6 +/- 1.2 (p< 0.01) and mean waist measurements were 92 +/- 11, 93 +/- 12 and 95 +/- 12 cm (p< 0.001) for the same groups of women, respectively. However, body mass index, waist/hip ratio and triglycerides showed no significant differences between the three groups. CONCLUSION: These data demonstrate an increase in CHD risk factors in a group of Tehranian women after the menopause.

Contraceptive methods and risk factors of cardiovascular diseases in Tehranian women: Tehran Lipid and Glucose Study.

Combined oral contraceptive (COC) users were reported to be at high risk for vascular thromboembolism and cardiovascular diseases. This cross-sectional study was aimed at determining the prevalence of cardiovascular risk factors in COC users and non-users in Tehran in 1999. The subjects were 2480 married women aged 15-49 years among the 15 000 participants in the Tehran Lipid and Glucose Study. The method of contraception (COCs, intrauterine devices (IUDs), condoms or coitus interruptus) was determined by questionnaire. Blood pressure, height and weight were measured. A 12-14 h fasting blood sample was taken for the determination of serum glucose, cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Two-hour postprandial plasma glucose, after 75 g oral glucose, was measured. Coitus interruptus, COC, condom and IUD were used in 48, 11, 4 and 5% of the individuals, respectively; 32% used no contraception. Serum cholesterol, triglycerides, HDL and LDL rates were within normal limits in all groups. No significant differences were observed in blood pressure, cholesterol, triglycerides and LDL between COC users and non-users. The present findings reveal the safety of COC pills in a group of Tehranian women. We recommend usage of COC pills in these women with respect to the background and confounding factors.

Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1).

OBJECTIVES: Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. This study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban population. METHODS: The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity was determined in 15,005 subjects, aged three years and over, selected by cluster random sampling in Tehran urban district-13 between February 1999 to August 2001. Total energy intake, percent of energy derived from protein, carbohydrate, and fat were assessed in a subsidiary of 1,474 persons by means of two 24-hour dietary recalls. RESULTS: In adults, 78% of men and 80% of women presented at least one CVD risk factor. The percentage of adult women with two or more risk factors was significantly greater than the one for men. Prevalence of DM, hypertension, obesity, high TC, low HDL, high TGs, and smoking was 9.8, 20.4, 14.4, 19.3, 32, 5.3, and 22.3%, respectively. In children and adolescents, two or more CVD risk factors were found in 9% of boys and 7% of girls. Prevalence of hypertension, obesity, high TC, low HDL, and high TGs, was 12.7, 5.2, 5.1, 10.2, and 5%, respectively. The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 57.8 +/- 6.9, 11.1 +/- 1.8, and 30.9 +/- 7.2, respectively. CONCLUSION: The prevalence of cardiovascular risk factors among Tehran urban population is high; particularly of high total cholesterol, low HDL cholesterol levels, and high waist to hip ratio. An effective strategy for life style modification is a cornerstone of a population approach to the cardiovascular risk factors. Moreover, these results will serve as a baseline for assessment of future trends in the risk factors studied.