International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110723Childhood Obesity: A Global Public Health Crisis17ENMasters of Public Health Program, American
Public University.Department of Health Studies,
East Stroudsburg University of Pennsylvania,
East Stroudsburg, PA, USA.2011071620110718<p>Introduction:Childhood obesity is a major public health crisis <br />nationally and internationally. The prevalence of childhood obesity has increased over few years. It is caused by imbalance between calorie intake and calories utilized. One or more factors (genetic, behavioral, and environmental) cause obesity in children. Physical, psychological, and social health problems are caused due to childhood obesity. Hence, effective intervention strategies are being used to prevent and control obesity in children. The purpose of this manuscript is to address various factors infuencing childhood obesity, a variety of interventions and governmental actions addressing obesity and the <br />challenges ahead for managing this epidemic.<br />Methods: In order to collect materials for this review a detailed <br />search of CINAHL, MEDLINE, ERIC, Academic Search Premier <br />databases was carried out for the time period 1999‑2011.<br />Results: Some of the interventions used were family based, school based, community based, play based, and hospital based. The effective school‑based interventions were seen targeting physical activity along with healthy diet education. The major challenges faced by these intervention programs are financial, along with stigmatization of obese children. Governments along with other health care organizations are taking effective actions like policy changing and environmentally safe interventions for children to improve physical activity.<br />Conclusions: In conclusion, childhood obesity can be tackled <br />at the population level by education, prevention and sustainable <br />interventions related to healthy nutrition practices and physical <br />activity promotion.<br />Keywords: Calorie imbalance, childhood obesity, interventions, <br />physical activity, policy changing</p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/263http://ijpm.mui.ac.ir/index.php/ijpm/article/download/263/375International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110716Tuberculosis in Asia and the Pacific: The Role of Socioeconomic Status and Health System Development816ENIMS Health
Shanghai, ChinaAssociate Professor, Department of Public Health Sciences, School of Life Sciences, University of Skovde.2011050320110714<p>Objective: To identify the relationship between socioeconomic <br />status, health system development and the incidence, prevalence and mortality of tuberculosis in Asia and the Pacific.<br />Methods: Incidence, prevalence and mortality rates of tuberculosis and 20 variables of socioeconomic, health system and biological behavioral issues were included in the study involving all 46 countries of the Asian Development Bank region (2007 data). Both univariate and multivariate linear regressions were used.<br />Results: The worst three tuberculosis affected countries were <br />Cambodia, India and Indonesia, while the least affected was <br />Australia. Tuberculosis incidence, prevalence and mortality rate <br />were higher in countries with lower human development index, <br />corruption perception index, gross domestic product (GDP) <br />per capita and countries with more people under minimum food <br />supplements. Among the health system variables, total health <br />expenditure per capita, governmental health expenditure per <br />capita, hospital beds, and access to improved water and sanitation were strongly associated with tuberculosis.<br />Conclusions: Socioeconomic determinants and health system <br />development have significant effect on the control of tuberculosis in Asia and the Pacific region. The study has some policy implications by means of lowering the corruption and improving the sanitation.<br />Keywords: Asia and the Pacific, health system development, <br />socioeconomic status, tuberculosis</p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/179http://ijpm.mui.ac.ir/index.php/ijpm/article/download/179/376International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110727General Practitioners’ Intentions and Prescribing for Asthma: Using the Theory of Planned Behavior to Explain Guideline Implementation1728ENAssociate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical
Sciences and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Iran.Professor Department of Clinical Trials, Center for Health Information Research and Evaluation, Swansea University School of Medicine, UK.2011072620110726Objectives: Limited studies have demonstrated that the Theory <br />of Planned Behavior (TPB) may be able to help in explaining the variation in physicians’ behavior. We selected the management of asthma as the tracer topic because asthma had nationally known clinical guidelines, and the main medicinal therapies used for asthma had limited applications for the treatment of other diseases, and hence, it was possible to trace the relevant prescribing from routine data. In this study we used the TPB to explain general practitioners (GPs) intentions and prescribing in accordance with asthma clinical guidelines.<br />Methods: We surveyed a stratified random sample of 122 GPs <br />in England. The GPs demographic and prescribing data were <br />obtained from routine sources. The participants completed a TPB <br />questionnaire that was developed based on qualitative interviews and had been tested in a pilot study. Regression methods were utilized for data analysis.<br />Results: Forty‑three percent of variance in prescribing intentions <br />was explained by direct TPB measures. Perceived controls were the main predictors of variation in intentions. TPB belief item variables contributed to regression analysis that explained up to 34% of variation in the efficiency prescribing indicators. Effective prescribing indicators were unrelated to TPB variables.<br />Conclusions: Using TPB was helpful in understanding the <br />prescribing intentions of GPs. This could help in promoting the <br />prophylactic usage of inhaler corticosteroids and prevent chronic <br />asthma symptoms and side‑effects. However, further empirical <br />and methodological researches are required.<br />Keywords: Asthma, prevention, control, guideline adherence, <br />primary care physicianhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/278http://ijpm.mui.ac.ir/index.php/ijpm/article/download/278/377International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110803Knowledge and Practice of Iranians Toward Colorectal Cancer, and Barriers to Screening2935ENHealth Education and Promotion Department, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran.MD, MPH. Digestive Diseases Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.MPH, PhD, FFPH, FRSPH. Mental Health Research Group, Mother and Child Health Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.PhD Candidate of Epidemiology, Department of Epidemiology and Biostatistics, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran.2011072720110728<p>Background: Colorectal cancer (CRC) is the third most common <br />malignancy in Iran. Limited data are available on knowledge and barriers in regard to CRC and screening tests in Iran. The aim of the study was to characterize knowledge, practice, and barriers toward CRC and its screening tests among an Iranian at‑risk population.<br />Methods: This cross‑sectional study was conducted with <br />participation of 200 individuals of both genders aged 50 years or older in a teaching hospital in Tehran, Iran. Data were collected via face‑to‑face interviews. A questionnaire containing demographics; knowledge about CRC and screening tests; screening practice; and reasons for not being screened was administered. The reliability alpha for knowledge items was 0.52. <br />Results: The age of the participants ranged from 50 to 83 years <br />(mean 60.13). Overall, 11% of the respondents reported prior <br />screening by either fecal occult blood test (6.5%) or colonoscopy <br />(4.5%). The majority of individuals had poor knowledge although respondents with prior screening obtained slightly higher score in comparison with nonparticipants in screening (26.74 vs. 23.24; P<0.05). Four commonly cited reasons for not having CRC tests were “doctor did not recommend the test,” “did not think it was needed,” “never think of the test,” and “no symptoms/problems” which were reported by 29%, 26%, 20%, and 17% of the participants, respectively.<br />Conclusion: It is necessary to design appropriate educational <br />interventions to increase the general population’s knowledge about CRC and screening before implementing preventive programs in Iran.<br />Keywords: Colorectal cancer, prevention, screening tests</p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/280http://ijpm.mui.ac.ir/index.php/ijpm/article/download/280/378International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110312General Health Status in a Cohort of Iranian Patients with Intentional Self‑poisoning: A Preventive Approach3641ENAssociate Professor of of Toxicology, Isfahan University of Medical Sciences, Isfahan, IranDepartment of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran.PhD, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Clinical Toxicology and
Forensic Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.General Physician, Isfahan University of
Medical Sciences, Isfahan, Iran.2011020220110307Background: Prevention of suicide is one of the most important <br />issues of community medicine in the world. Because of high <br />accessibility of people to different drugs in our society, one of <br />the easiest ways of suicide is intentional self‑poisoning. In this <br />study, demographic factors and health status of the patients with intentional self‑poisoning were evaluated.<br />Methods: A cross‑sectional study was conducted in the poisoning <br />referral center on 384 patients aged 15–40 years who committed intentional self‑poisoning. Information was gathered using two questionnaires about demographic characteristics and the general health status of the patients.<br />Results: 70.5% of the patients had easy accessibility to drugs. Most of the patients were women (62.5%) and single (51%). History of psychological disease was demonstrated in 82.5% of patients. In terms of general health status, the most common problems were social dysfunction (97.57%) and depression (88.9%).<br />Conclusion: Easy accessibility to drugs and psychological problems may increase the risk of intentional self‑poisoning. Being religious and the consequent hopefulness may have a positive protecting effect for the prevention of intentional self‑poisoning.<br />Keywords: Demographic characteristics, general health status, <br />intentional self‑poisoning, suicidehttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/118http://ijpm.mui.ac.ir/index.php/ijpm/article/download/118/379International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110628Methodologies and Messages in Iranian Articles on Maternal Care, Diabetes Mellitus, and Tuberculosis, Published in 2001 – 20064246ENMD, MPH, PhD candidate of Gerontology, Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Tehran, Iran.MD, PhD, School of Public Health, Knowledge Utilization Research Centre (KURC), TUMS-KTE Study Group, Tehran University of Medical Sciences, Tehran, Iran.MD, MPH, Knowledge Utilization Research Centre (KURC), TUMS-KTE Study Group, Tehran University of Medical Sciences, Tehran, Iran.MD, MPH, PhD candidate of Epidemiology, Knowledge Utilization Research Centre (KURC), TUMS-KTE Study Group, Tehran University of Medical Sciences, Tehran, Iran.Student of Masters in Health Education, Knowledge Utilization Research Centre (KURC), TUMS-KTE Study Group, Tehran University of Medical Sciences, Tehran, Iran.DVM, PhD, School of Public Health, Knowledge Utilization Research Centre (KURC), TUMS-KTE Study Group, Tehran University of Medical Sciences, Tehran, Iran.201103142011052220110521<p>Introduction: An article with a clear message can transfer research knowledge better. However, this is the case when the message suits the type of study methodology (research design) and its results. The objective of this study was to assess the presence of message articles and the type of study methodologies.<br />Methods: Articles published between 2001 and 2006, on <br />maternal care, diabetes, and tuberculosis, which were based on <br />studies performed on the Iranian population were investigated. A systematic search was performed in foreign databases ‘Pubmed, Medline, and Embase’, and national databases ‘Iranmedex, SID (Scientific Information Database), and Iranpsych’. Seven hundred and ninety‑five articles were examined for the type of study methodology and presence of an actionable message (one that specifies what and how an action should be carried out).<br />Results: Among the 795 articles accessed, cross‑sectional studies were the most frequent (50.9%) and systematic reviews were the least frequent (0.4%). Cohort cases were observed in 6.9% of the cases. Actionable messages were observed in 22.1% of all the cases and 24.7% of the cross‑sectional studies.<br />Conclusions: Cohort studies increased from 5% in 2001 to 6.9% <br />in 2006, but the shortage of systematic reviews represented a major weakness in the country’s knowledge production process. Studies with a higher level of evidence such as systematic reviews, and cohort and interventional studies should be among the priorities of knowledge production in the country.<br />Keywords: Evidence‑based medicine, knowledge management, <br />knowledge dissemination, knowledge translation, research design</p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/140http://ijpm.mui.ac.ir/index.php/ijpm/article/download/140/380International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110918Protective Role of Selective Nitric Oxide Synthase Inhibitor for Treatment of Decompensated Hemorrhagic Shock in Normotensive and Hypertensive Rats4753ENAssociate Professor of Physiology,
Department of Physiology, Isfahan
University of Medical Sciences,
Isfahan, Iran.Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran.201108142011091820110917Introduction: Different vasoactive factors can modulate <br />cardiovascular adaptation to hemorrhagic shock including Nitric <br />Oxide (NO). In this study we investigated the effect of the NO <br />synthase inhibitor for treatment of decompensated hemorrhagic <br />shock in normotensive and hypertensive rats.<br />Methods: Twenty‑four male Wistar rats were divided into two <br />groups: The normotensive and hypertensive groups. Hypertension was induced by the DOCA‑Salt method for eight weeks. Then, the animals were given hemorrhagic shock by continuously withdrawing blood until the mean arterial pressure (MAP) reached to 40 mmHg. The animals were maintained in the shock state for 120 minutes. Subsequently, they were randomly assigned to L‑NAME‑treated and non‑treated groups and monitored for 60 minutes. The survival time was recorded. Blood samples were taken before and after the shock and 60 minutes after L‑NAME administration.<br />Results: Infusion of L‑NAME caused a significant increase in <br />MAP in normotensive animals, however, slightly increased MAP <br />in hypertensive animals. The heart rate did not significantly alter. Hemorrhage caused a marked increase in serum nitrite levels in both groups (P<0.05). L‑NAME treatment significantly reduced the serum nitrite concentration in the normotensive group (P<0.05), without any change in the hypertensive group. All animals who received L‑NAME treatment survived at the end of experiment. Fifty percent of the hypertensive animals died four hours after the experiment. The 72‑hour survival rate was similar in the L‑NAME treated groups.<br />Conclusion: L‑NAME infusion during decompensated hemorrhagic shock plays a protective role in the improvement of hemodynamic responses and short‑term survival rate in <br />normotensive animals.<br />Keywords: Hypertension, hemorrhagic shock, nitric oxidehttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/306http://ijpm.mui.ac.ir/index.php/ijpm/article/download/306/381International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110712Prevalence of Goiter and Urinary Iodine Status in Six‑Twelve‑Year‑Old Rural Primary School Children of Bharuch District, Gujarat, India5459ENMedical College, Vadodara, Gujarat, IndiaDepartment of Community Medicine,
Medical College, Vadodara, Gujarat, India.2011052720110708<p>Background: Iodine deficiency disorder (IDD) creates major <br />public health problems in India, including Gujarat. The Bharuch <br />district is a known iodine deficiency endemic area. This study was conducted to estimate the prevalence of goiter in primary school children; to determine the median urinary iodine concentration; to assess the level of iodine in salt samples at the household and retail shop levels; and to study the profile of salt sold at retail shops. <br />Methods: This study was carried out by using the 30‑cluster <br />survey method in the primary schools of the rural areas in Bharuch district. A total of 70 students, including five boys and five girls from the first to seventh classes, who were present in class on the day of the visit were selected randomly for goiter examination from each village. Urine samples were collected from one boy and one girl from each class in each cluster. From each community, a maximum of two boys and two girls from each standard in the same age group were examined and also salt samples were tested from their households. From each village, one retail shop was visited and the salt purchased from those shops was immediately tested for iodine with spot kits.<br />Results: We found a goiter prevalence of 23.2% (grade 1 – 17.4% and grade 2 – 5.8%). As the age increased, the goiter prevalence decreased except in nine‑year‑olds. The median urinary iodine excretion level was 110 µg/L. An Iodine level > 15 ppm was found in 93% of the salt samples tested at the household level. <br />Conclusion: The present study showed moderate goiter prevalence in primary school children in the Bharuch district of Gujarat and an inadequate iodine content of salt at some household levels.<br />Keywords: Goitre survey, IDD, prevalence, primary school <br />children, household level</p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/204http://ijpm.mui.ac.ir/index.php/ijpm/article/download/204/382International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110828Patterns of Care Seeking During Episodes of Childhood Diarrhea and its Relation to Preventive Care Patterns: National Integrated Monitoring and Evaluation Survey (IMES) of Family Health. Islamic Republic of Iran6067ENAssociate professor, Department of Pediatrics, Faculty of Medicine,
Ahwaz University of Medical Sciences, Ahwaz, Iran.Associate Professor, Department of Community Medicine, Faculty of Medicine, Guilan University, Rasht, Iran.Assistant Professor of Pediatrics Department, Guilan University of Medical Sciences, Rasht, Iran.Department of Community Medicine, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.2011082620110826<p>Background: In Iran, diarrheal disease is the fourth cause of <br />under five‑year mortality. Proper care‑seeking behavior and <br />system‑based disease management in the national field will have a great effect in reducing morbidity and mortality.<br />Methods: This nationwide study was performed on a target <br />population of rural and urban communities; in all 31 provinces of the Islamic Republic of Iran. One lakh three thousand three hundred and thirty one (103331) families were sampled by multi‑stage stratifed random sampling and were interviewed with a standard data collection form. The collected data was entered into the Stata 8.0 software and analyzed by the survey analysis method.<br />Results: Of the 14625 (10.1%) children who were reported to <br />have diarrheal diseases two weeks prior to the interview, 8.8% <br />were cured and 1.5% were not. About 70% of them had at least <br />one visit for health seeking the most of patients were seen by <br />a rural health worker (Behvarz) in the rural and by a general <br />pediatrician in the urban areas. About 62% of the patients in <br />urban and 57% in the rural areas had been treated with antibiotics and these rates for ORS were 51% and 65%, respectively. The factors most related to a care‑seeking pattern were the level of routine preventive well‑child care, number of siblings, child age, and living area.<br />Conclusion: According to this national survey, our health system <br />needs to integrate all the levels of prevention, especially the <br />Integrated Management of Child Illnesses (IMCI) programs with a family physician project. Futher more, there is a great need for empowering the referral system and gate keeping in all referral levels, to make efficient national integrated programs.<br />Keywords: Diarrhea, antibiotic, health service, national survey, <br />preventive child care, referral system, Iran</p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/329http://ijpm.mui.ac.ir/index.php/ijpm/article/download/329/383International Journal of Preventive Medicine (Int J Prev Med)2008-78023120110716The Effect of Statin Therapy in Stroke Outcome: A Double Blind Clinical Trial160160ENAssociate professor of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Science, Isfahan, Iran.Associate Professor of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Science, Isfahan, Iran.Associate Professor of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Science, Isfahan, Iran.Medical Student, Isfahan Neurosciences Research Center, Isfahan University of Medical Science.Medical student, Isfahan Neurosciences Research Center, Isfahan University of Medical Science.Neurology Department, Isfahan University of Medical Sciences, Isfahan, Iran.201104092011071420110714Background: Through a clinical trial we evaluated statin therapy <br />benefits over stroke outcome.<br />Methods: All patients with moderate stroke in Middle <br />Cerebral Artery (MCA) were registered during February 2006 <br />to February 2008, in Al Zahra Hospital, Isfahan, Iran. Among <br />55 patients who were enrolled in the present study, 25 subjects <br />received 20 mg lovastatin daily, for 90 days after stroke attack <br />(group 1) and 30 patients received no treatment (group 2). Patients were assessed at admission, 7 and 90 days after stroke. National Institutes of Health Stroke Scale (NIHSS) score was recorded in the day 1 and 7 in the hospital with a questionnaire and BARTHEL index was estimated 90 days after stroke incidence by a telephone survey or in an outpatient visit. Data were analyzed by means of χ2 , ‘t’ test and Independent ‘t’ test.<br />Results: NIHSS score measured in first day immediately after <br />stroke attack and following 7 days, did not differ significantly in <br />two groups. Moreover, BARTHEL index recorded within 90 days <br />was not also different comparing group 1 and 2. After 90 days, no mortality was recorded in group 2, while one patient expired in group treating with statins (P‑value>0.05).<br />Discussion: We did not find statins administration to play any <br />role in stroke recovery and consequent long‑term prognosis. More researches with larger samples are needed to establish the possible favorable outcome of statins when administered in cerebrovascular diseases.<br />Keywords: Ischemic stroke, lovastatin, stroke prognosis, statinshttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/160http://ijpm.mui.ac.ir/index.php/ijpm/article/download/160/384