The quality of life of the patients with diabetes type 2 using EQ-5D-5 L in Birjand.

BACKGROUND: Due to high prevalence of diabetes and its complications, evaluating of the patients' quality of life is critical. EQ-5D-5 L is a valid tool for assessing the quality of life in chronic diseases including diabetes. The present study conducted to illustrate the quality of life for the patients who referred to the Diabetes clinic and determine its relationship with their demographic and clinical characteristics in Birjand in 2017. METHODS: In this cross-sectional study, 300 patients with type 2 diabetes were selected through a systematic sampling in 2017. Data were collected using a checklist including patients' demographic, clinical and laboratory information and the EQ-5D-5 L. Data were entered the SPSS (22) software, analyzed by independent sample T-test, ANOVA, Chi-Square and logistic regression tests. Statistical significance was inferred at α = 0.05. RESULTS: Mean age for the participants was 58.1 ± 9.6 years. The mean score for the quality of life based on the EQ-5D-5 L and VAS scale were 0.89 ± 0.13 and 65.22 ± 9.32, respectively. Moderate and severe problems were found in the anxiety/depression dimensions in 12% of the patients, while these numbers for the presence of pain/discomfort and mobility were slightly higher (13.7 and 13.6%, respectively). The mean scores for quality of life and VAS were significantly higher in the men, employed and patients < 50 years age. CONCLUSION: The quality of life for the type 2 diabetes patients is affected by numerous factors including sex, occupation, duration of the disease and the presence of complications such as neuropathy and nephropathy.

Comparison of dialectical behavior therapy and anti-anxiety medication on anxiety and digestive symptoms in patients with functional dyspepsia.

BACKGROUND: Functional dyspepsia is a common chronic digestive disorder. The purpose of this study was to compare the effectiveness of dialectical behavior therapy and anti-anxiety medication in patients with functional dyspepsia. MATERIALS AND METHODS: The present study was a randomized, controlled clinical trial with sixty patients who were suffering from functional dyspepsia that identified by the ROME III criteria. Patients were divided into three groups by using pre- and posttest design, including Group A (dialectal treatment and pantoprazole), Group B (anxiolytic drug treatment and pantoprazole), and Group C (no intervention, only pantoprazole were used). The Beck Anxiety Inventory and the patient assessment of Gastrointestinal Symptom Severity Index Questionnaire were completed by the patients after receiving the written consent. Finally, the data were analyzed using the Statistical Package for the Social Sciences software version 20. RESULTS: There was a significant improvement in the severity of dyspepsia after intervention in all three groups. The greatest decrease in the severity of functional dyspepsia was observed in the dialectical behavioral therapy group as compared to the other groups (Group A: -15.4 ± 6.61, Group B: -3.85 ± 2.77, and Group C: -7.8 ± 4.02; P = 0.001). Furthermore, the Beck Anxiety Inventory scores were statistically significantly improved in all three groups (Group A: -5.75 ± 2.53, Group B: -7.3 ± 3.19, and Group C: -2.60 ± 1.5; P = 0.001). There was a positive correlation between the change in dyspepsia score and change in anxiety score across different intervention groups (r = 0.55; P < 0.001). CONCLUSION: Dialectical behavioral therapy can be effective in reducing anxiety and improving the dyspepsia symptoms in patients with functional dyspepsia compared to anti-anxiety medication or conventional therapy. Therefore, communication between the physicians and psychologists and psychiatrists can have positive effects on the treatment of these patients.

Comparison of platelet number and function between nonalcoholic fatty liver disease and normal individuals.

BACKGROUND: There is interest about the role of platelet (PLT) number and function in nonalcoholic fatty liver disease (NAFLD). NAFLD patients have abnormalities of PLT number and function, especially mean platelet volume (MPV) which is known as a novel biomarker for atherosclerosis. We decided to compare PLT number and function between NAFLD and healthy participants. MATERIALS AND METHODS: In this case-control study, two groups of patients (65 cases with NAFLD and 65 cases without NAFLD) were included consecutively. The diagnosis of NAFLD was made using ultrasound examination of the liver. Venous blood samples were taken, and the required laboratory markers including PLT number and function (MPV, platelet distribution width [PDW]), prothrombin time (PT), partial thromboplastin time (PTT), lipid profile, hepatic transaminases, ferritin, and fasting blood sugar were assayed. RESULTS: Mean (± standard deviation [SD]) MPV in NAFLD group (10.29 ± 0.95 fL) was significantly higher than in control group (9.56 ± 1.18 fL); P < 0.001. No significant difference was observed regarding mean (± SD) PLT count between NAFLD (271.20 ± 52.11 × 103/mm3) and healthy participants (262.86 ± 75.81 × 103/mm3) (P = 0.46). Mean (± SD) PDW values were not significantly different between NAFLD and control groups. Logistic regression showed that NAFLD was positively associated with higher MPV (odds ratio [OR] =1.9, 95% confidence interval [CI] =1.20-3.02) and body mass index (OR = 1.5, 95% CI = 1.05-2.15) values. However, PT (OR = 0.14, 95% CI = 0.02-0.82) and PTT (OR = 0.72, 95% CI = 0.58-0.88) had negative association with NAFLD. CONCLUSION: Higher MPV was found to be significantly associated with NAFLD. However, such significant association was not detected regarding PLT count or PDW. As MPV is a reported risk factor for atherosclerosis, this marker may be useful in follow-up of patients with NAFLD. These findings provide basis for further studies to address this marker in long-term follow-up of NAFLD patients.

Lipid Profiles and Prevalence of Dyslipidemia in Eastern Iranian Adolescents, Birjand, 2012.

BACKGROUND: Cardiovascular risk factors begin in childhood and adolescence. This study aimed at assessing serum lipids and prevalence of Dyslipidemia in 11-18 year old students of Birjand. METHODS: The present cross-sectional, descriptive, and analytical study was done on 2,643 middle and high school students of Birjand aged 11-18 years (1,396 girls and 1,247 boys). Blood samples were collected for the measurement of blood lipids, including Cholesterol, Triglyceride, HDL, and LDL after a 12-hour fasting period. The defined borderline and abnormal values stated in 2011 by the American Academy of Child, was used. RESULTS: According to our results, it is concluded that: (i) 34.3% (31.3% girls and 37.6% boys) of adolescents had at least one dyslipidemia. (ii) 24.7% of the individuals had HDL lower than 40, where 14% of them TG≥130, 6.1% of cases TC≥200, and 3.5% of cases LDL≥130. Lipid disorder within low HDL type and hypertriglyceridemia were significantly higher in boys (P<0.05) than girls. Hypercholesterolemia and hypertriglyceridemia in the age group of 11-14 years and low HDL in the age group of 15-18 years showed the highest values (P<0.05). CONCLUSION: Adolescents of Birjand have high prevalence of dyslipidemia. Preventive measures are recommended to improve lifestyle, including healthy nutrition, encouraging adolescents to exercise, and more mobility.

Correlation of ADC values of adult brain tumors with the diagnosis and pathological grade: A cross-sectional multicenter study.

Background and Aim: Brain tumors are common, requiring physicians to have a precise understanding of them for accurate diagnosis and treatment. Considering that various histological tumor types present different cellularity, we conducted this research to examine the role of apparent diffusion coefficient (ADC) values in the differential diagnosis and pathologic grading of brain tumor types. Methods: In this cross-sectional study, we gathered pathology reports of histological samples of adult brain tumors. The tissue sample of brain tumors were examined histologically by a pathologist. The magnetic resonance imaging data of these patients were interpreted by a neuroradiologist. The measured ADC values and ADC ratios were calculated. Standard mean ADC values were expressed as 10- 6 mm2/s. The findings were compared according to the histological diagnosis of each tumor. Results: Sixty-eight patients were included in the study: 34 (50%) were male, and 34 (50%) were female. The average age of the patients was 51.69 + 16.40 years. In the examination of tumor type, 16 (23.5%) were astrocytoma, 9 (13.2%) were oligodendroglioma, 20 (29.4%) were glioblastoma, 4 (5.9%) were medulloblastoma, and 19 (27.9%) were metastatic tumors. the average value of ADC was statistically significantly different according to the pathological type of tumor (p < 0.001). The two-by-two comparison of average ADC among tumor types revealed significant differences, except for oligodendroglioma and glioblastoma (p-value = 0.87) and glioblastoma and medulloblastoma (p-value = 0.347). The average value of ADC and ADC ratio was statistically significantly different according to the pathological grade of the tumor (p < 0.001). In the two-by-two comparison of average ADC between all pathological grades of the tumor showed a significance difference except for Grade I and Grade II (p-value = 0.355). The mean value of ADC and ADC ratio for glioblastoma and metastatic tumors showed no significant difference. Conclusion: The assessment of brain tumor grade through ADC examination will help to estimate prognosis and devising suitable therapeutic strategies.

The anti-dyslipidemia property of saffron petal hydroalcoholicextract in cardiovascular patients: A double-blinded randomized clinical trial.

BACKGROUND AND AIMS: Dyslipidemia is one of the most important risk factors of cardiovascular diseases (CVDs). Despite developments in pharmacological treatments for dyslipidemia there are several challenges. Recently some herbs highly considered to control dyslipidemia due to their low toxicity and high potency. In this study we investigated the effects of saffron petals on the lipid profile of dyslipidemia patients as well as several other biochemical blood factors. METHODS: In this double blind, placebo controlled, clinical trial, we used systematic random sampling to divide 40 patients with at least two abnormalities in the following factors: (high-density lipoproteins (HDL) ≤40, low-density lipoproteins (LDL) ≥130, triglycerides (TG) ≥200, total cholesterol (Cho) ≥200), into 2 groups of 21 ones. At the end of the intervention period, serum lipid factors, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea, creatinin (CR) and fasting blood sugar (FBS) were measured and statistically compared with their values just before the intervention. RESULTS: We found that the saffron petal pills markedly (P < 0.001) decreased the serum lipid levels of patients (TG, Cho and LDL) in the intervention group (113.81 ± 12.93, 56.52 ± 4.68 and 48.28 ± 3.70) as compared to the placebo group (18.42 ± 15.79, 4.57 ± 4.40 and 7.38 ± 3.54). Also, comparing the mean value of differences in two groups before and after the intervention showed significant reduction in TG (113.81 ± 26), Cho (56.53 ± 0.30) and LDL (48.28 ± 4.30) levels (P < 0.001). CONCLUSIONS: The saffron petal pills considerably reduced blood serum lipid profile and as well as urea and CR of dyslipidemia patients. So, this plant may be used as a potent phytomedicine for treatment and prevention of dyslipidemia and cardiovascular disorders. However, the results indicated that no statistical change was observed in the level of other biochemical blood factors such as ALT, AST, ALP and FBS.

Prevalence of Metabolic Syndrome and Its Associated Potential Factors among the Elderly in the East of Iran.

BACKGROUND AND AIMS: This cross-sectional study aimed to determine potential factors with a strong association with metabolic syndrome (MetS) among obesity and lipid-related parameters, and liver enzymes, fasting blood glucose (FBG), and blood pressure (BP) as well as some sociodemographic factors in elderly over 60 years old from a sample of Birjand Longitudinal Aging Study (BLAS). METHODS: A total of 1366 elderly Birjand participants were enrolled and divided into non-MetS (n = 512) and MetS (n = 854) groups based on the status of MetS from January 2018 to October 2018. The anthropometric parameters, blood lipid profiles, liver enzymes, and disease history were evaluated and recorded. RESULTS: 62.5% of the participants from our sample of elderly Birjand have MetS (33.4% in males and 66.6% in females). The prevalence of MetS in females was significantly higher than in males (P < 0.001). The increasing trend in the number of MetS components (from 0 to 5) was observed in females (p < 0.001). Odds ratio showed a strong association between female gender [8.33 (5.88- 11.82)], obesity [8.00 (4.87-13.14)], and overweight [2.44 (1.76-3.40)] with MetS and acceptable association between TG/HDL [(1.85 (1.62-2.12)] with MetS. CONCLUSION: This study indicated that the female sex, overweight and obesity have a strong association with MetS and TG/HDL has an acceptable association found in the sample of the elderly Birjand population. However, due to the obvious limitations of our study including the homogeneous sex and race of population, and no adjustment for several important confounding factors including sex, different ages, stage in the elderly, alcohol consumption, smoking, married status, physical activity, diet, and family history of CVD, more epidemiological investigations are needed to address this question.

Influenza vaccination coverage rates and other related factors in high-risk groups in Birjand, East of Iran.

Background and Aims: Influenza is an acute respiratory disease with the highest mortality rate in the high-risk groups. Vaccination is a key public health strategy to prevent influenza in high-risk people. This study aimed to assess the influenza vaccination coverage rate and identify its demographic determinants in patients with end-stage renal disease (ESRD), chronic obstructive pulmonary disease (COPD), and diabetes in Birjand, Eastern Iran. Methods: This cross-sectional study included 400 patients (300 diabetic, 60 dialysis, and 40 COPD patients) from September 2017 to August 2018. Using interview method, we completed a questionnaire containing the patients' demographic characteristics, questions about patients' knowledge and attitude toward influenza vaccination, the influenza vaccination history, and the most common causes for vaccination. The relationship between the type of disease and patients' characteristics (exposure) with vaccination coverage (outcome) was investigated. Results: The mean age of participants was 58.7 ± 11.3 years. Also, 58.8% of the patients received at least one dose of the vaccine and the regular injection rate was 32.8%. The coverage of influenza vaccine in dialysis patients was significantly higher than other patients (p < 0.001). The mean knowledge score was 6.17 ± 2.15 out of maximum 9 scores. There was a positive association between age [p = 0.001, odds ratio (OR) = 1.04] and patients' knowledge (p < 0.001, OR = 1.42) with the vaccination coverage. Conclusion: The coverage of influenza vaccine in high-risk patients in Birjand was low. Hence, it is essential to increase the knowledge of high-risk groups about the importance of influenza vaccination and facilitate their access to vaccines.

The Assessment of Reliability and Validity of Persian Version of the Endometriosis Health Profile (EHP-30).

BACKGROUND: The Endometriosis Health Profile-30 (EHP-30) is a disease-specific questionnaire to measure the health-related quality of life in patients with endometriosis. The aim of this study was to evaluate the validity and reliability of the Persian version of Endometriosis Health Profile (EHP-30) in women with endometriosis referring to three Gynecology Clinics in Tehran, Iran. METHODS: One hundred women (20 to 50 years old) with surgically confirmed endometriosis recruited from three outpatient Gynecology Clinics affiliated to the Iran University of Medical Sciences. All 100 patients were asked to complete EHP-30 questionnaire while referring to the Clinics. The findings were analyzed using descriptive statistics, internal reliability consistency, construct validity (using short form-36, which had already been validated in Iran), factor analysis (with principle component analysis method), and item total correlation to assess the validity and reliability of the questionnaire. RESULTS: The internal consistency reliability of the questionnaire was high (Cronbach's α ranged between 0.80 and 0.93 for core, and 0.78 and 0.90 for modular parts). All items were loaded on their own factors except item 17 (feeling aggressive or violent) and item 18 (feeling unwell), which were loaded on pain and social support domains, respectively. Construct validity of EHP-30, established by using SF-36, indicates good correlations in several similar scales of these two questionnaires. CONCLUSION: The findings of the study demonstrate that Persian version of EHP-30 is a valid and reliable measure to assess the quality of life in women with endometriosis.

The Effect of Self-Care Training on Blood Sugar Control, HbA1C Level, and Life Quality of Diabetic Patients in Birjand, East of Iran: A Randomized Clinical Trial Study.

BACKGROUND: As one of the most important public health problems worldwide, diabetes is closely linked with patients' lifestyles. The optimal approach to treating diabetes is to prevent it. Our aim in this study was to assess the impact of self-care behaviors on quality of life, blood sugar control, and HbA1C level in patients with type 2 diabetes. METHODS: This randomized clinical trial examined 100 diabetic women referred to Ghadir Comprehensive Health Center in Birjand in 2019. A 5 cc fasting blood sample was taken from each participant. The participants were randomly assigned to experimental and control groups. For the experimental group, a 10-session self-care training workshop was held. Baseline and postintervention fasting blood glucose, HbA1C level, and life quality of the two groups were assessed and compared six months after the intervention. Data were analyzed in SPSS (16). RESULTS: In the experimental group, the mean serum HbA1C level decreased from the baseline 7.5 ± 1.5 to 6.3 ± 1.0 (P < 0.001). Fasting blood sugar in the intervention group decreased from 136.3 ± 43.5 to 127.3 ± 22.9, but the reduction was not significant (P=0.322). The mean scores of the quality of life (P=0.002) and the visual analogue scale (P < 0.001P < 0.001) in the experimental group increased significantly compared to the control group. CONCLUSION: Self-care training for diabetic women had positive effects on both life quality and disease control. Therefore, it is recommended that self-care training be delivered and taken more seriously by physicians and health care providers in addition to drug therapy.

The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran.

BACKGROUND AND OBJECTIVES: Taking unnecessary or inappropriate prophylactic antibiotics can cause infections with resistant organisms. The present study aimed to investigate administration prophylactic antibiotics in surgery ward and its compliance with standard protocol in Imam Reza teaching hospital of Birjand, Iran. MATERIALS AND METHODS: This descriptive-analytical study was performed to evaluate the pattern of prophylactic antibiotics on patients who underwent surgical operations from October to December 2019. A checklist including demographic information, type of prophylactic antibiotics, dose and duration of using drug, type of surgery, and compliance with standard protocol was used. The validity and reliability of the checklist were evaluated and confirmed prior to the study. All eligible patients were enrolled and the information of the prescribed drugs in the surgical wards was compared with the Schwartz's principles of surgery as standard protocol. RESULTS: Out of a total of 300 patients, 187 (62.3%) were male. Among the patients, 155 (51.7%) cases underwent general surgery, 119 (39.6%) cases orthopedic surgery, and 26 (8.7%) cases neurosurgery. The most popular prescribed antibiotics were cefazolin (170 cases) and ceftriaxone + metronidazole (67 cases). Furthermore, the maximum antibiotic administrations were two days (127 cases) and one day (93 cases). More importantly, 67.7% and 92.3% of the patients were in compliance with the standard protocol in terms of the type and time of administration, respectively. CONCLUSION: Our results showed that duration and route of administrating antibiotics were consistent with the standard protocol, but the type of drugs and indication did not match.

Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines.

BACKGROUND: Vancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines. SETTING: The study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013. METHODS: This retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen. RESULTS: The average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7%) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4%) and 28 (10.6%) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21% and 62% of all patients exhibited complete and partial recovery, respectively. We found that 90% of the cases showed compliance with the HICPAC recommendations. CONCLUSION: Comprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug.

Ceftriaxone-associated nephrolithiasis and gallstone in adults.

BACKGROUND: Ceftriaxone (CTX) is widely used for the treatment of bacterial infections; however, side effects such as gallstone and nephrolithiasis have been reported in children. There is limited information about urinary tract calculi as CTX side effects in adults. Therefore, the present study was aimed to evaluate the incidence of gallstone and nephrolithiasis following CTX administration. METHODS: The present study was conducted in the Vali-e-Asr Hospital. Eighty-four patients with various infectious diseases with different daily treatment (mean ± SD: 4.19±2.54) were included in this study, consisting of 49 females and 35 males. The mean of total doses used in patients was 10.2143 (SD: 5.8585). To detect possible gallstone, gallbladder sludge, and urolithiasis, patients were evaluated by serial ultrasound before and after CTX treatment. Patients with renal and hepatobiliary dysfunction were excluded from the study and did not receive any nephrotoxic drugs during this study. Demographic parameters including age, sex, body mass index, dosage of CTX, as well as the duration of treatment and hospitalization were determined. Statistical significances were determined using Fisher's exact test and independent t-test. RESULTS: Results from our study showed that the incidence of gallstone and nephrolithiasis were 8.8% and 1.5% following CTX administration, respectively. Surprisingly, we found a significant correlation in terms of age between patients with and without gallstone (P=0.03). CONCLUSION: Our findings suggest that the patients' age might play a role in the development of such a complication. This indicates the need for a close monitoring of CTX-treated patients to assess the possible formation of gallstone and nephrolithiasis.

The role of expression and activity of 15-Lipoxygenase isoforms and related cytokines in patients with Multiple Sclerosis and healthy controls.

BACKGROUND: Multiple Sclerosis (MS) as an inflammatory multifactorial auto immune nervous system disease imposes devastating burden of morbidity worldwide. Among environmental and genetic factors, the relevance of inflammatory mediators in MS pathogenesis is well documented. 15-Lipoxygense enzyme and its derived products have received attention as possible mediators of inflammatory responses. The involvement of 15-Lipoxygense pathway in the pathogenesis of inflammatory diseases such as MS has yet to be illustrated which is perused in the current study. METHODS: The expression level of 15-Lipoxygense isoforms was assessed via Real-Time PCR in the peripheral blood mononuclear cells separated from patients with MS and healthy subjects. The level of 15-Lipoxygense products (15(S) HETE, 13(S) HODE) and related cytokines (IL4 and IL13) were evaluated using enzyme immunoassay kits in serum samples. RESULTS: Our results demonstrated that 15-Lipoxygense-1 and 15-Lipoxygense-2 expression levels were increased in patients suffering from MS comparing to healthy subjects which were more obvious in Relapsing-Remitting MS. The elevated levels of 15-Lipoxygense isoforms were accompanied with 15(S) HETE and 13(S) HODE enhancement in serum of patients and the IL 13 elevation but not IL4 was consistent with higher expression of 15-Lipoxygense. The diagnostic value of 15-Lipoxygense isoforms and products were considerable between patients and healthy groups. CONCLUSION: The possible effect of 15-Lipoxygense pathway in the regulation of inflammatory events may light up new therapeutic possibilities regarding MS pathogenesis.

Prevalence of Burnout Syndrome and Associated Factors Among Rural Health Workers (Behvarzes) in South Khorasan.

BACKGROUND: Essential primary health care is delivered through the public health center PHC network by public health workers (Behvarzs). Health workers are exposed to different types of stresses while working. OBJECTIVES: The aim of this study is to determine the prevalence of burnout and associated factors among rural health workers in the health centers of Birjand University of Medical Sciences. PATIENTS AND METHODS: All rural health workers of health centers under the coverage of the Birjand University of Medical Sciences selected through census sampling participated in this cross-sectional study. The Maslach Burnout Inventory, GHQ-12 questionnaire, and demographic questionnaire were completed by the participants. Data were analyzed by SPSS 15 using descriptive statistics, chi-square (χ2), t-test, and ANOVA test. RESULTS: A total of 423 health workers participated in this study, and their mean age was 39 ± 8.4 years. Among the participants, 34.5% had moderate to severe levels of burnout. About 31.4% of the subjects had abnormal scores in emotional exhaustion, 16.8% in depersonalization, and 47% in the personal accomplishment subscales. The rate of abnormal mental health among the participants was 36.68%. The prevalence of mental disorders was 24.5% in subjects with low burnout or without burnout against 60.4% of subjects with moderate or severe burnout (P = 0.001). Age, education level, number of children, and years of employment were found to have a significant association with the burnout level of the participants (P < 0.05). CONCLUSIONS: Burnout was prevalent among health workers. Based on the high level of burnout among health workers, reducing job ambiguity/conflict, participating in planning new programs, and improving interaction with health authorities may help them to overcome their job-related pressure and to give a more desirable performance.

Prevalence of Dyslipidemia among Elementary School Children in Birjand, East of Iran, 2012.

BACKGROUND: Various studies have indicated that dyslipidemia starts in childhood. There is a relationship between the concentration of blood lipids and atherosclerosis. In this study, we assessed the prevalence of dyslipidemia in elementary school children. METHODS: This cross-sectional study was performed on 1,626 (882 girls and 744 boys) elementary school children aged between 6 and 11 years in Birjand in 2012. Samples were selected through multistage random sampling. The lipid profiles (i.e., cholesterol, triglyceride, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C]) of the subjects were measured after 12 hours' fasting. The definition of dyslipidemia was based on the criteria of The American Children Academia in 2011. RESULTS: Dyslipidemia (at least one abnormal level of a serum lipid) was detected in 31% of the children (31.3% of the girls vs. 30.6% of the boys). Total cholesterol was ≥ 200 mg/dL in 13.4% of the children, LDL-C was ≥ 130 mg/dL in 8.5%, HDL-C was < 40 mg/dL in 11.3%, and triglyceride was ≥ 130 mg/dL in 15.3%. The prevalence of hypertriglyceridemia was significantly higher in the females than in the males (16.3% in the girls vs. 13.8% in the boys; p value = 0.01) - while hypercholesterolemia (12.2% in the girls vs. 14.9% in the boys; p value = 0.16), high LDL-C (8.5% in the girls vs. 8.5% in the boys; p value = 0.05), and low HDL-C (12.7% in the girls vs. 9.5% in the boys; p value = 0.1) were not significantly different between the two sexes. CONCLUSION: The prevalence of dyslipidemia was high in the school children in Birjand and, thus, requires preventive measures.

Seroprevalence and Risk Factors for Hepatitis B in an Adult Population: The First Report from Birjand, South Khorasan, Iran.

BACKGROUND: Infection with the hepatitis B virus (HBV) is an important global health problem. Knowledge of the geographic distribution pattern of HBV infection can help to control the spread of the disease. OBJECTIVES: To determine the prevalence of HBV infections and risk factors for the disease for the first time in Birjand, Southeastern Iran. METHODS: This was an analytical cross-sectional study conducted in 2013 - 2014 of 5235 HBV cases in Birjand, South Khorasan Iran. Subjects aged 15 - 70 y were selected using the cluster sampling method. Blood samples were taken and tested at a reference laboratory for the hepatitis B core antibody (anti-HBc). Seropositive specimens were tested for the hepatitis B surface antigen (HBsAg). RESULTS: The mean age (± SD) was 39.07 (± 14.04) y, and 786 (15%) subjects were anti-HBc positive. The prevalence of HBsAg was 1.6% (n = 85). The prevalence of anti-HBc seropositivity was significantly higher in subjects with a lower level of education (P = 0.09), older subjects (P = 0.001), intravenous (IV) drug users (P<0.05), subjects with piercings (P < 0.001), and subjects with a positive history of familial HBV or HCV infection (P < 0.05). It was also significantly higher in those who drank alcohol (P = 0.09) or had a history of blood transfusions (P = 0.001), cupping (P = 0.004), hospital admission (P = 0.03), or endoscopy (P = 0.002). The rate of HBsAg positivity was significantly higher in subjects with a history of cupping (P=0.03), a positive history of familial HBV or HCV infection (P < 0.05), and older subjects (P = 0.015). CONCLUSIONS: Although the frequency of HBsAg seropositivity in the present study was close to that observed in the overall Iranian population, the seroprevalence of anti-HBc was higher, possibly due to the exposure of the elderly to more risk factors. The risk factors were similar. These included a history of blood transfusions, cupping, hospital admission, endoscopy, or familial HBV/HCV infection, in addition to piercings and drug abuse.

The Prevalence of Diabetes and Prediabetes Among Elementary School Children in Birjand.

BACKGROUND: Diabetes is associated with increased cardiovascular disease, mortality and morbidity. OBJECTIVES: The present study aimed at assessing fasting blood sugar (FBS) in elementary school students in Birjand, 2012. MATERIALS AND METHODS: This cross-sectional and descriptive study was done on 1530 elementary school students who had been selected through multiple cluster sampling. FBS of these students was tested applying the enzymatic process. The obtained data was analyzed by means of SPSS software (v15) and statistical tests t and X(2). RESULTS: In this study, 833 girls and 697 boys were evaluated. Mean FBS of the whole study population was 86.9 ± 8.8 mg/dL; FBS was higher in boys compared to girls. FBS of 1453 (95%) children was < 100 mg/dL, the mean being 85.8 ± 6.8 mg/dL. FBS of 698 (45.6%) students of the above population was 86-99 mg/dl. It was 100-125 mg/dL in 72 (4.7%) individuals. Five (0.3%) students had FBS >126 mg/dL. Mean FBS increased in proportion to age, which was statistically significant. CONCLUSIONS: Although the prevalence of diabetes is not considerable; however, based on the relatively high portion of those children with high degree of blood glucose in the range in which the risk of diabetes and prediabetes in the following years rises dramatically, the need for further care of health authorities, an extensive screening activity, and undertaking intervening measures to prevent the epidemic of diabetes and consequently cardiovascular disease is emphasized.

Prevalence of Metabolic Syndrome in Elementary School Children in East of Iran.

INTRODUCTION: Metabolic Syndrome (MS) in children and adolescents is becoming a global public health concern. MS tracks into adulthood increasing the risk for type 2 diabetes mellitus and cardiovascular diseases. This study was designed to verify the rate of MS in elementary school students of Birjand, as a representative sample of Iranian children to verify the best preventive measures in this age group. METHODS: This descriptive-analytical, cross-sectional study was performed on 1425 elementary school children through multiple-cluster sampling in 2013. Height, weight, waist circumference and blood pressure of children were measured by standard methods. Blood glucose, triglycerides, cholesterol, High-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) levels were also measured after 12 hours fasting. MS was defined according to the Adult Treatment Panel III (ATP-III) based on the National Cholesterol Education Program. Data were analyzed by SPSS using t test and chi-square test. Significance level was set at P < 0.05. RESULTS: The prevalence of MS was 5.3% which increased with age. 43.5% of the studied cases had one or more components of the MS. The most common components were hypertension, abdominal obesity, hypertriglyceridemia, low HDL-cholesterol and impaired fasting glucose, respectively. MS prevalence was 0.9% in normal weight, 11.3% in overweight and 36.2% in obese children. CONCLUSION: Regarding the high prevalence of MS in elementary school children in our region, screening for obesity is recommended to prevent adulthood complications. Therapeutic lifestyle changes and maintenance of regular physical activity are the most important strategies for preventing childhood obesity.

Prevalence of high normal FBS and prediabetes among adolescents in Birjand, East of Iran, 2012.

BACKGROUND AND OBJECTIVES: To determine the prevalence of impaired fasting glucose in adolescents in Birjand city in eastern Iran. MATERIALS AND METHODS: This cross-sectional study was done on 2653 students aged 11-18 years selected through multi-stage stratified and random sampling. Fasting blood glucose (FBS) of these students was measured applying the enzymatic process. The obtained data were analyzed by means of SPSS software (V: 15) and statistical tests T and X2. RESULTS: The mean age of individual was 14.5 ± 2 years. Mean FBS of the whole population was 89.8 ± 9.8 mg/dl, but it was significantly higher among boys than girls (P < 0.001). Out of the whole subjects (92.4%), 1,328 (95.1%) of the girls and 1,122 (89.3%) of the boys, FBS was less than 100 mg/dl among whom 64.4% had FBS above 86 mg/dl. In 200 subjects (7.5%) of whole population, FBS was 100-125 mg/dl; with that of the boys was 2.3 times than the girls revealing a prediabetes condition: OR = 2.3(CI: 1.7-3.2). Among the students, 3 (0.1%) had an FBS > 126 mg/dl. Mean blood glucose was significant regarding age and sex. CONCLUSIONS: High prevalence of high FBS (within normal range) among adolescents is warning and requires special attention of health officials. Screening of children and adolescents in order to identify those at risk and plan for intervening is urgent to prevent type-2 diabetes epidemic and following cardiovascular complications in the Society.