Socioeconomic status and mortality after acute myocardial infarction: a study from Iran

<p>Abstract</p> <p>Background</p> <p>Studies have shown an inverse relationship between socioeconomic status (SES) and mortality due to coronary heart disease (CHD). Little is known about this association in Iran. This study aimed to investigate whether mortality after myocardial infarction (MI) varies by SES.</p> <p>Methods</p> <p>In a retrospective study, 1283 MI patients who hospitalized in Tehran Heart Center from March 2005 to March 2006 were followed up in March 2008. Demographic, clinical and SES data were collected from case records and by telephone interviews. Multiple logistic regression analysis was performed to estimate the predictive effect of socioeconomic factors on outcome.</p> <p>Results</p> <p>In all 664 patients were studied. Of these, 500 patients were alive and 164 were dead due to MI (64 died at hospital and 100 died at home). The results of regression analysis showed that in addition to treatment (OR = 9.52, 95%CI 4.84-18.7), having diabetes (OR = 1.78, 95% CI 1.12-2.81) or hyperlipidemia (OR = 1.82, 95% CI 1.14-2.90), socioeconomic variables including living area in square per person (lowest level vs. upper level OR = 4.92, 95% CI 2.11-11.4), unemployment (OR = 3.50, 95% CI 1.50-8.13) and education (OR for illiterate patients = 2.51, 95% CI 1.00-6.31) were the most significant contributing factors to increased mortality after MI.</p> <p>Conclusion</p> <p>Although the findings should be interpreted with caution, the study results indicated that socioeconomic variables were significant contributing factors to increased mortality after myocardial infarction. The underlying role of socioeconomic status on increased mortality after MI deserves further investigation.</p

The association between serum lipids profile and HbA1c in type 2 diabetes mellitus in Tehran, Iran

Background and aims: Dyslipidemia is one of the major factors implicated in the development of the vascular complications of diabetes. In this study, it was evaluated the association between serum lipids profile and Hemoglobin A1c (HbA1c) in type 2 diabetes mellitus. Methods: In this cross-sectional study, the serum lipid profile and HbA1c was studied on 562 Iranian patients who were older than 30 years and had type 2 diabetes identified from the diabetes and metabolic diseases clinic of endocrinology and metabolism research institute. A Multiple Linear Regression analysis was also done with the HbA1c as outcome variable and serum lipids profile as predictor variables; adjusted for potential confounders (age, sex, diabetes duration and Body Mass Index (BMI)). Results: In 1966, 6.34 of the national total population was over 60 years compared to mean age of the participants that was 61.6±10.4 years, with a range of 32 to 89 years. The results confirmed that the Triglyceride (TG) (β: 0.11, 95 CI: 0.000-0.004, P=0.01) and cholesterol (β: 0.13, 95 CI: 0.000-0.009, P=0.04) were correlated with the HbA1c value but there were no significant association between HDL and LDL. Conclusion: This study demonstrated that in persons with type 2 Diabetes Mellitus (DM), HbA1c value is a good predictor of lipid profile. Therefore, lipid profiling for all persons with type 2 DM should be a routine test

How within-city socioeconomic disparities affect life expectancy? Results of Urban HEART in Tehran, Iran

There is substantial lack of knowledge about the role of socioeconomic status (SES) indicators on life expectancy (LE) within-cities, especially within mega-cities. We aimed to investigate the disparities of LE within city districts of Tehran, Iran, and specify how SES inequalities play role on LE.; The death and population data for 2010 by different age, gender, and residency district were obtained from the main cemetery of Tehran and statistical centre of Iran, respectively. Age-specific mortality rates and consequently LE were calculated for all 22 districts by different genders. Finally, based on the results of first Tehran's Urban Health Equity Assessment and Response Tool (Urban HEART) project in 2008, the influence of social classes (SCs), total costs, and education indicators were analyzed on LE at birth (e0).; The e0 for total males and females in Tehran were calculated as 74.6 and 78.4 years for 2010, respectively. The maximum LE of 80 years was observed in females of northern part with higher SES, and the minimum e0 of 72.7 years observed in males of southern part with lower SES. The e0 gender gap among districts was 5.5 years for females and 3.7 years for males. The highest and lowest mean of e0 observed in SC1 (highest class) and SC5 (lowest class), were 77.6 and 76.0 years, respectively. The lowest mean of e0 observed in the first group of total costs indicator and was 76.2 years. In addition, the lowest observed mean of e0 was in the first category of education indicator (illiterate) and was 76.0 years.; RESULTS indicate substantial disparities in LE within city districts. This confirms that SES disparities within-cities would have direct influences on LE

Prevalence of Multidrug Resistance Mycobacterium Bovis in Human: A Systematic Review and Meta-Analysis

Introduction: Human infection with multidrug resistant mycobacterium bovis (MDR-M.bovis) is very rare.  Recently, infection with this type of bacteria has been described. The WHO strategy to end TB by 2035, recall for more efforts in the diagnosis and treatment of mycobacterium bovis particularly in resource limited countries. The aim of this systematic review was to determine the prevalence of multidrug resistant tuberculosis M.bovis infects human. Methods: International database including Medline, EMBASE, and Web of Sciences, Scopus, and ScienceDirect were searched for related literature. Google Scholar searching engines as well as references list were explored. Studies met the inclusion criteria were included in the systematic review. Random effects model was used to estimate the pooled prevalence. Results: A total number of (4275) studies were retrieved and nine studies were included in the meta analysis. The overall estimated prevalence of the multidrug resistant Mycobacterium bovis was 0.04 (95% CI: 0.02, 0.06). Based one study quality, time and area of study, subgroup analysis were conducted to check for heterogeneity. The prevalence of MDR-M bovis in low quality studies was 0.04 (95% CI: 0.00, 0.06), and in high quality studies was 0.05 (95% CI: 0.02, 0.08). Conclusions: The finding of this study indicated that the prevalence of multidrug resistant M.bovis in human is low. However, more attention is needed in the diagnosis and treatment of M.bovis infection in Human. Keywords: Tuberculosis, Multidrug-Resistant     Mycobacterium bovis     review  meta-analysis   Human DOI: 10.7176/JHMN/69-01 Publication date: December 31st 201

Residential segregation of socioeconomic variables and health indices in Iran

Background: Measures of segregation are essential tools for evaluation of social equality. They describe complex structural patterns by single quantities and allow the comparison of inequalities over time or between residential places. In many countries, patterns of residential segregation are well described (e.g., South Africa, Great Britain, United States of America). In this study, for the first time in Iran, we measured residential segregation for some socioeconomic and health variables and described their pair wise correlation. Methods: We measured evenness dimension of segregation by generalized dissimilarity segregation index and information theory index and its ordinal equivalent for some determinants of socioeconomic status and health variables using data of last national census in Iran. Segregation indices were computed for 31 socioeconomic variables and four health indices. Results: All the provinces were in the category of low segregation for individual and family disability and death of at least one offspring of mother, but for infant mortality half of the provinces were moderately or highly segregated. For some of socioeconomic variables, many provinces were in the category of moderate, high, or extreme segregation. There was significant correlation between segregation of heath indices and some socioeconomic variables. Conclusions: Correlation of segregation of determinants of socioeconomic status with segregation of health indices is an indicator of existence of hot zones of health problems across some provinces. Further studies using multilevel modeling and individual data in health outcomes at individual level and segregation measures at appropriate geographic levels are required to confirm these relations

A community assessment model appropriate for the Iranian community

Community assessment is one of the core competencies for public health professionals; mainly because it gives them a better understanding of the strengths and drawbacks of their jurisdictions. We planned to recognize an appropriate model that provides a conceptual framework for the Iranian community.This study was conducted in Tehran, during 2009-2010 and consisted of two parts: a review of the literature and qualitative interview with selected experts as well as focus group discussion with health field staff. These steps were done to develop a conceptual framework: planning for a steering committee, forming a working committee, re-viewing community assessment models and projects, preparing the proposed model draft, in-depth interview and focused group discussions with national experts, finalizing the draft, and preparing the final model.Three different models published and applied routinely in different contexts. The 2008 North Carolina Community Assessment model was used as a reference. Ten national and 18 international projects were compared to the reference and one and six projects were completely compatible with this model, respectively.Our final proposed model takes communities through eight steps to complete a collaborative community assessment: form a community assessment team, solicit community participation and gain inter-sectoral collaboration, establish a working committee, empower the community, collect and analyze community's primary and secondary statistics, solicit community input to select health priorities, evaluate the community assessment and develop the community assessment document, an develop the community action plans

Risk factors for amputation in patients with diabetic foot ulcer in southwest Iran: a matched case-control study

OBJECTIVES: Amputation is a multifactorial complication in diabetic patients. The aim of this study was to determine the risk factors associated with amputation in patients with diabetic foot ulcers. METHODS: This matched case-control study was conducted based on new cases of amputation from March 2012 to November 2014. We selected new cases who had undergone amputation, and the control group was chosen from the cities or areas where the cases resided. Each case was matched with two controls based on the duration of diabetes and location. Conditional logistic regression was used to evaluate the associations between potential risk factors and amputation. RESULTS: A total of 131 cases were compared with 262 controls. The results of the adjusted model showed that sex (odds ratio [OR], 8.66; 95% confidence interval [CI], 2.68 to 27.91), fewer than two hemoglobin A1c (HbA1c) tests per year (OR, 13.97; 95% CI, 4.97 to 39.26), unsuitable shoes (OR, 5.50; 95% CI, 2.20 to 13.77), smoking (OR, 3.44; 95% CI, 1.45 to 8.13), and body mass index (OR, 1.20; 95% CI, 1.03 to 1.41) were associated with amputation in diabetic patients. CONCLUSIONS: The most important factors associated with amputation were females, irregular monitoring of HbA1c levels, improper footwear, and smoking. Developing educational programs and working to ensure a higher quality of care for diabetic patients are necessary steps to address these issues

Higher Education Initiatives for Disaster and Emergency Health in Iran

Iran’s health system is expanding the disaster and emergency higher education programs over the country to enhance the capacity of human resources for effective and efficient disaster mitigation, preparedness, response and recovery. In this article we present an overview about the initiatives and progress of disaster and emergency health higher education in Iran. Following the Bam earthquake, in collaboration with the Ministry of Health & Medical Education and National Institute of Health Research, School of Public Health at the Tehran University of Medical Sciences, Iran took the initiative to develop a Master of Public Health (MPH) with disaster concentration in 2006, a PhD in disaster and emergency health in 2011, and a well constructed certificate course in 2008 entitled Disaster Health Management and Risk Reduction (DHMR). Iran, Kerman and Shahid Beheshti Universities of Medical Sciences and University of Social Welfare and Rehabilitation are other academia that joined this initiative. Regarding the importance of programs evaluation, we have planned for a comprehensive evaluation of MPH and DHMR programs in 2013-4 and the Accreditation and Evaluation Board of Disaster & Emergency Health, based in MOH&ME, is responsible for evaluation of the PhD program in 3-5 years from initiation