Journal of community health research

129-130

Authors: Seyedeh Mahdieh Namayandeh , Seyedeh Sara Mousavi , Mina Arabian , Javad Kheirandish , Habib Dehghani Ashkezari

Dear Editor, According to the International Agency for Research on Cancer (IARC), Asia has the highest death rates and incidence of breast cancer; 27% of all cancers that occur among women in Iran are attributed to breast cancer. The role of obesity in breast cancer development has been known for decades. S strong evidence exists on the idea that obesity and weight gain during adulthood are associated with increased risk of postmenopausal breast cancer. Furthermore, growing evidence is available on the association of obesity with breast cancer and overall mortality rate in women’s premenopausal and postmenopausal periods (1). Evaluation of the breast cancer risk helps identification of the women with the high risk of developing breast cancer in the future. Some strategies to reduce this risk involve adopting a healthier lifestyle as well as involving diet and exercise in everyday life (2). Obesity and overweight are defined by Body Mass Index (BMI). The effect of high BMI on breast cancer was assessed in selected studies using the odds ratio (OR). The results of the data analysis using the random effects method showed that the risk of breast cancer was higher among the people with obesity (BMI ≥ 30): Pooled OR = 1.81, 95% CI = 1.24 - 2.64 and for overweight (30 > BMI ≥ 25): Pooled OR = 1.46, 95% CI = 1.13 - 1.89(3). According to the care plan for risk factors in non-communicable diseases (Steps 2016), the prevalence rates of obesity and overweight were 29.77% and 34.96% among Iranian women, respectively. Furthermore, population-attributable fractions of these diseases were 13.32% and 11.01%, respectively, which indicates that by eliminating obesity and overweight factors, we can expect 24.33% reduction in the population’s breast cancer. For instance, a well-designed randomized controlled trial in children with a particular disease found that 20% of the control group developed bad outcomes compared with only 12% of the individuals who received treatment. Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. In this example, the ARR is 8% (20% - 12% = 8%), which means that, if 100 children were treated, 8 would be prevented from developing bad outcomes. Another way of expressing this is the number needed to treat (NNT); that is the number of people who must be treated to benefit one person. It is the inverse of absolute risk reduction. If 8 children out of 100 benefit from a treatment, the NNT for one child to benefit is about 13 (100 ÷ 8 = 12.5)(4). A randomized, controlled, primary prevention trial was conducted in 40 US clinical centers from 1993 to 2005. In this study, a total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer were enrolled. Women were randomly assigned into the dietary modification intervention group (40% [n = 19,541]) and the control group (60% [n = 29,294]) (5). The baseline characteristics of BMI and breast cancer incidence indicated that overweight ARR rate equals 0.0025 that is 0.25% (NNT: 400), obesity ARR equals 0.0012 i.e., 0.12% (NNT: 833.33) and obesity grade 2 and more equals 0.0033 that is 0.33% (NNT: 303.03). In other words, by treating 400 patients suffering from overweight and 833.33 patients suffering from obesity, we can prevent one case of breast cancer. Overweight, obesity, and abdominal fat are associated with the risk of developing breast cancer in women during the premenopausal and postmenopausal periods. Therefore, in order to prevent breast cancer and its complications, an intervention program should be implemented to control obesity and a breast cancer screening program should be conducted among the obese and overweight women (6). Governments are responsible for maintaining, restoring, and promoting health in the community. In order to make the right decisions and direct resources of the health sector, the most common cancer in women should be investigated as a priority for the health system. Therefore, a special study of breast cancer is necessary considering the mortality rate and disability. In this regard, we decided to investigate the most relevant risk factor and evaluate the risk associated with breast cancer by reviewing articles related to breast cancer. Later, we examined the most effective interventional strategies in this area. Consequently, given high prevalence of the overweight and obesity, intervention plans should be implemented to reduce the risk factors of the breast cancer.

139-147

Authors: Mahnaz Saremi , Rohollah Fallah Madvari , Fereydoon Laal , Najaf Noorizadeh , Ebrahim Rahimi

Introduction: Firefighting is one of the occupations that require high physical and aerobic power due to the nature of the job and the physical demands of this profession. Therefore, the present study aimed to investigate the relationship among Work ability index (WAI), mental workload, musculoskeletal disorders (MSDs) and their effective factors in firefighters. Methods: This study was a cross-sectional study, which was carried out on 250 firefighters in Tehran. Data were collected using WAI, NASA-TLX and Body Discomfort Chart (BDC). Data analysis was carried out using descriptive statistics, linear regression, Pearson correlation and Spearman tests. Results: The mean and standard deviation of the total WAI score was 38.85±1.17. Also, the highest amount of mental workload was devoted to the physical load dimension (93.49±8.93). Meanwhile, the total mental load was also 70.07 ± 6.58. The results showed that the WAI is increased by 0.14 by augmentation of one unit at the academic level of firefighters (P = 0.03). The most common discomfort was reported in the lower (20%) and upper (16.8%) regions of the back. The total WAI relationship with total mental workload was positive and insignificant (P>0.05). There was a significant and reverse association between WAI and discomfort in wrist, leg and ankle. Conclusion: Despite the low rate of MSDs, even mild symptoms of musculoskeletal pain should be considered. Given the high level of mental workload, improving physical, psychosocial and social working conditions is important in increasing the ability of employees and augmenting the ability of their occupational activity

156-163

Authors: Ali Dehghani , Mohamad Hasan Lotfi , Hossein Falahzadeh , Katayon Vahdat , Zahra Shabani

Introduction: It is generally accepted that cutaneous leishmaniasis is an important health problem in the world which is caused by leishmaniasis protozoan. This disease is also considered as a health problem in some regions of Iran including Bushehr province. The present study investigated the geographical dispersion and epidemiological characteristics of subjects with the cutaneous leishmaniasis in this province during 2011-2015. Methods: In this cross-sectional and analytical study, the epidemiologic data including the age, gender, residential area, and counties with this disease was analyzed and collected from 663 patients who were followed up and treated during 2011 to 2015. Results: 422 (63.7%) of studied people were residents of urban areas and 241 (36.3%) lived in rural areas. 59.4% (394 people) were male and 40.6% (269) were female. The mean age of subjects was 21.91± 17.01 (ranging from 1 to 80 years). Kangan County with an average 5-year incidence of 17.72 per a hundred thousand people had the highest incidence, but Tangestan County with the incidence of 8.47 per a hundred thousand people had the lowest average incidence. Based on GIS results, Jam County, which was not recognized as the focus of this disease in the past, has been considered as a new focus of disease in recent years. Conclusion: The geographic information system (GIS) is an effective tool for the organization of diseases and health data. The crisis can be identified and controlled by taking proper measures with the discovery of spatial accumulation of diseases.

177-185

Authors: Gholam Hossein Halvani , Reza Jafari Nodoushan , Elham Halvani , Vida sadat Anoosheh

Introduction: Respiratory disorders, as common problems in farmers, have a high mortality rate in Yazd City. The aim of this study was to evaluate and compare the respiratory parameters as well as the prevalence of respiratory symptoms in three age groups in farmers and non-farmers. Methods: This case-control study was conducted on 300 farmers and 300 nonfarmers in Yazd. The administered questionnaires included cognitive knowledge and symptoms of respiratory diseases. All participants completed the questionnaires and took the lung function tests. Data were analyzed using independent T-t test, Chi square test, or Fisher's exact test by SPSS 24. Results: Spirometry results showed a significant reduction in the respiratory capacity of the farmer group compared to non-farmer. In all three age groups, the prevalence rates of respiratory symptoms in farmers were higher than nonfarmer groups and the prevalence of symptoms increased by increase of age. In the age group of "over 55 years", the risk of cough, phlegm, dyspnea, and wheezing were 17,10.78, 3.58, and 6.61 times more than the non-farmers, respectively. Among the respiratory symptoms, cough had the highest prevalence, while shortness of breath had the lowest prevalence. Discussion and conclusion: In order to prevent high prevalence of respiratory disorders in farmers, the mechanization of agricultural practices, promotion of farmers' health awareness by health professionals, appropriate implementation of training programs by the health department, and assistance of Jihad-eAgriculture are necessary