Journal of Health Sciences & Surveillance System

Abstract Background: For many trying to understand the sociology of technological artefacts and their influence in establishing human behaviour towards health, the study of m-Health applications becomes critical in the development of health and fitness behaviour among humans. M-Health is a growing field of study under ‘Social Construction of Technology (SCOT)’ wherein progress is witnessed in various categories such as the mobile application, developed to cater to the different needs of the digital health and fitness market.
Methods: Through the scoping review under the broader category of a systematic literature review in the present paper, the aim is to understand the sociological construction and adoption of the health and fitness m-Health applications. For this purpose, the review contains peer-reviewed papers and articles, books, and other literature. These studies have been developed systematically and a comprehensive scope of further research  that takes into account the contextual transformation of these m-Health applications has culminated.
Results: To d evelop b etter c onceptual i nnovations, t he idea of quantified self and research gaps are highlighted. Further, a wider scope for quantifying oneself can be expanded for studies in a developing country like India. The idea of m-Health application has revolved around various categories that take into consideration the formative needs of healthcare in a developing as well as a developed world.
Conclusion: Through this paper, we study the need to broaden the sociological lenses that comprehend the construction of these applications within the social context and how they are reshaping the behavioural patterns of health and fitness among individuals.

Abstract Background: Visualization is a practical method to determine a scientific field’s underlying intellectual framework. This study aims to conduct a scientometric analysis of selected scientific literature to assess research trends regarding the association between physical activity exercise, and cognitive function domains. The objective is to present a summary of the findings and identify the trending topics between 1970 and 2023 for this field of study.
Methods: In the current bibliometric analysis, relevant documents based on a reliable search strategy taken from the Web of Science (WOS) database were checked and evaluated using Excel, VOSviewer, and the bibliometrix R-package.ss
Results: The hot topics included Physical Activity, Exercise, Cognition, Aging, Dementia, Depression, Alzheimer’s disease, and Rehabilitation. “Frontiers in Psychology” and “International Journal of Environmental Research and Public Health” were the most active journals in this research area. Also, developed countries such as the United States, the United Kingdom, Canada, Australia, and Germany were the most productive countries. In addition, the top organizations which produced the most scientific documents were from Europe, Oceania, and North America. In the same vein, Arthur F Kramer was identified as the most active author. The study results will greatly contribute to future interdisciplinary articles by showing common trends in this research area.
Conclusion: The combination of PA and cognitive function is still a hot zone of future research. According to this study, the majority of literature on PA and cognitive function is from developed countries, and other cognition topics such as executive function, memory, and anxiety have obtained less attention from researchers.

Abstract Background: Hydroxychloroquine (HCQ) is a drug used to treat malarial parasites and it was extensively used during the initial phase of COVID-19. However, HCQ demonstrated certain serious effects when administered to patients. Hence, this study intends to determine its toxicity by exposing it to human peripheral blood and the fly model.
Methods: In the present experimental study, HCQ (200 mg) was tested in different volumes (62.5 μl - 500 μl) on human blood samples (in vitro) and Drosophila melanogaster (in vivo). Hemolytic assay, trypan blue assay, mitotic index, chromosomal aberration, and DNA fragmentation assay were used to assess the sublethal effects of HCQ.
Results: The results implied that HCQ, at its highest concentration (500 μl), showed maximum lysis in the hemolytic assay, and an increased number of dead cells were observed with increasing concentration in trypan blue assay. Also, the percent mitotic index decreased with increasing concentration of HCQ. Chromosomal aberrations, including breaks, centromeric disruption, dicentrics, and pulverized chromosomes, were observed on exposure to HCQ. The number of fragments in agarose gel electrophoresis revealed damage to DNA. Therefore, these results provide evidence and prove the cytotoxicity and genotoxicity of HCQ.
Conclusion: HCQ is found to have cytotoxic and genotoxic effects. These results imply that further examinations must be conducted before prescribing HCQ to treat various diseases.

Abstract Background: Stroke is recognized as the second leading cause of death and the primary cause of disability in developing and underdeveloped countries. This study investigated the time trend of calls for suspected stroke received by the Emergency Medical Services (EMS) from 2013 to 2019 in Shiraz, Iran.
Methods: This was a descriptive - ecological study using time series data. The necessary data were extracted from the Shiraz Emergency Medical Center from 2013 to 2019. Excel 2013 and SPSS (version 24.0) were used for data analysis. The results were then presented in figures and tables.
Results: From 2013 to 2019, the EMS call center in Shiraz City received 844,004 calls, of which 6,620 were suspected stroke cases. The number of suspected stroke cases demonstrated a steady trend within a certain range from 2013 to 2016. However, there was a significant increase between 2016 and 2017, after which the number of stroke cases reached relative stability. In the short-term seasonal trend, we found that the number of suspected stroke cases reported to EMS was higher in cold seasons compared to warm seasons.
Conclusion: The results showed that the long-term trend of reported suspected stroke cases to EMS is currently stable, following a previous increase in Iran.

Abstract Background: Intestinal parasitic infections pose a significant public health challenge in developing countries, with children being particularly susceptible. The prevalence of these infections varies across communities. This study aimed to determine the prevalence of intestinal parasitic infections among students in 12 primary schools on Kish Island, Iran, and to evaluate the infection status of family members of infected students.
Methods: A cross-sectional study was conducted on 443 students aged 7‒12 years in Kish Island, southern Iran, from May 2016 to 2017. Stool samples from 179 boys (40.4%) and 264 girls (40.4%) across 12 primary schools were examined for evidence of parasitic infections using direct wet mount, formalin ethyl acetate, and trichrome stain methods. Modified Ziehl Neelsen (ZN) staining was used to detect coccidian parasites. Conventional PCR was also employed to identify the genotype of Giardia lamblia. Data were analyzed using SPSS version 19.
Results: The prevalence of intestinal parasites was 5.2%. The highest incidence rate was found in Entamoeba coli (2.0%), followed by Giardia lamblia (1.6%). The prevalence rate of infection was significantly correlated with the type of drinking water (P<0.05). No significant difference was observed in the prevalence of intestinal parasitic infections between males and females (P>0.05). In this study, the genotypes of Giardia lamblia were molecularly characterized by studying the glutamate dehydrogenase (gdh) gene. This study represents the first molecular characterization of G. lamblia in children on Kish Island, with sequence analysis revealing assemblage B (BIII 100.0%).
Conclusion: This study indicates a low prevalence of parasitic infections in a sensitive population (children) on Kish Island. The prevalence of Giardia lamblia, a more pathogenic parasite, was quite low in our study. This cross-sectional study was conducted on all island residents; no significant difference was observed among them.

Abstract Background: Assessing the learning environment provides an overview of the current educational status and aids in identifying areas of concern. This study aimed to understand the students’ perceptions of the educational environment at the Paramedical Faculty of Ilam University of Medical Sciences in 2021.
Methods: This cross-sectional research was conducted at Ilam University of Medical Sciences, where 300 paramedical students were recruited by census. The Dundee Ready Education Environment Measure (DREEM) was used as the data collection tool. An independent t-test and one-way analysis of variance were used to investigate the relationships between demographic variables and each dimension of the questionnaire. Data analysis was performed using SPSS-26 software.
Results: The sample studied included 166 female and 134 male students with an average age of 24.68±7.837 years. The mean and SD of the perception of the educational environment were 112.34 (24.63). There was a significant relationship between marital status, education level, age, and academic semester with students’ understanding of the educational environment (P≤0.05). Twenty percent of the items in the questionnaire indicated a “problematic” situation, while the rest were in a “need of attention” status.
Conclusion: The results of this study showed that paramedical students have a positive perception of the educational environment. The lowest mean and SD of the dimensions of the questionnaire were observed in students’ understanding of learning and social self-perception. The other dimensions were in a more satisfactory condition.

Abstract Background: Brucellosis, a zoonotic disease, poses a significant health and economic challenge in many parts of the world, including Mediterranean and Middle Eastern countries. This study aimed to investigate the risk factors and recurrence of brucellosis, focusing on demographic variables such as age, gender, occupation, place of residence, and the spatiotemporal pattern of the population.
Methods: The study design was cross-sectional.The authors enrolled all Brucella cases registered in the infectious disease surveillance system of Fars province from 2014 to 2018 in the study. They performed a multivariate analysis of the disease risk factors using a Poisson regression model and a multivariate analysis of the risk factors associated with brucellosis recurrence using a logistic regression model.
Results: The incidence of brucellosis in Fars province exhibited a decreasing trend. The findings revealed that the sex ratio of patients who consumed unpasteurized dairy products, the mean age of patients per month, and the proportion of people living in rural areas relative to the total number of patients with brucellosis were significantly associated with the risk of brucellosis. Moreover, the probability of disease recurrence was higher in colder seasons compared to spring.
Conclusion: A higher ratio of lightweight livestock to heavyweight livestock was identified as a risk factor for brucellosis, indicating the more significant role of lightweight livestock in the incidence of brucellosis in Fars province. Therefore, controlling the disease in lightweight livestock is of paramount importance, and the vaccination of these livestock should be more strictly monitored and implemented.

Abstract Background: Access to healthcare services is a prerequisite for societal justice. Unfair distribution of these services can lead to patient migration to cities with higher quality medical centers for better medical services. This study aimed to determine the direct and indirect non-medical costs of patients referred from Sistan and Balouchestan to hospitals in Mashhad.
Methods: A descriptive-analytic study was conducted in Eastern Iran in 2020. The research sample included all patients who migrated from Sistan and Balouchestan to Mashhad for medical purposes and were hospitalized in government hospitals affiliated with Mashhad University of Medical Sciences. The total number of these patients was 2062, and they were identified using a census method in 2020. Given the large population size (2060 individuals), 350 patients were selected as a sample based on the Cochrane method. A validated checklist was used for data collection, and SPSS-23 software was used for data analysis.
Results: The average direct non-medical cost for medical services in Mashhad was 61,686,857 Rials (270 USD). The highest and lowest costs were related to travel costs (26,545,714 Rials or 116 USD), and care received for children (37,142 Rials or 0.16 USD), respectively.
Conclusion: According to the results of this research, an increase in direct non-medical and indirect costs due to patient migration for treatment imposes significant costs on patients and their families. It is crucial to have an equitable distribution of health and treatment resources and facilities across a country’s geographical regions to ensure access to health services.

Abstract Background: Iran has witnessed a significant and rapid decline in fertility rates over the past few decades, a phenomenon referred to as the reproductive revolution. One crucial factor influencing fertility rates is the preference for a child’s gender, which can impact family size. This study aimed to determine the gender preference and desired family size among marriage candidates in Southern Iran in 2021.
Methods: This cross-sectional study involved 744 marriage candidates from Jahrom County, Fars province, Iran, selected through convenience sampling. Data were collected using a researcher-developed questionnaire. Experts confirmed the questionnaire’s face validity and its reliability was established with a Cronbach’s alpha of 0.81.
Results: Of the participants, 54.6% were women, 86.8% resided in urban areas, and 60.6% had a diploma or lower educational level. The mean age at first marriage was 26.86±8.22 years, and the mean desired number of children was 2.09±1.10. The preference for a boy as the first child was 24.6% among men and 22.9% among women, while the preference for a girl was 17.4% among men and 24.1% among women (P=0.084). Furthermore, 46.4% of men and 47.8% of women believed they would continue having children if they did not have a son (P=0.72). Factors such as gender, age, education, occupation, monthly income, and place of residence showed no association with the preference for a boy as the first child (P>0.05).
Conclusion: On average, marriage candidates desired two children. There was a slight preference for boys. It is recommended that adolescents and young adults receive appropriate education about gender equality in schools and universities to mitigate gender bias and discrimination at the community level.

Abstract Background: Mortality statistics serve as a crucial component in community health planning systems. The causes of death can vary across different geographical areas due to factors such as indigenous culture and lifestyle. This study aimed to investigate the mortality trends and their causes from 2015 to 2019 in Hamedan province, located in the west of Iran.
Methods: This cross-sectional study examined all deaths (43,515 individuals) in Hamedan province from 2015 to 2019. Death data, including demographics and the underlying cause of death, were extracted from the mortality system of the Hamedan Health Center. Data collection utilized a checklist corresponding to the International Death Certificate issued by the WHO. Data analysis was performed using SPSS ver. 26.
Results: In 2019, the average monthly death rate was the highest compared to previous years (766.3±39.1), while this number for 2015 was 682.2±37.7. In 2019, U codes (for Emerging diseases) were used for Covid-19. The mean age of deceased females (73.3±18.2) was higher than that of deceased males (67.0±20.6), showing a significant difference (P<0.001). The top three causes of death in Hamedan during these years were cardiovascular diseases (CSDR=46.7%), neoplasms (CSDR=13.8%), and external causes of injuries (CSDR=8.8%), respectively.
Conclusion: The analysis of the findings indicates that health plans aimed at preventing mortality factors have not been very effective. Therefore, it is recommended that health officials in Hamedan province monitor mortality data and devise effective plans to control mortality factors. As these preventive plans cannot be implemented solely by the Hamadan University of Medical Sciences, other organizations in the province involved in public health need to play an effective role.

Abstract Background: A society’s culture, beliefs, and values are important and effective factors in lifestyle and health status. Therefore, this study aimed to determine the correlation between older adults’ tendency towards superstitions and their healthy
lifestyles.
Methods: This study was descriptive-analytical and of a correlational type. The statistical population consisted of all the older adults covered by healthcare centers in the North of Iran. The sample size was determined to be 360 using the multistage random sampling method. Data were collected using the Elderly Healthy Lifestyle and Tendency to Superstitions Questionnaires. Spearman’s test, regression analysis, chi-square, Kruskal-Wallis tests, and SPSS 28 software were utilized to analyze the data.
Results: Among a total of 360 elderly participants in the study, 173 were male, and 187 were female, in the age range of 60 to 91 years. The results indicated a significant correlation (P<0.001) with an effect size of 29% between superstitions and a healthy lifestyle. According to the findings, the regression model fitted with the predictive variable, superstitions, could explain 14% of the variance in the dependent variable, lifestyle.
Conclusion: The research results emphasized that the tendency towards superstitions could be a predictive and effective factor in older adults’ healthy lifestyles.

Abstract Background: Major β-Thalassemia is the most prevalent singlegene disorder in Iran. Over 2 million beta-thalassemia carriers
and more than 25,000 patients have been identified nationwide. This study aimed to evaluate the Major β-Thalassemia (MBT) screening surveillance system in the Jiroft district, southeast Iran.
Methods: This descriptive study was conducted using the census method and was based on the information recorded in the files of all major thalassemia births (born between 2011 and 2021) in the health centers of Jiroft University of Medical Sciences. A formula was used to calculate the program’s incidence, expected incidence, and success rate. Stata version 14 and Excel software were utilized to analyze the data, and the qualitative data are presented as numerical values and percentages.
Results: During the study periods, 91 patients with betathalassemia Major were born in the population covered by Jiroft University of Medical Sciences. By performing prenatal diagnosis tests in the first weeks of pregnancy and obtaining parental consent for legal abortion, the birth of 422 sick children was prevented. The 11-year incidence of beta-thalassemia major was 5.32 per 10,000, and the expected incidence (if no prevention program was implemented) was 30 per 10,000 live births. The mean success rate of the Major β-Thalassemia surveillance system during the study period was 82.26%, which reached 95.45% in 2021.
Conclusion: The i mplementation of efficient, e ffective h ealth policies influenced by the native culture of the region has resulted in the thalassemia prevention program in Jiroft City being completely effective. The implementation success rate of this program has exceeded 95%. Modeling and adapting these preventive policies can assist in implementing thalassemia prevention programs in other parts of the country and developing countries.

Abstract Background: Each country’s health system is tasked with providing services to ensure the health of its population. Dental services are among these essential services. However, dental service utilization is unevenly distributed worldwide. This study’s findings will give health sector officials and policymakers valuable insights to enhance system performance.
Methods: This descriptive-analytical study, conducted in 2021, aimed to determine the distribution of dentists worldwide. The analysis utilized the Pareto curve, the dentist-to-population ratio (DPR), the Gini Coefficient (GC), and the Lorenz curve. The goal was to identify the countries with the highest number of dentists.
Results: There are over 2,500,000 dentists globally, averaging 3.6 dentists per 10,000 people. However, the ratios vary significantly, with about 6.8 per 10,000 in countries with very high Human Development Index (HDI) groups and 0.19 per 10,000 in low HDI groups. The data indicates that more than 80% of dentists work in countries with very high and high HDI.
Conclusion: This study suggests that job concentration is higher in areas with superior welfare and facilities, and dentistry is no exception. Therefore, creating better welfare in more disadvantaged areas, implementing mandatory government plans, and strategic government planning can help mitigate distribution inequality.

Abstract Background: Youth is a unique stage in everyone’s life. During this period, individuals often engage in high-risk behaviors, including high-speed driving, smoking, sexual behaviors, alcohol consumption, physical inactivity, unhealthy eating habits, and violence. One of the factors influencing these high-risk behaviors is subjective norms. This study aimed to compare the correlation between two types of norms—descriptive norms (DN) and injunctive norms (IN)—with seven high-risk behaviors among college students.
Methods: This analytical cross-sectional study focused on the male and female students of Shiraz University of Medical Sciences. Participants were selected through multi-stage random sampling. An online researcher-made questionnaire, consisting of three parts: demographic information, questions about DN and IN, and questions about the frequency of behaviors, was sent to students. Descriptive analysis and bivariate Spearman’s correlation analysis were performed using SPSS 24.
Results: 245 students (66.9% female) participated in the study. In the total population, regular exercise (r=0.179; P=0.005) and fast food (r=0.154; P=0.016) positively correlated with IN. Meanwhile, high-speed driving (r=0.148; P=0.021), drinking alcohol (r=0.198; P=0.002), and sexual relations outside of marriage (r=0.221; P=0.001) had a positive correlation with DN. No significant relationships were observed between aggression and smoking with either of the two types of subjective norms.
Conclusion: The findings suggest that the two types of subjective norms do not affect health behaviors equally. Researchers should measure both descriptive and injunctive norms when using behavior change models that include the subjective norms construct.

Abstract Background: Thyroid problems have been reported in over 110 countries worldwide. In some countries, the prevalence of known thyroid disorders has been reported to be as high as 18.9%. Given that thyroid dysfunction can adversely affect adult health, we aimed to assess the prevalence of thyroid disease and related factors in the Fasa Persian Cohort Study Centre.
Methods: This cross-sectional study was conducted in southwestern Iran. It included 10,132 participants, with an average age of 48.63. Demographic and clinical data were used as baseline cohort information. Multiple logistic regression analysis was conducted to investigate factors associated with thyroid disease.
Results: The prevalence of thyroid disease was 8.8%. According to the results of the multiple analysis gender (AORfemale/ male=5.94.95% CI: 1.66-7.58), education level (AOR Literate/ Illiterate=1.21, 95% CI: 1.04-1.40), diabetes (AORYes/No=1.32, 95% CI: 1.09-1.69), hypertension (AORYes/No=1.38, 95% CI: 1.17-1.64), depression (AORYes/No=1.72, 95% CI: 1.38-2.13) were associated with the odds of thyroid disease. Also, metabolic equivalent task (MET) (AOR=0.99, 95% CI: 0.02-0.083), duration sleep (AOR6- 7/≤5=0.77, 95% CI: 0.61-0.97), and duration sleep (AOR≥8/≤5=0.80, 95% CI: 0.64-0.99) were  identified as protective factors in the study.
Conclusion: This study’s findings indicated that the total prevalence of thyroid disease in adults was 8.8%. The researchers found that gender, education level, hypertension, diabetes, and depression increased the odds of thyroid disease. In addition, duration of sleep and MET were identified as protective factors. Further consideration of thyroid disease and screening for this population is recommended.