The efficacy and safety of intravaginal oxytocin on vaginal atrophy: A systematic review

Genitourinary syndrome of menopause is a major issue in menopausal health. Because unlike vasomotor symptoms, it has a progressive trend. In this regard we conducted a systematic review to evaluate the efficacy of intravaginal oxytocin on postmenopausal vaginal atrophy. A search was performed for published studies in Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar and Persian databases without time and language limitations. Only randomized controlled trials that compared intravaginal oxytocin with placebos were included. The outcome measures were objective and subjective assessed symptoms of vaginal atrophy. Statistical heterogeneity was evaluated using the I². The standardized mean differences were pooled the fixed effects model. Of the five included studies, four studies meta-analysed. The meta-analysis in terms of the cytological analysis (standardized mean difference: 35.13, 95% confidence interval: 32.59-37.67, n = 218, I² = 96%) was statistically significant. In terms of histological assessments (standardized mean difference: -0.38, 95% confidence interval: -0.94 to 0.17, n = 38, I² = 0%) and endometrial thickness (standardized mean difference: 0.05, 95% confidence interval: -0.20 to -0.31, n = 95, I² = 0%), there were no statistically significant differences between the groups. Three studies reported a statistically significant improvement in the subjective symptoms; however, we were unable to perform a meta-analysis. Four of the included studies assessed side effects, but only two studies reported them. Oxytocin as a nonestrogenic compound can be a suitable alternative for the treatment of vaginal atrophy, especially in women with contraindications for using estrogenic compounds. Further good quality clinical trials with long-term follow-ups are recommended to demonstrate the effects of intravaginal gel in the treatment of vaginal atrophy.

Oral health status in relation to socioeconomic and behavioral factors among pregnant women: a community-based cross-sectional study

Background

Oral health of women during pregnancy is an important issue. Not only it can compromise pregnancy outcomes, but also it may affect their newborn’s overall health. The aim of this study was to assess the oral health status and associated factors in pregnant women.

Methods

A cross-sectional study was conducted amongst 407 pregnant women in the second and third trimester of pregnancy in Varamin, Iran. Oral health status was examined, and demographic, socioeconomic status and dental care behavior data were collected. Oral health indices included periodontal pocket, bleeding on probing (BOP) and decayed, missed, filled teeth (DMFT). Regression analysis of DMFT was used to study the association between demographic, dental care behaviors indicators and outcome variables using the count ratios (CR) and 95% confidence intervals (CI).

Results

The mean (SD, Standard Deviation) age of participants was 27.35 (5.57). Daily brushing, flossing habit were observed in 64.1, and 20.6% of mothers, respectively. Mean (SD) of DMFT, D, M, F were 10.34(5.10), 6.94(4.40), 2.22 (2.68) and 1.19(2.23), respectively. Women older than 35 years had significantly more DMFT [CR = 1.35 (95% CI 1.13; 1.60)], less D [CR = 0.75 (95% CI 0.59; 0.94)], and more M [CR = 3.63 (95% CI 2.57; 5.14)] compared to women under 25 years after controlling for education and dental care behaviors. Women with academic education had significantly less decayed teeth [CR = 0.63 (95% CI 0.48; 0.84)], compared to women with under 12 years of education.

Conclusions

Oral health status of pregnant women was not satisfactory, having an average of seven decayed teeth in their mouth.

Overall Effects of Risk Factors Associated with Dental Caries Indices Using the Marginalized Zero-Inflated Negative Binomial Model

The purpose of this paper is to identify risk factors for decayed, missing, and filled permanent teeth (DMFT) in a population of 12-15-year-old schoolchildren and to apply the marginalized zero-inflated negative binomial (MZINB) model for determination and estimation of the overall effects of the risk factors. A cross-sectional survey comprising 764 students aged between 12 and 15 years was used to analyze the association between caries in children and some background characteristics in children and their parents. Information on the samples' social, behavioral, and demographic status was obtained through a series of closed questions. The incidence rate ratios (IRR) were used to associate some risk factors with caries. In the entire sample, the frequency of zero was 194 (25.4%). The result of the shared-parameter marginalized zero-inflated negative binomial (SP-MZINB) model showed that being a girl (IRR = 1.18; p value = 0.021), higher dental visits frequency (IRR = 1.20; p value <0.001), lower tooth brushing frequency (IRR = 0.91; p value = 0.019), higher flossing frequency (IRR = 1.11; p value = 0.001), and lower mothers' education (IRR = 0.89; p value = 0.042) are associated with DMFT. Our results may provide better insights of the factors associated with DMFT, and health programs should focus their efforts on healthcare services, for both preventive and curative purposes. This regression model provides an appropriate fit and meaningful interpretation to handling zero-inflated count outcomes. Also, it provides direct estimates of the effects of risk factors on the overall mean that does not require postmodeling computations.

Population Survey of Knowledge about Oral Cancer and Related Factors in the Capital of Iran

Knowledge about oral cancer risk factors and signs is thought to improve prevention and early diagnosis, and in turn, increases survival. In this population-based survey, knowledge about oral cancer was assessed in Iran. A total of 1800 self-administered questionnaires (collecting sociodemographic data and questions regarding oral cancer risk factors and signs) were distributed through random sampling. Final scores ranged between 0 and 15 for the risk factors and 0-11 for the signs. Scores below the median indicated a low level of knowledge, scores representing the third quartile of correct answers indicated a moderate level of knowledge, and scores representing the upper quartile indicated a high level of knowledge. Statistical tests were used for analysis of knowledge level in different sociodemographic categories. A total of 1312 participants completed the questionnaires. The average of knowledge scores for risk factors was 5.3 ± 3.0 and for signs was 4.5 ± 2.9. Overall, 75 and 56% respectively were able to identify major risk factors (smoking and alcohol); 23.5% could not define any related signs and symptoms. Dividing scores into quartiles indicated that three out of four people had "low" knowledge about risk factors and 58% had "low" knowledge about signs and symptoms. Females and highly educated people had more knowledge of oral cancer. Significant difference was found between job and level of knowledge (P = 0.001). This survey revealed that public knowledge of oral cancer was not satisfactory in Iran. Efforts should be done to inform and educate people with risk factors, initial clinical presentation, and symptoms, in order to improve prevention and promote early diagnosis.

Relationship Between Mothers' Knowledge and Attitude Towards the Importance of Oral Health and Dental Status of their Young Children

PURPOSE

To examine the relationship between mothers' knowledge, attitude and dental caries status and their young children's dental caries status.

MATERIALS AND METHODS

In this cross-sectional study, 153 2- to 6-year old children old and their mothers were dentally examined. Mothers' decayed, missing or filled teeth (DMFT) and children's decayed, missing or filled teeth (dmft) were recorded. A validated questionnaire was used to examine maternal knowledge and attitudes regarding the importance for the oral health of their children.

RESULTS

The average age of children and mothers were 5.1 and 31 years, respectively. The mothers' and children's mean DMFT and dmft were 12 and 6, respectively. The mean level of mothers' knowledge was 31.5 out of 40, while the mean attitude was 24.5 out of 30 points. There was a statistically significant inverse correlation between mothers' knowledge and their DMFT (r = -0.7), and between mothers' knowledge and children's dmft (r = -0.6). Also, there was an inverse correlation between mothers' attitude and DMFT (r = -0.8), and between mothers' attitude and dmft (r = -0.7). A direct correlation between mothers' DMFT and children's dmft (r = +0.6) was observed.

CONCLUSION

Attempts at improving the knowledge and attitude in parents have a substantial impact on improving the oral health of next generation.

A Meta-Analysis of the Efficacy of Panax Ginseng on Menopausal Women’s Sexual Function

Objectives: An increase in life expectancy results in the aging population growth. This study was designed to evaluate the efficacy and adverse events of ginseng that could be used as a herbal medicine in women with sexual dysfunction. Materials and Methods: The authors of this study searched Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases without a time limitation until May 2018 and examined all the randomized clinical trials (RCTs) that compared the effect of different types of ginseng on sexual function of menopausal women as compared to the placebo controls. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. The heterogeneity was determined using the I2 index. In addition, standardized mean difference (SMD) was used instead of mean differences (MD) and a random effect was reported instead of fixed effect in meta-analysis. Results: The eligibility criteria were found in five RCTs. All the included studies were placebo-controlled. Two trials had a parallel design while three studies used a crossover design. Although four trials indicated that ginseng significantly improved sexual function, they didn’t report any treatment effect compared to the placebo group. Based on the results of meta-analysis obtained from five studies including 531 women, there was no statistically significant effect of ginseng on female sexual dysfunction (FSD) compared to the placebo control group (SMD: 0.26; 95% CI: -0.26 to 0.76). Nonetheless, there was a considerable heterogeneity among the studies (I2 = 81%; P < 0.0001). Moreover, all the included studies assessed adverse events, but in three of the RCTs, there was no significant difference between the placebo and ginseng groups. Conclusions: The evidence regarding ginseng as a therapeutic agent for sexual dysfunction is unjustifiable. Rigorous studies seem warranted in this respect.

Challenges impeding integration of oral health into primary health care

The primary healthcare (PHC) services in the Islamic Republic of Iran have succeeded in addressing high levels of communicable diseases; however, they seem less able to deal with maternal and paediatric oral diseases. The aim of this study was to examine problems in integrating oral health services into PHC. This was a qualitative research study comprising focus group discussions and interviews. Five focus-group discussions were held with midwives, family healthcare practitioners, rural PHC workers, duty-service dentists, and public health dentists. Also, individual interviews were organized with experts of faculty members in related fields, informant managers and policy makers, and in-depth interviews were done with pregnant women in four PHC centres. Audiotapes were transcribed following each session, and then a qualitative thematic analysis was carried out on gathered data. Data analysis resulted in 4 main themes relating to the challenges: environmental, educational, organizational and school-based programme factors. This study provides a clearer understanding of the challenges of integrating oral health services into PHC.

Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate and Three Calcium Phosphate on Enamel Microhardness

AIM

This study aims to investigate the effect of casein phos-phopeptide-amorphous calcium phosphate and three calcium phosphate (CPP-ACP and TCP) on increasing the microhardness of human enamel after induction of erosion.

MATERIALS AND METHODS

A total of 26 healthy human-impacted third molar teeth were chosen, and their hardness measured using a microhardness testing machine. The samples were immersed in Coca Cola (pH = 4.7) for 8 minutes. Then, micro-hardness was measured again, and these samples were randomly divided into four groups (two control groups and two experimental groups). (1) Negative control group: Artificial saliva was used for 10 minutes, (2) positive control group: Fluoride gel was used for 10 minutes, (3) β-TCP group: TCP was used for 10 minutes, (4) CCP-ACP group: CCP-ACP was used for 10 minutes. The final microhardness of those samples was measured, and the changes in microhardness of teeth within group and between groups were analyzed using the paired and analysis of variance tests respectively. Results were considered statistically significant at a level of p < 0.05.

RESULTS

No significant difference was observed in microhard-ness between CPP-ACP group and TCP group (p = 0.368) during the time microhardness significantly dropped after soaking in soda.

CONCLUSION

Casein phosphopeptide-amorphous calcium phosphate and TCP increased the microhardness of teeth. The increase in hardness in the TCP group was higher than in the CPP-ACP group, but this difference was not significant (p = 0.36).

CLINICAL SIGNIFICANCE

Casein phosphopeptide-amorphous calcium phosphate and TCP can affect the remineralization of erosive lesions.

Utility of orthokeratology contact lenses; efficacy of myopia correction and level of patient satisfaction in Iranian myopic/myope-astigmatic patients

Purpose

To investigate the medical profiles of patients referred to Iran Lens Clinic with myopic/myope-astigmatic refractive errors.

Methods

Medical records of 182 patients (364 eyes) with myopic/myope-astigmatic refractive errors that underwent orthokeratology contact lens wear and fulfilled a 6-month period of follow-up were recruited. Efficacy and safety of these contact lenses in improving the visual acuity and correction of the refractive errors were investigated. Time needed to achieve final targeted visual acuity and association of various factors in this time course and level of acuity were investigated. Complications related to these lenses that were recorded in the medical profiles were studied.

Results

In manifest refraction, the amount of spherical equivalent and myopia decreased significantly after orthokeratology contact lens wear (P < 0.001). A significant negative association was found between amount of mean baseline spherical equivalent and final achieved mean uncorrected visual acuity (P < 0.001). None of the parameters of age, gender, and keratometric findings influenced the outcomes significantly (P > 0.1).

Conclusion

Patients with myopic refractive error lower than −5.0 Diopters achieved higher final visual acuities rather than patients with higher amounts of myopic refractive errors.

Is the association between socioeconomic status and nonreplaced extracted teeth mediated by dental care behaviours in adults?

OBJECTIVE

To investigate whether the association between socioeconomic status (SES) and number of nonreplaced extracted teeth (NRET) is mediated by dental care behaviours (DCBs) in adults.

METHODS

A random sample of adults, who participated in the 2010 dental telephone survey (n = 1100) in Tehran, Iran, was investigated. The outcome was self-reported NRET due to dental caries or periodontal diseases. The main exposures were wealth index and education; and the potential mediators were the frequency of tooth brushing and flossing, and dental visiting in the previous year of the study. Multivariable regression analysis was applied to test mediation using the count ratios (CR) and 95% confidence intervals (CI).

RESULTS

The response rate was 73%. The mean age was 38.99 (SD=13.83), and 50.8% were female. The mean NRET were 1.28 (95% CI 1.14; 1.41). NRET were greater among participants who had less than 12 years of schooling [CR = 4.26 (95% CI 3.52; 5.52)] and those in the poorest quintile [CR = 1.89 (95% CI 1.36; 2.61)] compared with those in the most educated and wealthiest groups, respectively. People who brushed their teeth less than twice a day [CR = 1.38 (95% CI 1.17; 1.62)] and did not use dental floss daily [CR = 1.47 (95% CI 1.24; 1.75)] were more likely to present NRET. After controlling for DCBs, a slight decrease in the CRs was observed for both the poorest (13.3%) and the less than 12 years of schooling (7.6%) groups compared to the reference groups.

CONCLUSIONS

Although DCBs were associated with both SES and NRET, they could only be partially accountable for the observed socioeconomic inequalities in NRET.

Socioeconomic inequalities in oral health among adults in Tehran, Iran

OBJECTIVE

To identify the socioeconomic distribution of perceived oral health among adults in Tehran, Iran.

BASIC RESEARCH DESIGN

A cross-sectional population study.

PARTICIPANTS

A stratified random sample of 1,100 adults aged 18-84 years living in Tehran.

METHODS

Self-report data were obtained from the 2010 dental telephone interview survey. Oral health was evaluated using self-assessed non-replaced extracted teeth (NRET), and a three-item perceived dental health instrument. Socioeconomic status was measured by combining the variables of education and assets using principal component analysis. Inequalities in oral health were examined using prevalence ratios and concentration index.

RESULTS

The poorest quintile was 1.60 (95% confidence interval, CI, 1.30; 1.98) times as likely to have any NRET compared with the richest quintile, indicating a disparity. Inequality was most pronounced in the 35-59 age group with prevalence ratio 2.01 (95% CI 1.26; 3.05). The concentration index of NRET in adults in Tehran was -0.22 (95% CI -0.28; -0.16). No significant differences were found in perceived dental health between socioeconomic classes.

CONCLUSIONS

Adults from lower socioeconomic classes experienced more disabilities due to missing their teeth, specifically in the middle-age group. Inequalities in perceived dental health were not apparent in the studied population.

The effect of massage with medium-chain triglyceride oil on weight gain in premature neonates

Prematurity and poor weight gaining are important causes for neonatal hospitalization. The present study aimed to investigate the role of medium-chain triglyceride (MCT) oil via massage therapy as a supplementary nutritional method on the weight gain of Neonatal Intensive Care Units (NICU)-hospitalized neonates. This randomized clinical trial performed among 121 stable premature neonates hospitalized in the NICU of Qaem Educational Hospital, Mashhad, Iran. They were randomly divided into three groups: oil-massage, massage alone and control groups. These groups were compared on the basis of weight gain during a one-week interval. The three groups were matched for sex, mean gestational age, birth weight, head circumference, delivery, and feeding type (P>0.05). The mean weight gain on the 7th day in the oil massage group was 105±1.3gr and 52±0.1gr in the massage group; whereas 54±1.3gr weight loss was observed in the control group. Significant differences were observed between the oil-massage group and the other two groups, respectively (P=0.002 and P=0.000). The findings of this study suggest that transcutaneous feeding with MCT oil massage therapy in premature neonates can result in accelerated weight gain in this age group with no risk of NEC.

Quality of life in patients with bipolar I disorder: is it related to disorder outcome?

Bipolar I disorder (BID) and its treatments have shown to be associated with deep impacts on patients' subjective feelings and quality of life (QOL). There are also some comments about impact of these feelings on course and outcome of patients with BID. This study was aimed to evaluate quality of life in patients with BID and to assess its relationship with course of disorder. Fifty patients with BID were recruited based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) from May 2008 and followed for 12 months. Quality of life and mood disorder recurrence were assessed through World Health Organization Quality of Life and SCID-I tools respectively at baseline and after 6 and 12 months. Repeated measures analysis and logistic regression were used to analyze the independent effect of QOL and demographic factors on BID recurrence. Fifty patients (66% male; 48% never married; 48% in primary school level) with mean ± SE age and age of BID onset 33.8±1.5 and 26.6±1.1 years were studied. They had 3.4±0.6 episodes already. Twenty eight percent suffered from recurrences during the follow-up. The QOL scores at baseline, after 6 and 12 months were 70±1.8, 69.6±1.1 and 73±1.3 respectively. There were no significant change in QOL and its sub-domains during the follow-up (P=0.37). QOL showed no independent relationship with BID recurrences (P>0.1). No change in the QOL during the follow-up could denote lack of effectiveness of routine interventions on this factor. Also, short-term follow-up might be concerned as the possible reason. Of prime importance is to consider quality of life independently in treating patients with bipolar disorder.

Development of a socioeconomic status index to interpret inequalities in oral health in developing countries

PURPOSE

To develop an instrument to measure socioeconomic status (SES) in order to assess SES-related inequalities in oral health in a developing country.

MATERIALS AND METHODS

In order to develop a SES measurement tool, an expert panel generated a primary item pool from which the items were revised after validity and reliability testing. The final instrument was used in a 1100-sample survey in Tehran. SES was calculated using the weights produced by both principal component analysis (PCA) and expert panel two-stage paired comparisons (TSPC) methods.

RESULTS

The final instrument contained 10 items. Standardised SES scores derived from TSPC and PCA methods were significantly correlated (r = 0.749, P < 0.001). Five-level SES stratification by the two methods revealed a correlation coefficient of 0.701 (P < 0.001) for SES class.

CONCLUSION

The newly developed SES index was appropriate to be used in exploring oral health inequalities in the studied sample of the Iranian population. When formulating SES, domestic experts' opinions could help the researchers explore and weight sub-construct factors.

Suicide Risk Factors in Iranian Patients With Bipolar Disorder: A 21- Month Follow-Up From BDPF Study

OBJECTIVE

Bipolar disorder is strongly associated with suicidal ideations, attempts and commissions. Although several studies have been conducted on suicide risk factors in patients with bipolar disorder worldwide, a comprehensive study has not been reported from Iran.

METHODS

Patients with bipolar disorder type I, hospitalized in Iran Hospital of Psychiatry since May 2008 to August 2011 were sequentially enrolled. Patients were evaluated using Demographic and Clinical Variables Questionnaire, the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Young-Mania Rating Scale (Y-MRS), and Hamilton Depressive Rating Scale-7 (HDRS-7). One hundred patients were followed for 2 to 42 months (mean: 20.6 ± 12.5 months).

RESULTS

Only one patient attempted suicide during the follow-up period. 33% of the patients had history of previous suicide attempts. Female gender, divorce, and early age at onset of the disease were independently correlated with suicide attempt.

CONCLUSION

Suicide attempts rarely occur during systematic follow-up of patients with bipolar disorder type I. Larger samples and longer follow-ups are needed to confirm this finding.

DECLARATION OF INTEREST

None.