Preconceptional maternal hyperandrogenism and metabolic syndrome risk in male offspring: a long-term population-based study

PURPOSE

There is limited research on the effects of maternal hyperandrogenism (MHA) on cardiometabolic risk factors in male offspring. We aimed to compare the risk of metabolic syndrome (MetS) in sons of women with preconceptional hyperandrogenism (HA) to those of non-HA women in later life.

METHODS

Using data obtained from the Tehran Lipid and Glucose Cohort Study, with an average of 20 years follow-up, 1913 sons were divided into two groups based on their MHA status, sons with MHA (n = 523) and sons without MHA (controls n = 1390). The study groups were monitored from the baseline until either the incidence of events, censoring, or the end of the study period, depending on which occurred first. Age-scaled unadjusted and adjusted Cox regression models were utilized to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between MHA and MetS in their sons.

RESULTS

There was no significant association between MHA and HR of MetS in sons with MHA compared to controls, even after adjustment (unadjusted HR (95% CI) 0.94 (0.80-1.11), P = 0.5) and (adjusted HR (95% CI) 0.98 (0.81-1.18), P = 0.8). Sons with MHA showed a HR of 1.35 for developing high fasting blood sugar compared to controls (unadjusted HR (95% CI) 1.35 (1.01-1.81), P = 0.04), however, after adjustment this association did not remain significant (adjusted HR (95% CI) 1.25 (0.90-1.74), P = 0.1).

CONCLUSION

The results suggest that preconceptional MHA doesn't increase the risk of developing MetS in sons in later life. According to this suggestion, preconceptional MHA may not have long-term metabolic consequences in male offspring.

The Reasons Behind Long-Term Endemicity of Brucellosis in Low and Middle-Income Countries: Challenges and Future Perspectives

Brucellosis is a neglected worldwide zoonotic disease with more than 500,000 new human cases each year. Direct contact with infected animals and consumption of undercooked animal origin foods are the main routes of brucellosis transmission to humans. Although long endeavor has been applied to control and eliminate brucellosis from animal and human populations in developing countries especially in low- and middle-income countries (LMICs), the disease is still endemic in these regions. Many common or unique factors including raw milk consumption, unhygienic slaughter of livestock, extensive husbandry, budgetary limitations, misdiagnosis, and other conditions play a role in long-term endemicity of brucellosis in these locations. It has been shown that One Health is the only practical approach to control brucellosis; however, applying such methods is challenging in low-resource areas. In such conditions, brucellosis is continuously maintained in animals and repeatedly spread to human populations. In this article, factors playing a critical role in brucellosis endemicity, and the real conditions challenging the application of One Health approach in control of brucellosis are highlighted.

Strengthening the One Health Approach in the Eastern Mediterranean Region

One Health aims to use a multidisciplinary approach to combat health threats at animal, human, and environmental health interfaces. Among its broad focus areas are issues related to food safety, the control of zoonoses, laboratory services, neglected tropical diseases, environmental health, biosafety and biosecurity, and combatting antimicrobial resistance. A roundtable session was conducted on November 18, 2021, as part of the Eastern Mediterranean Public Health Network's (EMPHNET) seventh regional conference to highlight what role Global Health Development (GHD)|EMPHNET can play to strengthen the One Health approach. This viewpoint summarizes the findings of the roundtable discussion to highlight the experts' viewpoints on strengthening the One Health approach, including the extent of zoonotic diseases and the dynamics of pathogens and emerging diseases; the occurrence of antimicrobial-resistant pathogens as a silent pandemic; issues surrounding the globalization of trade and food safety; the importance of integrated solutions as a new norm; issues around the institutionalization and governance toward effective operationalization of the One Health approach in the region; and how the One Health approach can be operationalized at global, regional, and local levels. The panel concluded that One Health is an integrated unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems, and provided recommendations to strengthen the One Health approach. It also discussed how GHD|EMPHNET can play its role in transferring the concept of One Health from theory to practice via a solid operationalization road map guide at the Eastern Mediterranean region level. The five broad priority areas of this operational guide include (1) establishing and strengthening a governance architecture, legal framework, and policy and advocacy structure for One Health operationalization in the region; (2) fostering coordination, communication, and collaboration for One Health actions across the region and beyond; (3) building the workforce capacity for effective One Health operationalization in the region; (4) supporting regional platforms for timely, effective, and efficient data sharing and exchange on all One Health-related issues; and (5) supporting risk communication, behavior change communication, and community engagement efforts in the region.

The relationship between air pollutants and gestational diabetes: an updated systematic review and meta-analysis

PURPOSE

Air pollution is an environmental stimulus that may predispose pregnant women to gestational diabetes mellitus (GDM). This systematic review and meta-analysis were conducted to investigate the relationship between air pollutants and GDM.

METHODS

PubMed, Web of Science, and Scopus were systematically searched for retrieving English articles published from January 2020 to September 2021, investigating the relationship of exposure to ambient air pollution or levels of air pollutants with GDM and related parameters, including fasting plasma glucose (FPG), insulin resistance, and impaired glucose tolerance. Heterogeneity and publication bias were evaluated using I-squared (I2), and Begg's statistics, respectively. We also performed the subgroup analysis for particulate matters (PM2.5, PM10), Ozone (O3), and sulfur dioxide (SO2) in the different exposure periods.

RESULTS

A total of 13 studies examining 2,826,544 patients were included in this meta-analysis. Compared to non-exposed women, exposure to PM2.5 increases the odds (likelihood of occurrence outcome) of GDM by 1.09 times (95% CI 1.06, 1.12), whereas exposure to PM10 has more effect by OR of 1.17 (95% CI 1.04, 1.32). Exposure to O3 and SO2 increases the odds of GDM by 1.10 times (95% CI 1.03, 1.18) and 1.10 times (95% CI 1.01, 1.19), respectively.

CONCLUSIONS

The results of the study show a relationship between air pollutants PM2.5, PM10, O3, and SO2 and the risk of GDM. Although evidence from various studies can provide insights into the linkage between maternal exposure to air pollution and GDM, more well-designed longitudinal studies are recommended for precise interpretation of the association between GDM and air pollution by adjusting all potential confounders.

The targeted high-risk case-finding approach versus universal screening for thyroid dysfunction during pregnancy: thyroid-stimulating hormone (TSH) and/or thyroid peroxidase antibody (TPOAb) test?

PURPOSE

To compare the effects of different thyroid screening scenarios, using the universal and targeted high-risk case-finding approaches with different diagnostic tests on the prevalence of subclinical hypothyroidism (SCH), thyroid autoimmunity, and pregnancy outcomes after adjustments for the intervention.

METHODS

During a secondary analysis of data collected in Tehran Thyroid and Pregnancy Study, a total of 2277 women from the total population, including 1303 high-risk individuals for thyroid dysfunction. The Cochran-Mantel-Haenszel method, adjusted for the intervention, was also used to evaluate the relationships between different screening scenarios [i.e., universal approach using thyroid-stimulating hormone (TSH) and/or thyroid peroxidase antibody (TPOAb) tests and targeted high-risk case-finding approach using TSH and/or TPOAb tests] and pregnancy outcomes (i.e., preterm delivery and NICU admission). The universal approach using both TSH and TPOAb measurements was considered as the reference scenario. We analyzed outcomes of different screening methods in individuals treated with LT4, compared to those individuals who were not treated.

RESULTS

Compared to the universal screening approach with both TSH and TPOAb measurements, the targeted high-risk case-finding approach overlooked approximately 42%, 62%, and 74% of women with elevated TSH (> 4 µlU/mL) when using both TSH and TPOAb tests, TSH alone, and TPO alone, respectively. After adjusting for the missed cases, 2.86% of women with preterm delivery and 2.76% of women with NICU admission were missed when they were screened using the targeted high-risk case-finding approach by measuring both TSH and TPOAb. The percentage of missed cases increased when applying the targeted approach with the TSH test alone, without measuring TPOAb. Overall, 4.16% and 4.02% of women with preterm delivery and NICU admission were overlooked in this scenario, respectively. After adjustments for the intervention, the probability of NICU admission in neonates of mothers, who were screened using the targeted high-risk case-finding approach with TPOAb measurement, was 2.31 folds higher than those screened by the reference scenario.

CONCLUSION

This study suggests that although the targeted high-risk case-finding approach including both TSH and TPOAb tests, may overlook some women with SCH, it is a reasonable option since it is not associated with a higher risk of adverse pregnancy outcomes.

The Role of demand - control - support model in nursing musculoskeletal disorders:A systematic review

Introduction: Nursing is one of the high risk jobs in the world and its occupational hazards have a direct impact on the health of nurses. Work-based musculoskeletal disorders are prevalent among health care workers, particularly nursing staff.  The purpose of this study was to systematically review studies on the relationship between occupational stress based on demand-control-support model and nurses' musculoskeletal disorders. Materials and Methods: In this study, major international electronic databases including PubMed, ISI Web of Science, Scopus and ScienceDirect and Persian databases, including SID, Irandoc, Magiran and Medlib were studied. The keywords used were: social support, job stress, job control, job demand, and musculoskeletal disorder. The main criterion for inclusion was the survey of the top three variables in the nursing community. After evaluating the inclusion criteria and the quality of the articles, 6 studies were identified and included in the study. Results: According to the results of 6 studies, in 4 studies variables of job strain and in 5 studies psychological demands of job were related to the musculoskeletal disorders. The relationship between job control and supervisor support has also been confirmed in one study. Conclusion: Surveys clearly show that the greater the individual's perception of control over their work and the lower the level of psychological demands in their job, the health of the individual increases.

HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data)

BACKGROUND

Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV-HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV-HCV co-infected cannabis users and to characterize persons who reduced their use.

METHODS

We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not.

RESULTS

Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one's dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction).

CONCLUSIONS

Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.

The effectiveness of mindful parenting training on attention deficit/hyperactivity disorder symptoms in male students

OBJECTIVE

One of the main influential factors in the occurrence of behavioral problems in children with attention deficit/hyperactivity disorder (ADHD) is the behavior related to the parenting styles. This study aimed at investigating the effect of mindful parenting training on mothers of children with ADHD in reducing the symptoms of hyperactivity/impulsivity and inattention behaviors.

MATERIALS AND METHODS

The research method was quasi-experimental with a pretest-posttest control group. The study population consisted of all mothers of children from 8 to 12 years. Therefore, 24 mothers of children with ADHD whose scores in the Connors questionnaire (parent form) were above the cut-off point score and diagnostic interview were selected and randomly paired and assigned into two experimental and control groups. All the mothers were between 30 to 38 years old. The research tools included the Connors questionnaire. Mindful parenting training was accomplished in eight 90-minute sessions for the experimental group. In the end, the two groups completed the questionnaires as post-test. Analysis of covariance was used to analyze the data.

RESULTS

The analysis of the results showed the effect of mindful parenting training on reducing the symptoms of hyperactivity/impulsivity and inattention behaviors of children with ADHD in the experimental group compared to the control group (p-value <0.05).

CONCLUSIONS

The educational and behavioral methods that parents and especially mothers use in response to their children's problematic and undesirable behaviors can increase the incidence of these behavioral problems in the long run. Hence, it is addressed in this study due to the great importance of changing the behavioral and educational methods of such parents. The findings generally show that mindful parenting education has affected the emotional climate governing parent-child interactions and has reduced behavioral problems in children suffering from ADHD.

Field Epidemiology and Public Health Research Priorities in the Eastern Mediterranean Region: Delphi Technique

Research is essential for evidence-based decision making. This study aimed to identify research priorities in the areas of field epidemiology and public health in the Eastern Mediterranean Region (EMR) from the perspectives of public health professionals. A Delphi technique, using online survey, was employed to reach 168 public health professionals who have experience in the EMR countries. The study took place between November 2019 and January 2020. Consensus on the research priorities was reached after two-round online questionnaires. A list of top 10 field epidemiology and public health research priorities in the EMR was developed. Of those priorities, four fell under health in emergency, war and armed conflict, two under communicable diseases, two under immunization, one under digital health, and one under sexual, reproductive, and adolescent health. Availability, adequacy, and quality of health services in crisis settings were scored as a top priority (mean = 4.4, rank 1), followed by use of technology to improve the collection, documentation, and analysis of health data (mean = 4.28, rank 2), and capacity of countries in the region to respond to emergencies (mean = 4.25, rank 3). This study was conducted prior to COVID-19 pandemic and, thus, it did not capture COVID-19 research as a priority area. Nevertheless, identified priorities under communicable diseases including outbreak investigation of infectious diseases, epidemics and challenges related to communicable diseases in the EMR were still notable. In conclusion, the field epidemiology and public health research priorities identified in this study through a systematic inclusive process could be useful to make informed decisions and gear the research efforts to improve the health of people in the EMR.

Improved Constraints on Primordial Gravitational Waves using Planck, WMAP, and BICEP/Keck Observations through the 2018 Observing Season

We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220  GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8  μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.

Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics

OBJECTIVES

This study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan.

METHODS

Explorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis.

RESULTS

Two themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality.

CONCLUSIONS

This study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.

Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives

BACKGROUND

Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices.

OBJECTIVE

The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services.

METHODS

We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis.

RESULTS

Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women's empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional.

CONCLUSIONS

As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices.

Real-Time Surveillance of Infectious Diseases, Injuries, and Chronic Conditions During the 2018 Iraq Arba'een Mass Gathering

The Arba'een pilgrimage in Iraq is now the largest annual gathering in a single place worldwide. To monitor and address the health needs of pilgrims in field clinics near the pilgrimage route, a syndromic surveillance system was designed and implemented by Global Health Development/Eastern Mediterranean Public Health Network in collaboration with Iraq Ministry of Health. This study aimed to analyze the effectiveness of the surveillance system and the data it gathered in evaluating the burden of common acute and infectious conditions, chronic conditions, and trauma and injuries during the Arba'een pilgrimage in 2018. Data were collected at 152 field clinics located across 11 governorates in Iraq at strategic points along the Arba'een pilgrimage route from all governorates to Karbala between October 8 and November 3, 2018. A team of 24 surveillance supervisors trained, oversaw, and provided technical support for 304 data collectors. The data collectors recorded data from 338,399 patients (42.5% female and 57.5% male) in the span of 26 days. The vast majority of patients were from Iraq (n = 294,260, 87.6%) and Iran (n = 34,691, 10.3%). Of the 338,399 patients whose data were recorded by the surveillance system, 246,469 (72.8%) reported acute and infectious conditions, 202,032 (59.70%) reported chronic conditions, and 6,737 (2.0%) reported traumas and injuries. Many patients reported several conditions in multiple categories. The most prevalent acute condition treated was influenza-like illness, identified through patients exhibiting a combination of fever and cough symptoms. Findings from this study will help inform future planning efforts so healthcare workers can be better prepared for treating such cases at mass gatherings. With the latest challenges posed by the COVID-19 pandemic, preparations for a possible future outbreak of the novel coronavirus are also discussed. The information from this study serves as a foundation to inform and optimize future planning of wide-scale surveillance efforts and address challenges in health service delivery and health security.

Effects of oral contraceptives on serum concentrations of adipokines and adiposity indices of women with polycystic ovary syndrome: a randomized controlled trial

PURPOSE

To compare the effects of oral contraceptives (OCs) with different progestins, including Levonorgestrel (LNG), Desogestrel (DSG), Cyproterone Acetate (CPA), and Drospirenone (DRSP) on adipokines levels and adiposity indices in women with polycystic ovary syndrome (PCOS).

METHODS

In this parallel randomized clinical trial, 120 women with PCOS randomly assigned to intervention with OCs containing LNG, DSG, CPA, or DRSP. Outcomes of interest, including serum concentrations of adiponectin, leptin, and resistin, and adiposity indices, i.e., body mass index (BMI), waist circumference (WC), obesity, central obesity, waist to hip ratio (WHR), waist to height ratio (WHtR), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), and visceral adiposity index (VAI), and lipid profiles were assessed at baseline, and 6 months of treatment.

RESULTS

This study showed no significant differences in serum concentrations of adipokines between the four study groups after 6 months of treatment. Our results also showed that patients treated with various compounds of OC for 6 months had no significant differences in their adiposity indices, except for LAP (p = 0.04), and VAI (p = 0.03). PCOS patients treated with OCs containing CPA had significantly a higher mean LAP, compared to those using products containing LNG. Besides, patients treated with OCs containing CPA had significantly a higher mean VAI, compared to those treated with OCs containing DRSP.

CONCLUSION

This study demonstrated that OCs with low androgenic and antiandrogenic activities had identical effects on serum concentrations of adipokines, and adiposity indices, except LAP, and VAI parameters.

REGISTRATION NUMBER

IRCT20080929001281N3.

An overview of the sexual and reproductive health status and service delivery among Syrian refugees in Jordan, nine years since the crisis: a systematic literature review

BACKGROUND

The Syrian refugee crisis has led to massive displacement into neighboring countries including Jordan. This crisis has caused a significant strain on the sexual and reproductive health (SRH) services to the host communities and Syrian refugees. The Minimum Initial Service Package (MISP) is a standard package of services that should be implemented at the onset of an emergency. Due to their importance in protracted humanitarian crisis, this systematic review aimed to assess the utilization of SRH and MISP after 9 years of the crisis.

METHODS

We searched PubMed, Medline/Ovid and Scopus for both quantitative and qualitative studies from 1 January 2011 to 30 November 2019. Our search included both free text key words and Medical Subject Headings (MeSH) for various forms and acronmym of the following terms: (Sexual and) Reproductive Health, Sexual/Gender-based/Family/Intimate partner violence, Minimum Initial Service Package, MISP, Women, Girls, Adolescents, Syrian, Refugee, Jordan, Humanitarian crisis, War, (armed) conflict, and Disaster. Boolean operators and star truncation (*) were used as needed. We further conducted an in-depth review of the available grey literature published during the same timeframe. Using a narrative synthesis approach, two authors independently extracted and analyzed data from published papers. After removal of duplicates, screening, and assessing for eligibility of 161 initially identified citations, 19 papers were selected for review.

RESULTS

Findings from this review indicated a number of barriers to access, utilization, and implementation of SRH services, including lack of reliable information on sexual and gender-based violence (SGBV), aggravation of early marriages by crisis setting, gaps in the knowledge and use of family planning services, inadequate STIs and HIV coverage, and some issues around the provision of maternal health services.

CONCLUSION

The findings from this review are suggestive of a number of barriers pertaining to access, utilization, and implementation of SRH services. This is especially true for transitioning from MISP to comprehensive SRH services, and particularly for refugees outside camps. Following are needed to address identified barriers: improved inter-agency coordination, better inclusion/engagement of local initiatives and civil societies in SRH services delivery, improved quality of SRH services, adequate and regular training of healthcare providers, and increased awareness of Syrian women and adolescent girls. Also, more implementing research is required to identify ways to transition SRH provision from the MISP to comprehensive care for the Syrian refugee population in Jordan.

Real-Time Surveillance of Infectious Diseases and Other Health Conditions During Iraq's Arbaeenia Mass Gathering: Cross-Sectional Study

Background

The most common religious mass gatherings in the Middle East are the Hajj at Mecca in Saudi Arabia, which occurs annually, and the Arbaeenia in Karbala. The importance of developing public health surveillance systems for mass gatherings has been previously emphasized in other reports.

Objective

This study aimed to describe the common illnesses and health conditions affecting people during the Arbaeenia mass gathering in Iraq in 2016.

Methods

A total of 60 data collectors took part in the field data collection over a period of 11 days, from November 12, 2016 to November 22, 2016. Data were collected from 20 health outlets along the major route from Najaf to Karbala (10 health facilities in each governorate). Two digital forms, the Health Facility Survey and the Case Survey, were used for data collection.

Results

A total of 41,689 patients (33.3% female and 66.7% male) visited the 20 health care facilities over a period of 11 days from November 12, 2016 to November 22, 2016. More than three quarters of patients (77.5%; n=32,309) were between 20-59 years of age, more than half of patients were mainly from Iraq (56.5%; n=23,554), and about 38.9% (n=16,217) were from Iran. Patients in this study visited these health care facilities and presented with one or more conditions. Of a total 41,689 patients, 58.5% (n=24,398) had acute or infectious conditions and symptoms, 33.1% (n=13,799) had chronic conditions, 23.9% (n=9974) had traumas or injuries, 28.2% (n=11,762) had joint pain related to walking long distances, and 0.3% (n=133) had chronic dermatologic conditions.

Conclusions

The Arbaeenia mass gathering in 2016 exerted a high burden on the Iraqi health care system. Therefore, efforts must be made both before and during the event to ensure preparedness, proper management, and control of different conditions.

Antimicrobial Effect of Copper Oxide Nanoparticles on Some Oral Bacteria and Candida Species

STATEMENT OF PROBLEM

Acid producing bacteria including Streptococcus mutans and lactobacilli cause tooth demineralization and lead to tooth decay. Also, oral colonization of the species of Candida has been reported in many studies that are resistant to antifungal agents.

OBJECTIVES

In this study, antibacterial and antifungal effects of nano-CuO were studied against some oral bacteria and yeast fungi.

MATERIALS AND METHODS

The minimum inhibitory concentrations (MICs) of copper oxide nanoparticles (CuO NPs) for oral bacterial and fungal test strains were determined in 96-well microtiter plate technique. The agar diffusion test (ADT) was employed to assess the antifungal properties of nystatin.

RESULTS

The MIC₅₀ value of CuO NPs was determined at the range of 1-10 µg/ml for S. mutans, < 1 µg/ml for L. acidophilus, and 10 µg/ml for L. casei. Higher concentrations of CuO NPs (100-1000 µg/ml) were effective on the bacterial cell growth, resulting in 100% reduction in the optical density in TSB medium. The cells of Candida albicans, C. krusei and C. glabrata were treated with CuO NPs and the results showed a decrease in fungal growth at a concentration of 1-1000 µg/ml in TSB medium. The MIC50 value of CuO NPs was determined 1000 µg/ml for three species of Candida. The diameter of growth inhibition zones of 1100 µg/ml nystatin was obtained 15-21 mm for clinical isolates of three species of Candida.

CONCLUSIONS

With respect to the potential bactericidal activity of CuO NPs on various cariogenic bacteria examined in this study, these NPs could be introduce as a candidate control agent for preventing dental caries or dental infections. In our study, on the other hand, Nano copper oxide had a weak effect on the candida species.

Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches

Musculoskeletal disorders are considered the underlying cause of cervicogenic headache, but neck pain is commonly associated with migraine and tension-type headaches. This study tested musculoskeletal function in these headache types. From a group of 196 community-based volunteers with headache, 73 had a single headache classifiable as migraine ( n = 22), tension-type ( n = 33) or cervicogenic headache ( n = 18); 57 subjects acted as controls. Range of movement, manual examination of cervical segments, cervical flexor and extensor strength, the cranio-cervical flexion test (CCFT), cross-sectional area of selected extensor muscles at C2 (ultrasound imaging) and cervical kinaesthetic sense were measured by a blinded examiner. In all but one measure (kinaesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups (all P < 0.001). A dicriminant function analysis revealed that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the CCFT, had 100% sensitivity and 94% specificity to identify cervicogenic headache. There was no evidence that the cervical musculoskeletal impairments assessed in this study were present in the migraine and tension-type headache groups. Further research is required to validate the predictive capacity of this pattern of impairment to differentially diagnose cervicogenic headache.

Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 2: Subjects With Concurrent Headache Types

A pattern of musculoskeletal impairment inclusive of upper cervical joint dysfunction, combined with restricted cervical motion and impairment in muscle function, has been shown to differentiate cervicogenic headache from migraine and tension-type headache when reported as single headaches. It was questioned whether this pattern of cervical musculoskeletal impairment could discriminate a cervicogenic headache as one type of headache in more complex situations when persons report two or more headaches. Subjects with two or more concurrent frequent intermittent headache types ( n = 108) and 57 non-headache control subjects were assessed using a set of physical measures for the cervical musculoskeletal system. Discriminant and cluster analyses revealed that 36 subjects had the pattern of musculoskeletal impairment consistent with cervicogenic headache. Isolated features of physical impairment, e.g. range of movement (cervical extension), were not helpful in differentiating cervicogenic headache. There were no differences in measures of cervical musculoskeletal impairment undertaken in this study between control subjects and those classified with non-cervicogenic headaches.

Smart micro/nanoparticles in stimulus-responsive drug/gene delivery systems

New achievements in the realm of nanoscience and innovative techniques of nanomedicine have moved micro/nanoparticles (MNPs) to the point of becoming actually useful for practical applications in the near future. Various differences between the extracellular and intracellular environments of cancerous and normal cells and the particular characteristics of tumors such as physicochemical properties, neovasculature, elasticity, surface electrical charge, and pH have motivated the design and fabrication of inventive "smart" MNPs for stimulus-responsive controlled drug release. These novel MNPs can be tailored to be responsive to pH variations, redox potential, enzymatic activation, thermal gradients, magnetic fields, light, and ultrasound (US), or can even be responsive to dual or multi-combinations of different stimuli. This unparalleled capability has increased their importance as site-specific controlled drug delivery systems (DDSs) and has encouraged their rapid development in recent years. An in-depth understanding of the underlying mechanisms of these DDS approaches is expected to further contribute to this groundbreaking field of nanomedicine. Smart nanocarriers in the form of MNPs that can be triggered by internal or external stimulus are summarized and discussed in the present review, including pH-sensitive peptides and polymers, redox-responsive micelles and nanogels, thermo- or magnetic-responsive nanoparticles (NPs), mechanical- or electrical-responsive MNPs, light or ultrasound-sensitive particles, and multi-responsive MNPs including dual stimuli-sensitive nanosheets of graphene. This review highlights the recent advances of smart MNPs categorized according to their activation stimulus (physical, chemical, or biological) and looks forward to future pharmaceutical applications.

Assessment of the Effects of IL9, IL9R, IL17A, and IL17F Gene Polymorphisms on Women with Allergic Rhinitis in Shahrekord, Iran

Background:

The genes encoding IL9, IL9R, IL17A, and IL17F have recently been implicated in the genetic basis of rhinitis and allergy.

Aim:

The purpose of this study was to assess the association of the single nucleotide polymorphisms (SNPs) of IL9, IL9R, IL17A, and IL17F and potential interaction of these genes with the determination of IgE levels in women with allergic rhinitis (AR) in Shahrekord, Iran.

Subjects and Methods:

In a case–control study, SNPs from the IL9, IL9R, IL17A, and IL17F were genotyped in 394 random samples including 195 AR patients and 199 normal controls. Enzyme-linked immunosorbent assay was performed for the determination of serum total IgE levels. The Student's t-test was used to compare the differences. The Chi-square test was performed to compare proportions of cases with different clinical features among cases with different genotypes. The genotype and allele frequencies were obtained by direct counting. Hardy–Weinberg equilibrium was tested between cases and controls separately. The relative risk associated with rare alleles was estimated as an odds ratio with 95% confidence interval. P ≤ 0.05 was considered statistically significant.

Results:

The rs731476 SNP in the IL9R was significantly associated with the AR phenotype in women. No association was found between any of the other SNPs in IL9, IL17A, and IL17F genes and AR. In the gene–gene interaction analysis, we found that IL9R/IL9 genotype rs731476 T-/rs2069885 G conferred a higher risk for AR phenotype development. We also did not find a significant association in terms of IgE levels between cases and controls.

Conclusion:

Our result suggests that the rs731476 SNP located in the IL9R is associated with an increased susceptibility to AR in females. In a subsequent gene–gene interaction analysis, the rs731476 T-/rs2069885 G-genotype combination (IL9R/IL9) has significantly been associated with the development of the AR phenotype.

Impact of treatment with inhaled corticosteroids on bone mineral density of patients with asthma: related with age

The effect of inhaled corticosteroid on bone mineral density (BMD) was investigated in 44 asthmatic patients after median treatment duration of 6.5 years. Compared with controls, BMD decreased only in patients aged <50 years in both the spine (11.3 %, p = 0.013) and hip (8.8 %, p = 0.044), whereas in patients ≥50 years BMD did not decrease significantly.

INTRODUCTION

The results of studies which addressed the impact of inhaled corticosteroid (ICS) therapy on BMD of patients with asthma are conflicting. This case-control study aimed to compare BMD status in ICS user with asthma with healthy controls according to age.

METHODS

BMD at the lumbar spine (LS), femoral neck (FN) was measured by dual energy X-ray absorptiometry (DEXA). Patients and controls were compared according to BMD gr/cm(2), BMD T-score, BMD Z-score, frequency of osteoporosis (defined as BMD T-score ≤-2.5), and frequency of patients with BMD Z-score <-1 at LS and FN with regard to age <50 and ≥50 years old.

RESULTS

Forty-four ICS user patients (females 63.6 %) with median treatment duration of 6.5 years and 50 controls (females, 69.4 %) with respective mean age of 49.2 ± 9.5 and 47.4 ± 10.5 years (p = 0.38 and p = 0.35) entered the study. Overall LS-BMD and FN-BMD gr/cm2 in total patients were lower than in controls by 6 % (p = 0.065) and 5.9 % (p = 0.09), respectively. In patients <50 years, mean LS-BMD gr/cm(2) was lower than controls by 11.3 % (p = 0.013) and FN-BMD by 8.8 % (p = 0.044). Mean BMD T-score and BMD Z-score in both measurement sites were also lower than controls (p = 0.013 and 0.01, respectively. Frequency of osteoporosis did not differ but frequency of patients with BMD Z-score <-1 was significantly higher in patients (odds ratio (OR) = 6.57 95 % CI, 1.8-23.9, p = 0.004). In age group ≥50 years old, reduction of BMD in both measurement sites did not reach to a significant level.

CONCLUSION

This study indicates that BMD reduction in ICS user with asthma is dependent on age and appears that younger patients are at greater risk of BMD loss. These findings suggest preventive measures particularly in patients <50 years.

Boceprevir and telaprevir-based triple therapy for chronic hepatitis C: virological efficacy and impact on kidney function and model for end-stage liver disease score

Triple therapy using telaprevir or boceprevir [hepatitis C virus (HCV)-NS3/NS4A protease inhibitors (PI)] in association with PEG-IFN/ribavirin has recently become the new standard of care (SOC) for treatment of HCV genotype 1 patients. Our objective was to assess the efficacy and tolerance of triple therapy in routine clinical practice. A total of 186 consecutive HCV patients initiating triple therapy were enrolled in a single centre study. Clinical, biological and virological data were collected at baseline and during follow-up as well as tolerance and side effect details. Among 186 HCV patients initiating triple therapy, 69% received telaprevir and 31% boceprevir. Sixty-one per cent of patients had cirrhosis. The overall extended rapid virological response (eRVR) rate and sustained virological response (SVR) rate were 57.0% and 59.7%, respectively. IL28B CC phenotype was associated with increased probability of achieving eRVR and SVR, whereas previous non-response was associated with low eRVR and SVR rates. The SVR rate increased from 30.8% in previously non-responders to 59.1% in partial non-responders and 75% in relapsers. SVR rate in naive patients was 62.5%. Glomerular filtration rate assessed by MDRD after 12 weeks of therapy was significantly reduced for both PI (P < 0.001). The model for end-stage liver disease (MELD) score was significantly increased at W12 for telaprevir (P = 0.008) and at W24 for boceprevir (P = 0.027). PI-based triple therapy leads to high rates of virological response even in previously non-responder patients. Renal function after triple therapy is impaired as well as MELD score in all patients. Cautious clinical monitoring should focus not only on haematological and dermatological side effects but also on renal function.

Afghanistan's national strategy for improving quality in health care

Quality problem or issue

When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services.

Initial assessment

A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed.

Plan of action

In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity.

Implementation

The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan.

Lessons Learned

Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented.

Regulation of luteinizing hormone receptor in hippocampal neurons following different long-lasting treatments of castrated adult rats

The aim of this study was to investigate the effects of different Luteinizing hormone (LH) and steroid hormones levels on LH receptor (LHR) expression in the hippocampal cells. Rats (24 males and 24 females) were assigned to four groups: one control and three experimental [gonadectomy (GDX), gonadectomy + gonadotropin releasing hormone analogue (GDX+GnRHa) and GDX+GnRHa+estradiol (E2) or testosterone (T)] independently for each gender. All experimental rats were gonadectomized; then GnRHa was administrated to GDX+GnRHa group, and GnRHa plus steroid hormone to GDX+GnRHa+E2 or T group in both genders for four-month. LHR mRNA expression and its protein level in hippocampal cells were measured using QRT-PCR and Western blotting. Quantification of mRNA revealed a decrease in LHR transcripts level in GDX+GnRHa group of females. A significant change was observed between GDX groups and GDX+GnRHa+E2 or T versus GDX+GnRHa group in females. High levels of LH decreased significantly the immature isoform of LHR in GDX group compared to control group in both genders, but low LH concentrations in GDX+GnRHa group induced immature LHR isoform production only in females. Therefore increased LH concentration induces production of incomplete LHR transcripts in hippocampal cells and decreases immature LHR at the protein level. This implies that LH decreases the efficiency of translation through either producing non-functional LHR molecules or preventing their translation.

Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery

OBJECTIVE

To identify the incidence of sternal wound infection and the risk factors before, during and after open-heart surgery in an Iranian critical care unit.

METHOD

A descriptive, analytic study investigating all open-heart surgery patients from March 2010 to March 2011, in terms of the incidence of sternal wound infection and the risk factors before, during, and after surgery. Patients were examined for signs of infection at the site of surgical incision on presentation to the ward, daily during their stay, and on discharge. The same investigator reviewed all wounds, every day.

RESULTS

The incidence of sternal wound infection was found to be 10%. Multivariate regression analysis identified the following risk factors: diabetes (OR: 0.439; 95%CI: 0.21-0.95; p=0.04), age (OR: 1.033; 95%CI: 1.003-1.064; p=0.03), hyperlipidaemia (OR: 1.008; 95%CI: 1.005-1.011; p<0.001), history of respiratory disorders ([COPD] OR: 2.952; 95%CI: 1.3-6.4; p=0.007), female gender (OR: 2.06; 95%CI: 1.40-3.03; p<0.008), and history of addiction to opiates (OR: 2.33; 95%CI: 1.56-3.49; p<0.006).

CONCLUSION

This study found a high rate of surgical sternal wound infection in open-heart surgery patients in an Iranian critical care unit, suggesting that the medical and care-giving team in the cardiac intensive care unit need further education.

DECLARATION OF INTEREST

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

Mental health promotion of Iranian university students: the effect of self-esteem and health locus of control

The purpose of this study was to investigate the effect of self-esteem and health control belief on promoting students' mental health. In so doing, 144 students from two medical universities in the north-east of Iran were recruited into study. They were pair-matched and randomly assigned to case and control groups. The data were collected through Goldberg's General Health Questionnaire-28, Multidimensional Health Locus of Control and Rosenberg's Self-Esteem Scales. The results showed that there were significant differences between the groups before and after the intervention. The external components of health locus of control (chance and powerful others) showed a significant decrease but the internal health locus of control and self-esteem revealed a significant increase after the intervention (P < 0.0001). Moreover, the students' mental health had a significant increase after 3 months of intervention (P < 0.0001). The findings emphasize that the programme can improve the health locus of control beliefs, self-esteem and mental health promotion of the students. This will require additional monitoring and uninterrupted attempts to be effective.

Treatment outcome, mortality and their predictors among HIV-associated tuberculosis patients

The risk of death is significantly higher in HIV-infected patients with tuberculosis (TB). This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a tertiary TB centre in Iran. In total, 111 patients were recruited from 2004 to 2007. Mycobacteriological studies and demographic, clinical, and laboratory data from all patients were analysed and predictors of unsuccessful outcomes as well as mortality were determined. The mean age for all 111 TB-HIV patients was 38 ± 9 years (range 22-70) and 107 (96.3%) were men; 104 (93.7%) had a history of drug abuse and 96 (86.4%) had a history of imprisonment. The method of HIV transmission was intravenous drug use in 88 (79.3%). Twenty-three (20.7%) had a history of Category 1 (CAT I) TB treatment and six (5.4%) Category 2 (CAT II) treatment. Combination antiretroviral therapy (cART) was given to 48 (43.2%). No significant associations were found between treatment outcomes or mortality and gender, smoking, drug and alcohol abuse, imprisonment, method of transmission, history of CAT I and CAT II treatments, CD4 counts or adverse effects (P > 0.05). Administration of cART led to significantly better outcomes (P < 0.001). Lower serum albumin levels and low body weight were significantly associated with mortality.

The effect of egg yolk oil in the healing of third degree burn wound in rats

BACKGROUND

Burn injury is a major cause of death and disability worldwide. A domestic medication in wound healing, preventing infection and reduction of scar tissue as well as availability is still an important challenge. This study aims to evaluate the efficacy of yolk egg oil in treatment of burn wounds in rats.

METHODS

A standard 3rd degree burn wound was produced and the animals were divided into three groups according to topical treatment including yolk oil, 1% silver sulfadiazine (SSD) and control. In days 7, 14 and 30,animal's weight, wound size, as well as histopathological findings of skin were evaluated in different groups.

RESULTS

Average size of wound after 7 days was 3.4, 5.3, and 6.7 cm in yolk oil, SSD and control groups. There were significant differences between yolk oil and the other groups in this aspect. The wound size of yolk egg group was also significantly smaller than other groups in 14th and 30th days. Results of the histological studies indicated significant differences between yolk oil, SSD and control groups on day 30, with mean score of 3.75, 3.5 and 2.8 respectively. The difference between yolk oil and the other groups was significant.

CONCLUSION

Yolk oil-treated burned animals showed abundant re-epithelialization without tissue scar in comparison with SSD group. Although the egg yolk has many vital nutrients, but its exact mechanism in healing process is unknown. Therefore, further studies evaluating the influence of individual components on burn-healing process is advised.

On the thermodynamic entropy of fatigue fracture

Entropy production during the fatigue process can serve as a measure of degradation. We postulate that the thermodynamic entropy of metals undergoing repeated cyclic load reaching the point of fracture is a constant, independent of geometry, load and frequency. That is, the necessary and sufficient condition for the final fracture of a metal undergoing fatigue load corresponds to a constant irreversible entropy gain. To examine validity, we present the results of an extensive set of both experimental tests and analytical predictions that involve bending, torsion and tension-compression of aluminium 6061-T6 and stainless steel 304 specimens. The concept of tallying up the entropy generation has application in determining the fatigue life of components undergoing cyclic bending, torsion and tension-compression.