To assess the contributing factors of nutritional and health status amongst elderlies residing in the nursing homes of fars province, Iran: A cross sectional study

Background and Aims

In line with the global trend, the number of elderly is rising in Iran. It should be noted that the nutritional and health needs of these people, especially those living in nursing houses, are extremely significant. The present study aimed to identify the nutritional and health status and uncover their relationship with received care services by elderlies residing in nursing homes.

Methods

All 373 elderlies living in the nursing homes in Shiraz entered the study, and the requisite data were collected by references to elderlies' files, respective nurses, and elderlies themselves.

Results

The majority of the elderlies were at risk of malnutrition (62.5% of the total population, 55.4% of females, and approximately 44.6% of males). Elderlies with no insurance coverage mainly fell into the at-risk and malnutrition categories. There was a significant relationship between the needs assessment scores, reflecting the need for physical and psychological actions, and elderlies' malnutrition (odds ratio = 1.87, 95% confidence interval: 1.79-1.95). For each unit increase in the Physical and psychological need score, the odds of exposure to malnutrition (vs. nonmalnourished and at risk of malnutrition) was 1.87 times after adjustment for confounders.

Conclusion

The results of our study revealed that most of the elderlies living in the nursing homes of Shiraz had some levels of malnutrition such as at-risk for malnutrition (62.5%) and malnourished (18.9%). Based on these results, it is suggested that health policy-makers take practical steps toward promoting the nutritional care of old people and direct extra supervision to nursing homes and all healthcare provisions.

Machine learning algorithms to uncover risk factors of breast cancer: insights from a large case-control study

Introduction

This large case-control study explored the application of machine learning models to identify risk factors for primary invasive incident breast cancer (BC) in the Iranian population. This study serves as a bridge toward improved BC prevention, early detection, and management through the identification of modifiable and unmodifiable risk factors.

Methods

The dataset includes 1,009 cases and 1,009 controls, with comprehensive data on lifestyle, health-behavior, reproductive and sociodemographic factors. Different machine learning models, namely Random Forest (RF), Neural Networks (NN), Bootstrap Aggregating Classification and Regression Trees (Bagged CART), and Extreme Gradient Boosting Tree (XGBoost), were employed to analyze the data.

Results

The findings highlight the significance of a chest X-ray history, deliberate weight loss, abortion history, and post-menopausal status as predictors. Factors such as second-hand smoking, lower education, menarche age (>14), occupation (employed), first delivery age (18-23), and breastfeeding duration (>42 months) were also identified as important predictors in multiple models. The RF model exhibited the highest Area Under the Curve (AUC) value of 0.9, as indicated by the Receiver Operating Characteristic (ROC) curve. Following closely was the Bagged CART model with an AUC of 0.89, while the XGBoost model achieved a slightly lower AUC of 0.78. In contrast, the NN model demonstrated the lowest AUC of 0.74. On the other hand, the RF model achieved an accuracy of 83.9% and a Kappa coefficient of 67.8% and the XGBoost, achieved a lower accuracy of 82.5% and a lower Kappa coefficient of 0.6.

Conclusion

This study could be beneficial for targeted preventive measures according to the main risk factors for BC among high-risk women.

Environmental exposure to organophosphate pesticides and effects on cognitive functions in elementary school children in a Middle Eastern area

Although the fundamental reasons for cognitive function disorders have been well documented, little is known about the impact of environmental exposures, such as pesticides, on children's cognitive function development. This study investigated the effect of exposure to organophosphate pesticides on children's cognitive function. In order to determine various factors of exposure, hair samples were collected from 114 elementary school children who lived in Boyer-Ahmad County in the province of Kohgiluyeh and Boyer-Ahmad, Iran. A detailed questionnaire was utilized to gather demographic information and exposure profile. Pesticides were detected in hair samples using a gas chromatography-mass spectrometer (GC-MS); also, cognitive function was assessed using the trail-making test (TMT), which was divided into two parts: TMT-part A and TMT-part B. Participants in the study were 10.12 ± 1.440 years old on average. Children in rural areas had higher mean total pesticide concentrations (13.612 ± 22.01 ng/g) than those who lived in the urban areas (1.801 ± 1.32). The results revealed that boys (46.44 s and 92.37 s) completed the TMT-part A and part B tests in less time than girls (54.95 s and 109.82 s), respectively, and showed better performance (2.14) on the cognitive function exam than girls (2.07). Diazinon and TMT-part B were positively correlated (p < 0.05). With the increase in pesticides, there was no discernible difference in cognitive function. Pesticide use throughout a child's development may affect certain cognitive function indicators. In order to assess causal relationships, group studies and case studies are required because the current research was cross-sectional in nature.

Gender difference in the perceived cause of fall leading to fracture and its potentially contributing factors among older adults

BACKGROUND

the present study aimed to investigate gender difference in the perceived cause (intrinsic or extrinsic) of falls leading to fracture (FLF) and its association with selected social, health, and environmental factors.

METHODS

All patients aged 60 years or older who were admitted to two referral hospitals due to FLF from August 1, 2018, to the end of May 2019, were included in the study. An interview-administered questionnaire was used to collect the required data from 300 participants (136 men and 164 women).

RESULTS

When compared to men, women were less physical active, were less smoker, had lower education, had more vision problems, used more sedatives, and were more satisfied with their life (P less than 0.05 for all). No statistical difference was observed between men and women about the perceived cause of Fall.

CONCLUSIONS

Although women and men were the same in the perceived cause of fall, they had considerably riskier lifestyles and lower health status. These factors include education, vision condition, physical activity, occupation, and taking sleeping pills. On the other hand, men were more smoker and alcohol user.

Prevalence of Cardiovascular Complications in Coronavirus Disease 2019 adult Patients: A Systematic Review and Meta-Analysis

Background

It has been found that the new coronavirus can affect various parts of the cardiovascular system. Cardiovascular complications caused by coronavirus disease 2019 (COVID-19) are often serious and can increase the mortality rate among infected patients. This study aimed to investigate the prevalence of cardiovascular complications in COVID-19 adult patients.

Methods

A systematic review and meta-analysis of observational studies published in English were conducted between December 2019 and February 2021. A complete search was performed in PubMed (PubMed Central and MEDLINE), Google Scholar, Cochrane Library, Science Direct, Ovid, Embase, Scopus, CINAHL, Web of Science, and WILEY, as well as BioRXiv, MedRXiv, and gray literature. A random effect model was used to examine the prevalence of cardiovascular complications among COVID-19 patients. The I2 test was used to measure heterogeneity across the included studies.

Results

A total of 74 studies involving 34,379 COVID-19 patients were included for meta-analysis. The mean age of the participants was 61.30±14.75 years. The overall pooled prevalence of cardiovascular complications was 23.45%. The most prevalent complications were acute myocardial injury (AMI) (19.38%, 95% CI=13.62-26.81, test for heterogeneity I2=97.5%, P<0.001), arrhythmia (11.16%, 95% CI=8.23-14.96, test for heterogeneity I2=91.5%, P<0.001), heart failure (HF) (7.56%, 95% CI=4.50-12.45, test for heterogeneity I2=96.3%, P<0.001), and cardiomyopathy (2.78%, 95% CI=0.34-9.68). The highest pooled prevalence of cardiac enzymes was lactate dehydrogenase (61.45%), troponin (23.10%), and creatine kinase-myocardial band or creatine kinase (14.52%).

Conclusion

The high prevalence of serious cardiovascular complications in COVID-19 patients (AMI, arrhythmia, and HF) necessitates increased awareness by healthcare administrators.

Antigen-Based Diagnosis of Human Giardiasis: A Systematic Review and Meta-Analysis

Background

We aimed to present a systematic review and meta-analysis of studies that used antigen-based assays for the diagnosis of human giardiasis.

Methods

All the related published literature cited within PubMed, ISI web of science, Google Scholar, Embase, and Scopus, were searched up to December 2021. The search terms, both as MeSH terms and text words, were "Giardia", "Giardia lamblia", "Giardia intestinalis", "giardiasis", combined with "diagnosis", "antigen detection", serodiagnosis, or serological diagnosis. The required data was extracted from the papers. Pooled estimates of sensitivity and specificity were obtained and forest plots and summary receiver operating characteristics (SROC) plots were used to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

The search of databases found 1683 papers, of which 46 articles fulfilled our eligibility criteria. The sensitivity of antigen-based methods for the diagnosis of human giardiasis ranged from 45% (95% CI: 31-59%) to 100% (95% CI: 100-100%) and the pooled estimate of sensitivity was 92% (95% CI: 90-93%). The pooled estimated specificity was 97% (95% CI: 96-98%), ranged from 81% (95% CI: 68-89%) to 100% (95% CI: 98-100%). The summary estimate of PPV and NPV were 92 % (95% CI: 90-93%) and 97% (95% CI: 96-98%) respectively. Comparing the performance of the antigen detection assays by region revealed a significant difference in the assay's performances in different regions of the world.

Conclusion

The antigen-based detection methods have acceptable and satisfactory performance in the diagnosis of human giardiasis. The task ahead is to identify more specific target antigens and design simpler, cheaper, and more sensitive methods for the diagnosis of this common worldwide-distributed parasitic infection.

Investigating the factors affecting health care workers' intention to remain in villages

Background

Settlement in a village and being native is one of the special conditions for choosing to be a health care worker as they must be accessible day and night and provide people with health services when needed. The aim of this study was to investigate the factors affecting health care workers' intention to remain in villages covered by Jundishapur University, Ahvaz, Iran.

Methods

This is a cross-sectional study in 2019. The total number of health workers working at Ahvaz Jundishapur University of Medical Sciences and Health Services, Iran was 1034, amongst whom 280 individuals participated in this study. The data collection tool was a questionnaire consisted of two parts, in the first part of which there were 11 questions on personal information of the participants. In the second part, a total of six measures (physical, social, educational and cultural, occupational, welfare, personal and family) were used to examine the factors affecting the health workers' intention to remain in rural areas.

Results

The results of this study showed that the current residence of 55% of the health workers was villages while 45% of them lived in urban areas. The results indicated that there was a significant relationship between physical, social, educational and cultural, occupational, welfare, personal and family factors and the health workers' intention to remain in rural areas. Besides, female HCWs were more affected by personal and family factors compared to the male participants.

Conclusion

Increasing the quality and paying more attention to physical, social, educational and cultural, occupational, welfare, personal and family factors can cause health workers to remain longer in rural areas.

Point and Lifetime Prevalence of Sexually Transmitted Diseases Based on the Definitions of the Iranian Syndrome Surveillance System: A Hospital-Based Survey

Background: Sexually transmitted infections (STIs) are among the most common infectious diseases and a globally concerning public health issue, especially in developing countries. Objectives: This study aimed to evaluate the syndrome-based point and lifetime prevalence of sexually transmitted infections in a big Iranian city. Methods: This cross-sectional study was conducted in 2019 on a hospital-based random sample of 2107 people (men and women aged 15 - 50) at Marvdasht Central Hospital (Iran). Results: The lifetime prevalence of Sexually Transmitted Diseases (STDs) was significantly higher in women than in men (81.56% vs. 33.60%, P-value < 0.0001). Also, about 20.7% of men and 48.26% of women had at least one of the STIs-associated syndromes at the time of the interview (instantaneous prevalence) (P-Value = 0.001). Conclusions: The estimated prevalence of syndromes associated with sexually transmitted infections is alarmingly high. The results emphasize the need for further studies on effective health care and health promotion services to reduce STIs (including early detection and treatment of infections and public education).

Falls leading to fracture and nutrition among older adults: a case-control study

OBJECTIVES

Injurious falls, especially those leading to bone fracture, are major causes of death and disability among older people. Our aim was to measure the association of nutritional factors and physical activity with falls leading to fracture among Iranian older adults.

METHODS

This is the second phase of a previously published case-control study on 300 patients and 590 controls.

RESULTS

In addition to the socio-economic factors that were reported before, our results revealed that consumption of fish, vegetables, fruits, and nuts reduced the risk of falling, whereas consumption of cheese, red meat, and sweets raised the risk of falls among the participants.

CONCLUSION

The results of our study suggested that diets rich in fish meat fruits and vegetables should be encouraged in the everyday life of older adults. We suggest health officials to take these important results into consideration when planning protective measures.

Applications of different machine learning approaches in prediction of breast cancer diagnosis delay

Background

The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal.

Objectives

The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran.

Methods

In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey.

Results

Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis.

Conclusion

Machine learning techniques suggest that women with an urban residency who got married or had their first child at an age older than 30 and those without children are at a higher risk of diagnosis delay. It is necessary to educate them about BC risk factors, symptoms, and self-breast examination to shorten the delay in diagnosis.

Pattern of contributing behaviors and their determinants among people living with HIV in Iran: A 30-year nationwide study

Introduction

A major shift in the routes of HIV transmission seams to be taking place in Iran. Our study aimed to investigate the 30-year trend of major HIV related behaviors in Iran.

Methods

The national HIV/AIDS registry database (from September 1986 to July 2016 with data on 32,168 people newly diagnosed with HIV) was used to study the 30 years trend and demographic determinants of major HIV related behaviors.

Results

The highest rate of drug injection (DI) among people living with HIV (PLHIV) was reported during 1996 to 1999 (p-for trend < 0.001) while the highest rate of sexual activity by minorities or hard to reach groups was during 2004 to 2011 (p-for trend < 0.001). Among males, drug injection was directly associated with being single (OR_{single/married} = 1.34), being unemployed (OR_{unemployed/employed} = 1.94) and having lower level of education (OR_{<highschool/≥highschool} = 2.21). Regarding females, drug injection was associated with being housewife (OR_{housewife/employed} = 1.35) and lower level of education (OR_{<highschool/≥highschool} = 1.85). In females, condomless sexual contact was more common among those younger (OR_20-29/<20 = 6.15), and married (OR_{married/single} = 7.76). However, among males those being single (OR_{married/single} = 0.82), being more educated (OR_{≥highschool/<highschool} = 1.24), and being unemployed (OR_{unemployed/employed} = 1.53) reported more sexual activity by minoritised or hard to reach groups.

Discussion

The pattern of major HIV related behaviors among Iranian males and females have been rapidly changing and people living with HIV (PLHIV) are being diagnosed at a younger age. Health education to younger individuals is an essential HIV controlling strategy among Iranian population. Implementation of surveys in hidden and hard-to-reach populations is also recommended.

Evaluating the effect of digital game-based nutrition education on anemia indicators in adolescent girls: A randomized clinical trial

Iron deficiency anemia is the most common type of micronutrient deficiency in the world. Adolescence represents a period of increased risk of iron deficiency. Therefore, we aimed to determine the impact of nutrition education by a digital game on markers of iron-deficient anemia in adolescent girls. In this study, 176 adolescent girls were randomly dichotomized into the intervention and control groups. At the beginning and the end of the intervention, knowledge, attitude, and practice of both groups were assessed by a questionnaire. Girls in the intervention group received the necessary education through a digital game during a 14-week period, while those in the control group received basic nutritional education through PowerPoint and pamphlets. Additionally, serum transferrin, serum iron, transferrin saturation, ferritin, CBC difference, and total iron binding capacity (TIBC) tests were checked. In this study, nutrition education significantly increased the level of knowledge, attitude, and practice of adolescent girls regarding their diet (p ˂ .05). Hemoglobin level was also significantly raised (p ˂ .05). However, no significant effect was observed on other markers of iron-deficient anemia, such as serum iron, TIBC, and hematocrit, in the intervention group compared with the control group (p ˃ .05). The results of this study indicated the positive impact of nutrition education based on digital game on knowledge, attitude, and practice scores, as well as a significant difference in hemoglobin. It is recommended that educational games be designed for students in the future to promote health and nutrition information.

Survival Rate of Liver Transplantation in Asia: A Systematic Review and Meta-Analysis

Background: Liver transplantation is one of the most effective treatments for acute liver failure, chronic liver cirrhosis, and hepatocellular carcinoma. This study was implemented to evaluate the survival rate of liver transplant in Asia. Methods: Studies that investigated the survival rate of liver transplant were selected using a systematic search strategy in the following databases: Medline, Embase, Scopus, ProQuest, ISI Web of Science, and Cochrane to Nov 30th, 2020. Pooled survival rate and 95% confidence intervals were calculated using Der-Simonian and Laird method. Stata 16.0 (Stata Corp, College Station, TX, USA) was used for analysis. Results: One, 2, 3, 5, and 10-year survival rates of liver transplant were estimated to be 85%, 80%, 75%, 73%, and 71%, respectively. The results of the univariate meta-regression for defining the sources of heterogeneity for one-Year survival rate (SR) showed significant effects of bias (β high risk/ moderate risk =0.059, 95% CI: 0.002, 0.115, P-Value=0.04) and follow up time (β=-0.0002, 95% CI: -0.0003, -0.00, P-Value=0.02) on heterogeneity. Conclusion: The survival rate of liver transplant in Asia is comparable with the corresponding rate reported in the United States and Europe. This study provides a better view of the efficiency of medical cares, regarding liver transplantation. Medical care be enhanced to increase the survival of liver transplant patients.

Late diagnosis of HIV infection and its associated factors in Shiraz, Southern Iran: a retrospective study

Late diagnosis (LD) of HIV infection can give rise to suboptimal responses to antiretroviral treatment. The current study aimed to determine the prevalence and associated factors of HIV LD in Shiraz, Southern Iran. This retrospective cohort study was conducted from August 1997 to May 2018. Medical records were examined to extract required data. Individuals with time period less than three months from HIV diagnosis to an advanced phase of AIDS on CD4 < 350 were considered as LD. Multivariable logistic regression used to investigate the associated factors of late HIV diagnosis and adjusted odds ratios were reported. Of 1385 individuals, 1043 (75.3%) were considered as LD. The following factors were identified as the associated factors of LD: age at diagnosis (OR = 1.72, 95% CI: 1.22, 2.41), HCV co-infection (OR = 1.65, 95% CI: 1.23, 2.21), not living in Shiraz (OR = 1.36, 95% CI: 1.02, 1.82), increased likelihood of LD and being housewife (OR = 0.67, 95% CI: 0.47, 0.95) which decreased the likelihood of LD. Our results showed delayed diagnosis of a large proportion of individuals with HIV. It is critical to improve the HIV testing guidelines in Iran to identify individuals with HIV without delays in order to provide them with timely HIV medical care and treatment.

The association of food insecurity and cardiometabolic risk factors was independent of body mass index in Iranian women

Background

Investigations on food insecurity have shown that food insecurity is inversely associated with health. We examined the association of food insecurity and cardiometabolic risk factors in women living in Shiraz, Iran.

Methods

The cross-sectional study was performed on 190 females. Food insecurity was assessed by Household Food Insecurity Access Scale. Cardiometabolic risk factors including anthropometric characteristics, blood pressure, and serum glucose and lipids were measured. Metabolic syndrome score was calculated according to the criteria described for Iranian adults. The association of food insecurity and cardiometabolic risk factors was assessed by linear regression.

Results

The prevalence of food security, and mild, moderate, and severe food insecurity was 42.6%, 40.5%, 15.8%, and 1.1%, respectively. Cardiometabolic risk factors worsened with increasing severity of food insecurity. Among the risk factors, body mass index (BMI) had the strongest association with food insecurity. After controlling demographic factors and BMI, fasting blood glucose, triglycerides, total, LDL, and HDL cholesterols, and metabolic syndrome score still showed significant associations with food insecurity (P < 0.01) but systolic and diastolic blood pressure were no longer associated with food insecurity after adjustment for BMI.

Conclusion

Overall, although BMI was strongly associated with food insecurity, cardiometabolic risk factors including blood glucose, triglycerides, total, HDL, and LDL cholesterols, and metabolic syndrome score were associated with food insecurity independent of BMI, suggesting that other factors such as lifestyle and diet may have contributed to the exacerbated cardiometabolic risk in food insecure participants of this study. Future studies need to clarify underlying factors in the association of food insecurity and cardiometabolic risk factors.

Dietary fats and their sources in association with the risk of bladder cancer: A pooled analysis of 11 prospective cohort studies

The effects of fat intake from different dietary sources on bladder cancer (BC) risk remains unidentified. Therefore, the present study aimed to investigate the association between fat intakes and BC risk by merging world data on this topic. Data from 11 cohort studies in the BLadder cancer Epidemiology and Nutritional Determinants (BLEND) study, provided sufficient information on fat intake for a total of 2731 BC cases and 544 452 noncases, which yielded 5 400 168 person-years of follow-up. Hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were estimated using Cox-regression models stratified on cohort. Analyses were adjusted for total energy intake in kilocalories, gender, smoking status (model-1) and additionally for sugar and sugar products, beers, wine, dressing and plant-based and fruits intakes (model-2). Among women, an inverse association was observed between mono-unsaturated fatty acids (MUFAs) and BC risk (HR comparing the highest with the lowest tertile: 0.73, 95% CI: 0.58-0.93, P-trend = .01). Overall, this preventative effect of MUFAs on BC risk was only observed for the nonmuscle invasive bladder cancer (NMIBC) subtype (HR: 0.69, 95% CI: 0.53-0.91, P-trend = .004). Among men, a higher intake of total cholesterol was associated with an increased BC risk (HR: 1.37, 95% CI: 1.16-1.61, P-trend = .01). No other significant associations were observed. This large prospective study adds new insights into the role of fat and oils in BC carcinogenesis, showing an inverse association between consumption of MUFAs and the development of BC among women and a direct association between higher intakes of dietary cholesterol and BC risk among men.

Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study

Objectives

Late initiation of antiretroviral therapy (ART) is associated with poor outcome among people living with HIV (PLHIV) and higher risk of transmission of infection. This study was conducted to identify the determinants of late ART initiation among PLHIV in Southern Iran.

Methods

A historical cohort study was conducted on 1,326 PLHIV of ≥15 years of age who were registered with the behavioral diseases counseling center (BDCC) in southern Iran from August 1997 to March 2021. Late ART initiation was defined as a CD4 cell count &lt;200 cells/mm3 or having a clinical AIDS diagnosis at the time of ART initiation. The required demographic and clinical data were collected from the patients' medical records. Multiple regression analysis was conducted to define late ART initiation associated factors.

Results

Late ART initiation was found among 81.9% of patients. Based on the results of the multivariate analysis, older age (odds ratio [OR] = 1.02, 95% CI = 1.00–1.04), being single (ORsingle/married = 1.80, 95% CI = 1.17–2.78), history of drug use (ORyes/no = 1.64, 95% CI = 1.02–2.62), year of ART initiation (OR2011−2013/2018−2021 = 3.65, 95% CI = 2.28–5.86), and possible route of transmission (ORdruginjection/sexual = 7.34, 95% CI = 1.16–46.21) were directly associated with the risk of late ART initiation.

Conclusions

The results show that the prevalence of late ART initiation was alarmingly high. For better infection control and better prognosis of infection, people at high risk need to be provided with timely services (e.g., diagnosis, treatment, training, and social support).

Sleep quality, stress and thyroid cancer: a case-control study

BACKGROUND

Stress and sleep disturbance have been found to be associated with numerous adverse health outcomes, including cancer. Our study aimed to measure the association between quality of sleep, short-temperedness, and stress in life with the risk of thyroid cancer.

METHODS

The present study is conducted on 361 newly diagnosed TC patients and 347 sex-age frequency matched controls. Control and case participants were registered with the same health centers. We used multiple logistic regression to investigate the association between TC risk and the interested factors.

RESULTS

Based on the results of the multivariate analysis, stress (OR_{always stressful/often calm} = 3.07, 95% CI 1.42-6.63) and short-temperedness (OR_nervous/calm = 2.00, 95% CI 1.28-3.11) were directly associated with the risk of TC. On the other hand having a quality sleep (OR_{sometimes/never} = 0.36, 95% CI 0.16-0.79) and quality sleep (OR_often/no = 0.45, 95% CI 0.21-0.96, P = 0.041) seems to be a protective factor.

CONCLUSIONS

Some community-based interventions, e.g., lowering stress levels and improving sleep quality, may help in preventing different types of cancer, including TC. We suggest further evaluation of these important findings in the prevention of TC cancer.

Health risk assessment of polycyclic aromatic hydrocarbons in individuals living near restaurants: a cross-sectional study in Shiraz, Iran

Polycyclic aromatic hydrocarbons (PAHs) are persistent toxic substances that have ubiquitous presence in water, air, soil, and sediment environments, posing serious environmental risks. The present study aimed to investigate the concentrations of urinary PAHs and their health effects in individuals living near restaurants via a health risk assessment analysis. This cross-sectional study was performed on 57 people living near restaurants and 30 individuals as the control group. Five urinary metabolites of PAHs were monitored. In order to evaluate the effects of the urinary metabolites of PAHs on Malondialdehyde (MDA) concentration, Total Anti-oxidation Capacity (TAC) in urine samples, and C-Reactive Protein (CRP) in serum samples, regression model was used by considering the effects of the possible confounding factors. Non-carcinogenic health risk was calculated, as well. The median concentration of urinary PAHs was 1196.70 and 627.54 ng/g creatinine in the people living near restaurants and the control group, respectively. Among the metabolites, the lowest and highest mean concentrations were related to 9-OHPhe and 1-OHP, respectively in the two study groups. Moreover, PAHs were significantly associated with MDA level and TAC (p < 0.05). Hazard Quotient (HQ) and Hazard Index (HI) were less than 1. Long-term studies are required to determine the actual health effects by identifying the sources of PAHs emission and to find ways to decrease the production of these compounds.

Cosmetic use and serum level of lead (not cadmium) affect bone mineral density among young Iranian women

Bone mineral density is a crucially important index for skeletal health. A low amount of bone density (osteoporosis) is a common health problem among men and especially women. Among different parts of the body, women's face is the area on which many types of (facial) cosmetics are routinely applied. The aims of this study were to measure the association of cosmetic use with BMD of the lumbar spine and femoral neck among young female students. This is a cross-sectional study on 65 female students in the 2017 academic year. The study participants were students at Shiraz University of Medical Sciences who were selected randomly using phone directory sampling method. Based on the results of multiple linear regression, adjusted for several important covariates, cosmetic use is inversely associated with the BMD z-scores. Lead was significantly associated with trochanteric z-score (B = -0.002 to 95% CI = -0.004 to -0.0003, p = 0.02) and total lumbar z-score (B = -0.002 to 95% CI = -0.004 -0.0005, p = 0.01). In the present study, duration of using cosmetics was significantly associated with BMD of key skeletal regions. The big market of cosmetics in many countries especially those in the Middle East is highly a vastly neglected health issue. Many more observational prospective or interventional studies are required to understand the benefits and hazards caused by cosmetics in women.

Dietary patterns and risk of bladder cancer: a systematic review and meta-analysis

BACKGROUND

Several studies have investigated the relationship between dietary patterns and the risk of bladder cancer (BC) in different regions including Europe, the United States, and Asia, with no conclusive evidence. A meta-analysis was undertaken to integrate the most recent information on the relationship between a data-driven Western diet (WD), the Mediterranean diet (MD), and dietary-inflammatory-index (DII) and the risk of BC.

METHOD

We looked for published research into the relationship between dietary patterns and the incidence of BC in the PubMed/Medline, Cochrane Library, Web of Science, and Scopus databases up until February 2021. Using a multivariate random-effects model, we compared the highest and lowest categories of WD, MD and DII patterns and provided the relative risk (RR) or odds ratios (OR) and 95 percent confidence intervals (CIs) for the relevant relationships.

RESULTS

The analysis comprised 12 papers that were found to be suitable after scanning the databases. Both case-control (OR 0.73, 95% CI: 0.52, 0.94; I2 = 49.9%, n = 2) and cohort studies (RR 0.93, 95% CI: 0.88, 0.97; I2 = 63%, n = 4) found a substantial inverse association between MD and BC. In addition, although cohort studies (RR 1.53, 95% CI 1.37, 1.70; I2 = 0%, n = 2) showed a direct association between WD and BC, case-control studies (OR 1.33, 95% CI 0.81, 1.88; I2 = 68.5%, n = 2) did not. In cohort studies, we found no significant association between DII and BC (RR 1.02, 95% CI 0.93, 1.12; I2 = 38.5%, n = 2). In case-control studies, however, a strong direct association between DII and BC was discovered (RR 2.04, 95% CI 1.23, 2.85; I2 = 0%, n = 2).

CONCLUSION

The current meta-analysis showed that MD and WD have protective and detrimental effects on BC risk, respectively. No significant association between DII and the risk of BC was observed. More research is still needed to confirm the findings. Additional study is warranted to better understand the etiological mechanisms underlying how different dietary patterns affect BC.

TRIAL REGISTRATION

Protocol registration number: CRD42020155353. Database for protocol registration: The international prospective register of systematic reviews database (PROSPERO). Data of registration: August 2020.

Chronic kidney disease and its health-related factors: a case-control study

BACKGROUND

Chronic kidney disease (CKD) is a non-communicable disease that includes a range of different physiological disorders that are associated with abnormal renal function and progressive decline in glomerular filtration rate (GFR). This study aimed to investigate the associations of several behavioral and health-related factors with CKD in Iranian patients.

METHODS

A hospital-based case-control study was conducted on 700 participants (350 cases and 350 controls). Logistic regression was applied to measure the association between the selected factors and CKD.

RESULTS

The mean age of cases and controls were 59.6 ± 12.4 and 58.9 ± 12.2 respectively (p = 0.827). The results of multiple logistic regression suggested that many factors including low birth weight (OR yes/no = 4.07, 95%CI: 1.76-9.37, P = 0.001), history of diabetes (OR yes/no = 3.57, 95%CI: 2.36-5.40, P = 0.001), history of kidney diseases (OR yes/no = 3.35, 95%CI: 2.21-5.00, P = 0.001) and history of chemotherapy (OR yes/no = 2.18, 95%CI: 1.12-4.23, P = 0.02) are associated with the risk of CKD.

CONCLUSIONS

The present study covered a large number of potential risk/ preventive factors altogether. The results highlighted the importance of collaborative monitoring of kidney function among patients with the above conditions.

Trend of geographical distribution of stomach cancer in Iran from 2004 to 2014

BACKGROUND

Among different common types of cancer, gastric cancer (GC) is a worldwide health priority in both developing and developed countries. The aim of this study was to map the distribution of incident cases of GC in Iran to provide a geographical presentation of the incidence of the disease.

METHODS

This study used the Iranian National Cancer Registry (INCR) data from 2004 to 2014. We calculated the crude and age-standardized incidence rates of GC for each province and also defined the frequency distribution of different types and locations of GC by the provinces.

RESULTS

According to the results of the present study, the patients were predominantly male 49,907 (70.0%) and the most prevalent type of tumour was A1 (almost 96.4%) and C3‌ (2.0%). Also, a significant difference was observed between males and females in the distribution of the types of tumour (P < 0.001). In addition, a comparison of the distribution of the types of GC in Iran suggested that a significant difference exists between the provinces (P < 0.001). A significant difference was observed when the distribution of the location of GC tumors was compared between males and females and provinces (P < 0.001). Accordingly, pylori and cardia are the most common location of GC cancer among the study population (28.1% and 31.3% respectively).

CONCLUSIONS

The results of the current study suggested a higher rate of GC incidence in Iran when compared to the global figure in both females and males. Our study also revealed significant disparities between provinces with regard to the distribution of types, and location of GC. This may suggest involving different factors in GC in different parts of Iran. Further studies are needed to better understand the epidemiology and etiology of the disease in Iran.

Prenatal exposure to polycyclic aromatic hydrocarbons and effects on neonatal anthropometric indices and thyroid-stimulating hormone in a Middle Eastern population

Prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) evokes extensive concerns regarding public health. Monitoring the pregnant women's exposure can be considered a suitable alternative to assess the fetus's exposure. This study aimed to monitor pregnant women's exposure (n = 126) to PAHs using a biomonitoring approach to evaluate effects on anthropometric indices and neonatal thyroid-stimulating hormone (TSH) in Shiraz, Iran. PAHs priority compounds were measured by gas chromatography-mass spectrometry (GC-MS) after separating blood serum and liquid-liquid extraction (LLE) method. Information on anthropometric indices, neonatal TSH levels, and data from the respondents was obtained from medical records and questionnaires. The mean PAHs concentrations ranged from 0.29 to 327.91 ng/g lipid. There was no significant difference between the measured PAHs in maternal serum at the seventh month and pregnancy termination except for ACY (p-Value<0.05). Regression analysis results showed a significant correlation (p-value<0.05) between exposure to passive smoke and total PAHs concentrations. There was no significant relationship between exposure to PAHs and weight, height, head circumference, and Apgar score of newborns. The results showed TSH decreased by 0.99 units as ACE increased per unit (β = -0.001). This study is the first to evaluate relationships between prenatal exposure to PAHs and effects on newborn health indicators, including TSH levels in a Middle Eastern population. Future studies are suggested to perform detailed assessments of PAHs intake sources, especially in vulnerable populations such as pregnant women and children.

Assessing BTEX concentrations emitted by hookah smoke in indoor air of residential buildings: health risk assessment for children

Hookah smoke is one of the major indoor sources of Volatile Organic Compounds (VOCs), including Benzene, Toluene, Ethylbenzene, and Xylenes (BTEX). The present study aimed to investigate potential exposure to BTEX compounds among primary school children whose parents smoked hookah at home. BTEX concentrations in indoor air were measured in 60 residential buildings of Khesht, southwestern Iran (case = 30 and control = 30). Target compounds were sampled by charcoal tubes, and the samples were then analyzed by GC-FID. Monte Carlo simulation was used to assess the carcinogenic and non-carcinogenic risks of BTX exposure for the children aged 7-13 years. The concentrations of benzene (7.19 ± 3.09 vs. 0.82 ± 0.5 μg/m³), toluene (1.62 ± 0.69 vs. 0.3 ± 0.22 μg/m³), and xylenes (2.9 ± 1.66 vs. 0.31 ± 0.22 μg/m³) were considerably higher in the indoor air of the case houses compared with the control houses (p < 0.05). The Incremental Lifetime Cancer Risk (ILCR) of benzene for non-smoking and smoking houses were estimated 1.8 × 10^-6 and 15 × 10^-6, respectively, exceeding the recommendations of the World Health Organization (WHO) and the Environmental Protection Agency (EPA) (1 × 10^-6). Moreover, Hazard Quotients (HQs) of all BTX compounds were < 1. The indoor benzene concentration was significantly influenced by the floor at which families lived and type of the kitchen. In order to prevent children's exposure to BTX emitted by hookah, banning indoor smoking is the only way to eliminate these compounds in the indoor air.

The association between the urinary biomarkers of polycyclic aromatic hydrocarbons and risk of metabolic syndromes and blood cell levels in adults in a Middle Eastern area

PURPOSE

Limited studies have been published on the association between the urinary biomarkers of Polycyclic Aromatic Hydrocarbons (PAHs) and risk of Metabolic Syndromes (MetS) and blood cell levels in adults in the Middle East. The present study aimed to evaluate the exposure to PAHs and the distribution of urinary OH-PAH levels in the general population of Shiraz, Iran, as well as, the association between OH-PAHs and the prevalence of MetS and blood cell levels.

METHODS

In this study, 200 participants were randomly selected from the adult population, and their first-morning void urine samples were collected.

RESULTS

The mean concentrations of 1-OHNap, 2-OHNap, 2-OHFlu, 9-OHPhe, and 1-OHP were 639.8, 332.1, 129, 160.3, and 726.9 ng/g creatinine, respectively. The prevalence of MetS was 26% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The results showed that urinary OH-PAHs, especially 1-OHP, were positively and significantly associated with higher waist circumstance (p < 0.001), triglyceride level (p < 0.001), systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), number of white blood cells (p = 0.041) and red blood cells (p < 0.001). It also caused lower levels of High Density Lipoprotein-Cholesterol (HDL-C). In conclusion, the results emphasized the adverse health effects of PAHs on human health, including obesity, hypertension, dyslipidemia, and decreased number of blood cells.

CONCLUSION

Therefore, in order to identify the PAHs sources and to develop methods for decreasing the amount of emissions to the environment, broader researches are needed.

Effect of protein and carbohydrate distribution among meals on quality of life, sleep quality, inflammation, and oxidative stress in patients with type 2 diabetes: A single-blinded randomized controlled trial

BACKGROUND/OBJECTIVES

Patients with diabetes mellitus have a lower quality of life and sleep compared with healthy individuals. Nutrition therapy has an important role in the management of diabetes and can improve inflammation and quality of life in patients with diabetes. The present study aimed to evaluate the effect of high-protein versus high-carbohydrate intake during evening meal on quality of life, sleep quality, inflammation, and oxidative stress in subjects with type 2 diabetes.

SUBJECTS/METHODS

This is a 10-week randomized controlled trial. 96 adult patients with type 2 diabetes were assigned into one of the following three groups: standard evening meal (ST), high-carbohydrate evening meal (HC), and high-protein evening meal (HP). The effect of these diets was examined on high-sensitivity C-reactive protein, malondialdehyde, quality of life, and sleep quality.

RESULTS

Sleep quality improved significantly in all groups (p < .05). The quality of life and high-sensitivity C-reactive protein improved in all groups except for the HP group (p < .05). Serum malondialdehyde level did not change significantly throughout the study (p > .05).

CONCLUSIONS

Small manipulation of protein and carbohydrate distribution among the meals might not affect sleep quality. A diet with an even distribution of macronutrients among the meals or with a higher percentage of carbohydrates in the evenings can improve the quality of life and reduce inflammation in patients with type 2 diabetes, while a diet with a higher percentage of protein in the evenings may not improve it.

Impact of social and clinical factors on the diagnostic delay of chronic kidney disease: an evaluation study

AIM

This study aimed to investigate the impact of social and clinical factors on the diagnostic delay of chronic kidney disease (CKD) among Iranian patients.

MATERIALS AND METHODS

Our study was conducted on 350 CKD patients who were referred to Faghihi and Motahari clinics (the two largest kidney diseases referral centers in Shiraz the capital of Fars province). Data were collected via an interviewer-administered questionnaire. A multiple linear regression model was used to measure the effect of factors affecting the delay of CKD diagnosis.

RESULTS

The medians and Interquartile ranges (IQR) of all delays, patient delay, and doctor delay were 6.5 (0-12.2), 5.1 (0-11.2), and 0.9 (0-3.1) months, respectively. The results showed that women were diagnosed 1.61 months earlier than men (p < 0.05). The duration of all delays in patients residing in the rural areas was 1.28 months longer than patients residing in the urban areas (p < 0.05). Also, patients with perceived good economic status were diagnosed 1.30 months earlier than patients who reported having very poor economic status (p < 0.05).

CONCLUSIONS

The delay is in part due to the neglect and misinterpretation of symptoms by both patients and physicians. It is necessary to improve the awareness of CKD among general public and medical professionals.

The dignity of burn patients: a qualitative descriptive study of nurses, family caregivers, and patients

Background

As an ethical principle, showing respect for human dignity is a professional duty of all nurses. The aggressive nature of severe burn injuries makes it hard to respect the existential values and dignity of burn patients. However, only a few studies have been conducted on the preservation of the dignity of burn patients. The purpose of this study is to identify and describe burn patients’ dignity as perceived by nurses, family caregivers, and burn patients.

Methods

The present study has a descriptive, qualitative research design. Nurses, family caregivers and patients in the biggest burns hospital in the south of Iran were selected via purposeful sampling from October 2017 to August 2018 (n = 25). Data were collected using semi-structured, in-depth, individual interviews. Thereafter, data analysis was performed through conventional content analysis.

Results

Three main themes were extracted from the information obtained in the interviews: empathic communication, showing respect, and providing comprehensive support.

Conclusion

The care provided to burn patients should be combined with effective communication, spending time with them, and attending to their repetitive requests, so that they can freely express their feelings and concerns. In addition, the patients’ human values and beliefs should be respected and all aspects of their existence should be taken into account to preserve their dignity. Workshops designed based on the findings of the present study can help with improving the quality of burn nursing care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00725-w.

Development and assessment of the psychometric properties of a compassionate care questionnaire for nurses

Background

Compassionate care is emphasized within professional ethics codes for nursing and is a key indicator of care quality. The purpose of the present study is to develop and assess the psychometric properties of a compassionate care instrument for nurses.

Methods

This methodological study was carried out in two phases -qualitative and quantitative-from February 2016 to October 2018. In the qualitative stage of the study, a content analysis approach was used to establish the concept of compassionate care through interviews with nurses, patients, and family caregivers. The initial draft of the questionnaire was developed based on the qualitative findings and a subsequent review of the literature. In the second phase, the psychometric properties of the questionnaire were assessed for validity and reliability. Data analysis was performed using descriptive and inferential statistics in SPSS v.16.

Results

From the results of the qualitative phase and review of literature, 80 items were extracted. In the quantitative phase, after evaluation of the face and content validity, 40 items were kept. After measurement of the construct validity, 28 items whose factor loading was above 0.4 were retained. Measurement of convergent validity showed a moderate correlation between the questionnaire and the nurses’ caring behaviors scale (r = 0.67, P = 0.01). The reliability of the 28-item questionnaire was tested by measuring its Cronbach’s alpha coefficient and intra-class correlation coefficient which were found to be 0.91 and 0.94 for the whole questionnaire, respectively.

Conclusion

The questionnaire has enough validity and reliability to be used for measuring the nurses’ compassionate care. Therefore, the instrument can be used to measure and record the quality of nursing care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00691-3.

Which criteria is a better predictor of ICU admission in trauma patients? An artificial neural network approach

PURPOSE

One of the most critical concerns in the intensive care unit (ICU) section is identifying the best criteria for entering patients to this part. This study aimed to predict the best compatible criteria for entering trauma patients in the ICU section.

METHOD

The present study was a historical cohort study. The data were collected from 2448 trauma patients referring to Shahid Rajaee Hospital between January 2015 and January 2017 in Shiraz, Iran. The artificial neural network (ANN) models with cross-validation and logistic regression (LR) with a backward method was used for data analysis. The final analysis was performed on a total of 958 patients who were transferred to the ICU section.

RESULTS

Based on the present results, the motor component of the GCS score at each cutoff point had the highest importance. The results also showed better performance for the AUC and accuracy rate for ANN compared with LR.

CONCLUSION

The most critical indicators in predicting the optimal use of ICU services in this study were the Motor component of the GCS. Results revealed that the ANN had a better performance than the LR in predicting the main outcomes of the traumatic patients in both the accuracy and AUC index. Trauma section surgeons and ICU specialists will benefit from this study's results and can assist them in making decisions to predict the patient outcomes before entering the ICU.

COVID-19, body mass index and cholesterol: an ecological study using global data

Background

Coronavirus disease 2019 (COVID-19) is now globally considered a serious economic, social and health threat. A wide range of health related factors including Body Mass Index (BMI) is reported to be associated with the disease. In the present study, we analyzed global databases to assess the correlation of BMI and cholesterol with the risk of COVID-19.

Methods

In this ecological study, we used age-standardized BMI and cholesterol levels as well as the incidence and mortality ratio of COVID-19 at the national-levels obtained from the publicly available databases such as the World Health Organization (WHO) and NCD Risk Factor Collaboration (NCD-RisC). Bivariate correlation analysis was applied to assess the correlations between the study variables. Mean differences (standard deviation: SD) of BMI and cholesterol levels of different groups were tested using independent sample t-test or Mann–Whitney rank test as appropriate. Multivariable linear regression analysis was performed to identify variables affecting the incidence and mortality ratio of COVID-19.

Results

Incidence and mortality ratio of COVID-19 were significantly higher in developed (29,639.85 ± 20,210.79 for cases and 503.24 ± 414.65 for deaths) rather than developing (8153.76 ± 11,626.36 for cases and 169.95 ± 265.78 for deaths) countries (P < 0.01). Results indicated that the correlations of BMI and cholesterol level with COVID-19 are stronger in countries with younger population. In general, the BMI and cholesterol level were positively correlated with COVID-19 incidence ratio (β = 2396.81 and β = 30,932.80, p < 0.01,‌ respectively) and mortality ratio (β = 38.18 and β = 417.52, p < 0.05,‌ respectively) after adjusting for socioeconomic and demographic factors.

Conclusion

Countries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11715-7.

Effects of dietary advanced glycation end-products restriction on renal function in patients with diabetic nephropathy; a randomized, double-blind clinical trial

Introduction: It has been proposed that advanced glycation end-products (AGEs) are contributory factors in diabetic nephropathy (DN) pathogenesis. Interventions regarding restriction dietary AGEs (dAGEs) intake indicate improvement in clinical outcomes. Objectives: The present study aimed to compare the effects of 10-week low AGEs diet (LAGEsd) based on recommended diabetic diet (DD) versus DD alone on glycemic status, lipid profile, serum creatinine (sCr), blood urea nitrogen (BUN), urine albumin to creatinine ratio, eGFR and urine albumin in patients with DN. Patients and Methods: This randomized, double-blind clinical trial was conducted on 62 patients with DN. Patients were assigned randomly to LAGEsd (n=31) and DD (n=31) groups for 10 weeks. All patients were prescribed calorie adjusted diet in regards to American Diabetes Association’s recommendation. In addition, patients in the LAGEsd group were instructed how to reduce dAGEs intake based on established guidelines. Demographic data were collected and dietary intakes, physical activity level, fasting blood sugar (FBS), hemoglobin A1C (HbA1c), lipid profile, sCr, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urine albumin to creatinine ratio (Alb/Cr), and urine albumin were measured before and after of 10-weeks intervention, and compared between the two groups. Results: The results showed that dAGEs intake decreased significantly in the LAGEsd group compared with the DD group (P<0.001). In the LAGEsd group, eGFR improved significantly compared with the DD group (18.77±20.99 mL/min/1.73 m2 versus 1.57±21.06 mL/min/1.73 m2 , P=0.002); however there were no significant difference in FBS, HbA1c, lipid profile, sCr, BUN, urine Alb/Cr, and urine albumin between the two groups (P>0.05). Conclusion: In sum, dAGEs restriction plus DD is superior to DD alone in improvement of renal function marker in patients with DD. Trial Registration: This study was registered at Iranian Registry of Clinical Trials (identifier: IRCT20191004044979N1, https://en.irct.ir/trial/42914, ethical code #IR.SUMS.REC.1398.798).

The association between meat and fish consumption and bladder cancer risk: a pooled analysis of 11 cohort studies

Evidence on the effects of meat consumption from different sources on the risk of bladder cancer (BC) is limited and controversial. Therefore, this study aimed to evaluate the associations between meat consumption and BC risk using a pooled data approach. Individual data from 11 prospective cohorts comprising 2848 BC cases and 515,697 non-cases with a total of 5,498,025 person-years of follow-up was pooled and analysed to investigate the potential associations between total red meat and products, red meat, processed meat, poultry and total fish and BC risk. Hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were estimated using Cox regression models stratified on cohort. Overall, an increased BC risk was found for high intake of organ meat (HR comparing highest with lowest tertile: 1.18, 95% CI: 1.03, 1.36, p-trend = 0.03). On the contrary, a marginally inverse association was observed for total fish intake and BC risk among men (HR comparing highest with lowest tertile: 0.79, 95% CI 0.65, 0.97, p-trend = 0.04). No associations were observed for other meat sources. Results of this prospective study suggest that organ meat consumption may be associated with BC development. Replication in large-scale prospective studies and investigation of possible causal mechanisms is needed.

Graft and Patient Survival Rates in Kidney Transplantation, and Their Associated Factors: A Systematic Review and Meta-Analysis

Background:

End-Stage Renal Disease (ESRD) is an irreversible impairment of kidney function that leads to permanently dependent on alternative therapies such as hemodialysis, peritoneal dialysis, and renal transplantation. This study aimed to systematically investigate the survival rate of patients with renal transplantation, graft, and its related factors in Iran.

Methods:

This systematic review and meta-analysis drew on articles indexed in six international and one internal databases (Medline/PubMed, ProQuest, Scopus, Embase, SID, and Web of knowledge) until Nov 2020. The reporting of the present study was performed in terms of PRISMA statement. All analyzes were performed using the STATA software.

Results:

Overall, 367 titles from 6 databases were evaluated of which 86 articles met the inclusion criteria. According to the random model, the graft survival rate at one, three, five, and 10 years were 92.48%, 85.08%, 79.96% and 68.15% respectively. Additionally, the patient survival rates at one, three, five, and 10 years were 91.27%, 86.46%, 81.17% and 78.15% respectively. There was a significant relationship between the age recipient and three-year graft survival rate (P=0.021). Additionally, there was an inverse and significant relationship between the donor age and 10-year patient survival rate (P=0.011).

Conclusion:

The patient and graft survival in transplanted kidney patients is comparable with most developed countries.

The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV: a systematic review and meta-analysis

BACKGROUND

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common among individuals with human immune deficiency virus (HIV) infection worldwide. In this study, we did a systematic review and meta-analysis of the published literature to estimate the global and regional prevalence of HCV, HBV and HIV coinfections among HIV-positive prisoners.

METHODS

We searched PubMed via MEDLINE, Embase, the Cochrane Library, SCOPUS, and Web of science (ISI) to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV. We used an eight-item checklist for critically appraisal studies of prevalence/incidence of a health problem to assess the quality of publications in the included 48 cross-sectional and 4 cohort studies. We used random-effect models and meta-regression for the meta-analysis of the results of the included studies.

RESULTS

The number of the included studies were 50 for HCV-HIV, and 23 for HBV-HIV co-infections. The pooled prevalence rates of the coinfections were 12% [95% confidence interval (CI) 9.0-16.0] for HBV-HIV and 62% (95% CI 53.0-71.0) for HCV-HIV. Among HIV-positive prisoners who reported drug injection, the prevalence of HBV increased to 15% (95% CI 5.0-23.0), and the HCV prevalence increased to 78% (95% CI 51.0-100). The prevalence of HBV-HIV coinfection among prisoners ranged from 3% in the East Mediterranean region to 27% in the American region. Also, the prevalence of HCV-HIV coinfections among prisoners ranged from 6% in Europe to 98% in the East Mediterranean regions.

CONCLUSIONS

Our findings suggested that the high prevalence of HBV and HCV co-infection among HIV-positive prisoners, particularly among those with a history of drug injection, varies significantly across the globe. The results of Meta-regression analysis showed a sliding increase in the prevalence of the studied co-infections among prisoners over the past decades, rising a call for better screening and treatment programs targeting this high-risk population. To prevent the above coinfections among prisoners, aimed public health services (e.g. harm reduction via access to clean needles), human rights, equity, and ethics are to be seriously delivered or practiced in prisons. Protocol registration number: CRD42018115707 (in the PROSPERO international).

Osteoprotective effects of kefir fortified with omega-3 and vitamin C in ovariectomized rats

Nutritional interventions can be valuable for the prevention of postmenopausal osteoporosis. This study aimed to investigate the effects of kefir fortified with omega-3 and vitamin C on the bone and uterus parameters of ovariectomized rats. Seventy-seven female Sprague-Dawley rats were ovariectomized or sham-operated. The ovariectomized rats were assigned to six groups and received 1 ml/day of distilled water (OVX group), milk, kefir, kefir fortified with omega-3 (kefir+ω3), kefir fortified with vitamin C (kefir+vit-C) or kefir fortified with omega-3 and vitamin C (kefir+ω3+vit-C) for 12 weeks. The sham group also received 1ml/day of distilled water. Subsequently, bone mineral content (BMC) and bone mineral density (BMD) of various bones were assessed. Femurs and uteri were harvested for bone ash analysis and histopathological examinations, respectively. Sera were analyzed for carboxy-terminal cross-linked telopeptide of type 1 collagen, procollagen type 1 amino-terminal propeptide, calcium, phosphorous, tumor necrosis factor-α (TNF-α) and total antioxidant capacity levels. Ovariectomy resulted in significant reduction in bone density (P<0.05). Kefir+ω3+vit-C significantly improved BMC of lumbar spine (0.699±0.027 g compared with 0.580±0.018 in the OVX group), and kefir, kefir+vit-C and kefir+ω3+vit-C significantly increased BMD of tibia (0.118±0.003 g/cm², 0.119±0.001 and 0.120±0.004 compared with 0.102±0.005 in the OVX group). Moreover, ovariectomy markedly elevated TNF-α level, which was significantly reversed by kefir+ω3+vit-C. Significant atrophy of the uterus was observed following ovariectomy, although the uterus parameters did not change by any of the interventions. In conclusion, kefir fortified with omega-3 and vitamin C may have protective effects against bone loss through suppressing inflammation.

18-year temporal trend of multiple sclerosis in southern Iran

BACKGROUND

Multiple Sclerosis (MS) imposes significant burdens on patients, their families, and national healthcare systems particularly when there is a resource constraint. Proper prioritization and resource allocation are therefore essential for any effective disease management. Accordingly, we sought to assess the temporal profile of MS incidence over the past two decades in southeast Iran.

METHODS

A longitudinal design was employed using data from the Iranian multiple sclerosis registry system from March 2001 to March 2019 (n=6034). Annual age-standardized incidence rates of MS (cases of clinically isolated syndrome were also included) were calculated and the trend of incidence from 2001 to 2018 was analyzed.

RESULTS

The age-adjusted incidence rate of MS raised from 1.72/100,000 in 2001 to 11.29/100,000 in 2018 (average of 18-year incidence rate was 6.30/100,000), indicating a notable rise in the incidence of MS (P-Value<0.001). However, the female to male ratio of 3.62 remained relatively stable during the study period.

CONCLUSION

Our study suggests that, in Fars province, the incidence of MS has been remarkably rising over the past two decades. We recommend further studies to better understand the determinants of this pattern. Implementing effective policies in lowering the burden of MS is another important step in this regard.

Thyroid cancer and its associated factors: A population-based case-control study

Considering the rising incidence and mortality of thyroid cancer (TC) worldwide, the aim of our study was to determine the risk factors for TC in a province with the highest incidence of TC in the country located at the South of Iran. A population-based case-control study was performed on 708 participants (361 new cases and 347 controls). The case participants were selected from the Iranian National Cancer Registry database. Frequency matched for gender and age, and the control participants were selected randomly from the neighborhood of the cases. Based on the results of multiple logistic regression analysis, benign thyroid diseases (eg, hyperthyroidism OR_yes/no = 14.06, 95% CI: 5.13-38.51), family history of TC (OR_yes/no = 3.54, 95% CI: 1.51-8.26), radiation exposure of the head (OR_yes/no = 1.92, 95% CI: 1.03-3.60), family history of thyroid diseases (OR_yes/no = 1.76, 95% CI: 1.19-2.62) and family history of other types of cancer (OR_yes/no = 1.67, 95% CI: 1.01-2.74), significantly increased the risk of developing TC. On the other hand, high blood pressure (OR_yes/no = 0.35, 95% CI: 0.19-0.64), higher education (OR_{college/illiterate} = 0.54, 95% CI: 0.30-0.96), consumption of unsaturated fat (OR_{unsaturated/saturated} = 0.59, 95% CI: 0.39-0.87) and being married (OR_{married/single} = 0.60, 95% CI 0.37-0.98) were found to be protective factors. Some community-based interventions, for example, reduction in radiation exposure and screening members of families with underlying thyroid diseases may help in preventing or early diagnosis of TC. More studies on the health effects of local herbs are highly recommended.

Muscle mass and function are related to respiratory function in chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD), as an airway limitation condition, is accompanied by alteration of muscle mass and function. We aimed to determine the relationship between disease severity and body composition, muscle function, and nutritional status in COPD patients. Methods: This cross-sectional study was conducted on 129 COPD participants. Muscle strength, body composition, and calf circumference (CC) were measured using a hydraulic hand dynamometer, bioelectrical impedance analysis (BIA), and a tape measure, respectively. Furthermore, fat-free mass index (FFMI), body mass index (BMI) and muscle mass value were calculated by equations. Forced expiratory volume in one second (FEV1) was assessed as well. Nutritional status was also evaluated by subjective global assessment (SGA) questionnaire. SPSS software (version 21 ) was used, chi-square, fisher's exact test, univariate and multivariate linear regression models were used for statistical analysis. P-values less than 0.05 were considered significant. Results: Based on FEV1 classification, 52.7% of the patients had severe conditions. The reports indicated that the prevalence of low CC was 54.2%, low muscle mass 38.7%, low FFMI 34.8%, low right handgrip strength 61.2% and low left handgrip strength 64.3%. Furthermore, there was an increasing trend based on FEV1 in low CC (p=0.032), low muscle mass (p=0.005), low FFMI (p=0.002), low right handgrip strength (p=0.004) and low left handgrip strength (p=0.014). The results of univariate analysis showed muscle mass (p=0.036), total protein (p=0.043), FFM (p=0.047), FFMI (p=0.007), SGA (p=0.029), right handgrip strength (p=0.004) and left hand grip strength (p=0.023) were associated with FEV1. In addition, the results of multivariate analysis demonstrated low values of FFMI (p=0.005) and right handgrip strength (p=0.042) were the main detrimental factors for FEV1. The results of multivariate analysis were confirmed by stepwise model. Conclusion: Low values of muscle mass and function are prevalent among COPD patients. The present study revealed that low FFMI and handgrip strength were closely related to disease severity.

Serum level of lead and cadmium is linked to facial cosmetics use among Iranian young women

Cosmetics are applied widely by women and men for different proposes mainly beauty and skin care. However, the biologically active substances which are used in these products and their health effects are not fully known. The aims of this study were, first, to estimate the prevalence of cosmetics use, and second, to examine if any association exists between cosmetic use and serum levels of lead and cadmium (two heavy metals with major health effects) among young women. This is a cross-sectional study conducted on 65 female students during the first semester of 2017 academic year. Study sample was selected randomly using phone numbers. About 70% of the study participants started using cosmetics under age 20 years (about 14% under 15), and 50% were using the products on a daily base. After adjusting for possible confounders, significant associations were found between the participants age (B = - 0.0008, CI = - 0.001 to - 4.71, P = 0.03) and duration of using cosmetics (B = 0.0006, CI = 0.0001 to 0.115, P = 0.01) with the level of cadmium in their serum samples. Duration of using cosmetics (B = 0.008, CI 0.001 to 0.01, P = 0.01) was the only variable which was significantly associated with serum level of lead in the participants. According to the results of the present study, most Iranian girls start using cosmetics at a very young age making them more vulnerable to the potential hazards of the ingredients of cosmetic products including heavy metals and preservatives. The association between duration of using cosmetics and serum level of lead and cadmium may cause serious health problems for women at young ages and their fetus or children via placenta and breast milk. The big market of cosmetics in many countries especially Middle East is highly important.

Performance of diabetes screening tests: an evaluation study of Iranian diabetes screening program

BACKGROUND

Type 2 diabetes is a common non-communicable disease that is responsible for about 9% of all deaths and a 25% reduction in life expectancy. However, nearly half of the diabetic patients are not aware of their disease. In this regard, to identify un-known diabetic patients, diabetes screening is of great importance. This study was conducted to evaluate the performance of two commonly used diabetes screening tests that are currently recommended by the Iranian diabetes screening program for (DSP).

METHODS

The validity of the two diabetes screening tests were measured among 1057 participants who were older than 30 years of age. The studied screening tests included capillary fasting blood glucose (CBG) and glycated hemoglobin (HbA1c). The golden standard for measuring the validity of the tests was venous fasting plasma glucose (VPG).

RESULTS

According to the results, the sensitivity of CBG and HbA1c tests was 69.01% and 84.5%, and the specificity of the tests were 95.7% and 79.3%, respectively. Positive and negative predictive values were 53.84% and 97.72% for CBG and 22.72% and 98.61% for HbA1c, respectively. The recommended cut points for CBG and HbA1c were 116.5 mg/dl and 7.15%, respectively. Using these values as the new cut points, sensitivity and specificity of CBG and HbA1c changed to 80.30% and 89.10%, and 77.50% and 94.20%, respectively.

CONCLUSIONS

Compared to several other countries, the performance of Iranian DSP is relatively better. The Receiver Operating Characteristic Curve suggested new cut points for significantly better performance of DSP.

An Online Investigation of Knowledge and Preventive Practices in Regard to COVID-19 in Iran

BACKGROUND

Until now, there was no available study on the knowledge and practice of the people of Iran with regard to the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

This study aimed to investigate the knowledge and preventive practices of Iranians toward the COVID-19 pandemic.

METHODS

This is a cross-sectional study of 925 people who completed an online questionnaire in March 2020. The study used 21 and 14 questions, respectively, to assess the knowledge and preventive practices of the population in regard to COVID-19. Cronbach's alpha was 0.75 for the knowledge scale and 0.71 for the practice scale. To determine the importance of each independent variable in explaining the participant's practice, a multiple regression model was applied.

KEY RESULTS

The results indicated a moderate level of knowledge and preventive practices in regard to COVID-19 in most of the respondents (56.8% and 56.5%, respectively). According to the multiple regression analysis, knowledge showed the highest effect on the practice of the participants (β = 0.479). The determination coefficient for the model (R2 = 0.509) also showed approximately 51% of the variance in practice was explained by gender, occupational status, knowledge, cost of hand sanitizer, and the belief in the effectiveness of using such necessities.

CONCLUSIONS

Acceptable rates of knowledge and practice were observed in most Iranians. However, approximately 10% of the participants were unaware of the effective measures for preventing the infection, which can cause active transmission of the virus. In addition to considering the importance of high community awareness in prevention and isolation measures, the government should provide disinfectants and other materials at a low price to reduce the transmission, as this may lead to effective practice to break the chain of transmission of COVID-19. [HLRP: Health Literacy Research and Practice. 2021;5(1):e15-e23.] PLAIN LANGUAGE SUMMARY: This study sought to evaluate the knowledge and preventive practices of Iranians toward the coronavirus disease 2019 pandemic. Findings of this research demonstrate acceptable rates of knowledge and practice in most Iranians; however, about 10% of them were unaware of the true prevention practices, which can cause active transmission of the virus.

Adherence to a Western dietary pattern and risk of bladder cancer: A pooled analysis of 13 cohort studies of the Bladder Cancer Epidemiology and Nutritional Determinants international study

Little is known about the association of diet with risk of bladder cancer. This might be due to the fact that the majority of studies have focused on single food items, rather than dietary patterns, which may better capture any influence of diet on bladder cancer risk. We aimed to investigate the association between a measure of Western dietary pattern and bladder cancer risk. Associations between adherence to a Western dietary pattern and risk of developing bladder cancer were assessed by pooling data from 13 prospective cohort studies in the "BLadder cancer Epidemiology and Nutritional Determinants" (BLEND) study and applying Cox regression analysis. Dietary data from 580 768 study participants, including 3401 incident cases, and 577 367 noncases were analyzed. A direct and significant association was observed between higher adherence to a Western dietary pattern and risk of bladder cancer (hazard ratio (HR) comparing highest with lowest tertile scores: 1.54, 95% confidence interval (CI): 1.37, 1.72; P-trend = .001). This association was observed for men (HR comparing highest with lowest tertile scores: 1.72; 95% CI: 1.51, 1.96; P-trend = .001), but not women (P-het = .001). Results were consistent with HR above 1.00 after stratification on cancer subtypes (nonmuscle-invasive and muscle-invasive bladder cancer). We found evidence that adherence to a Western dietary pattern is associated with an increased risk of bladder cancer for men but not women.

Association of FTO rs9939609 polymorphism with serum leptin, insulin, adiponectin, and lipid profile in overweight adults

FTO gene polymorphisms are associated with obesity and food intake. This study aimed to investigate the association of FTO rs9939609 polymorphism genotypes with serum glucose, lipid profile and serum hormones level. This cross-sectional study was carried out on 196 randomly selected overweight adults. Anthropometric measurements including weight, height, body mass index (BMI), fat mass, and fat-free mass were assessed. Serum TGs, total cholesterol, HDL cholesterol, LDL cholesterol, glucose and insulin levels were measured. The FTO gene was Genotyped for rs9939609 polymorphism. Dietary intake was assessed by avalid 168-item semi-quantitative food frequency questionnaire (FFQ). The homozygotes for the FTO rs9939609 risk allele (A) had higher serum leptin (p = 0.005, F: 5.131) and lower HDL (p = 0.001, F: 7.687) level than TT genotype. The differences between TT and AT genotypes were not significant. The association remained significant for HDL level after adjustments for age and sex, calorie intake, physical activity, and BMI. The association between rs9939609 polymorphism genotypes and leptin was disappeared after adjustments for calorie intake and physical activity. In conclusion, rs9939609 risk allele was associated with higher serum leptin and lower HDL levels in overweight people. Further studies are warranted.

A Randomized Controlled Trial on the Effects of 12 Weeks of Aerobic, Resistance, and Combined Exercises Training on the Serum Levels of Nesfatin-1, Irisin-1 and HOMA-IR

Background/objective: This study aimed to investigate the impacts of a 12-week training of the aerobic exercise (AE), resistance exercise (RE), and combined exercise (CE) on the serum levels of nesfatin-1, irisin-1 and some other metabolic and anthropometric indices in overweight women with metabolic syndrome. Methods: Sixty overweight women with metabolic syndrome were assigned equally into four groups: aerobic exercise (AE, n = 15), resistance exercise (RE, n = 15), combined exercise (CE, n = 15), and control (n = 15). All groups underwent 12 weeks of intervention. The study variables were measured before and 24 h after the intervention period. Results: Twelve weeks of training resulted in an increase of irisin-1 in the AE and CE groups and nesfatin-1 in all the intervention groups. As expected, all the trained groups exhibited a positive alteration in anthropometric indices and lipid profile in comparison with the control group. Besides, compared with the control group, insulin resistance (based on the homeostatic model assessment) in AE (p = 0.022), RE (p = 0.032), and CE (p < 0.001) groups were reduced significantly. According to the observed changes in the measured indices, serum irisin-1 was significantly correlated with body weight, BMI, body fat percentage, fasting insulin, and HOMA-IR. However, with regard to nesfatin-1, only a negative correlation was observed with body fat percentage and LDL-cholesterol. Conclusions: The 12-week systematic training program changed circulating irisin-1 and nesfatin-1. Also, change in the serum irisin-1 and nesfatin-1 were correlated with the change in glycemic and anthropometric indices in addition to LDL-cholesterol. Also, exercise training significantly reduced fasting insulin and HOMA-IR in all the intervention groups. RCT Registration Code: IRCT20180806040721N2.

Patient Dignity in Iranian Clinical Care Settings as Perceived by Physicians, Caregivers, and Patients

Introduction

All over the world, healthcare team members are recommended to respect patients’ human dignity. However, the dignity of hospitalized patients is not preserved in many cases. Due to the abstract, complex, and cultural nature of the concept of human dignity, further studies are required to precisely determine the different aspects of this concept.

Purpose

The aim of the present study was to explore the experiences and perceptions of physicians, nurses, family caregivers, and hospitalized patients with regard to patient dignity in Iranian clinical setting.

Materials and Methods

This is a qualitative, exploratory study in which physicians, nurses, family caregivers, and patients were recruited from 2 educational hospitals located in an urban area in Iran from April 2016 to February 2017 using the purposive sampling method (n = 24). Data were collected through individual interviews and subsequently analyzed using conventional content analysis in the software MAXQDA 2007, VERBI^O`.

Results

Three major themes emerged from analyses of the data obtained from the interviews: a peaceful environment, respect, and comprehensive support.

Conclusion

From the participants’ point of view, in order for their dignity to be preserved, patients need to be hospitalized in a peaceful environment in which they are treated with empathy, they receive comprehensive support, and the care settings are managed properly. Furthermore, it is important to respect patient’s values and beliefs, to provide unbiased care and treatment, and to maintain patient’s autonomy in order to maintain hospitalized patients’ dignity.