Validity and reliability of parent assessments of pubertal maturation among adolescent girls in Isfahan, Iran

OBJECTIVES

The current paper presents the steps considered for validation of a questionnaire for assessment of sexual maturity among Iranian adolescent girls.

METHODS

This cross-sectional study was performed in 2022 in Isfahan, Iran. Based on the Growth and Development Questionnaire that included both the Pubertal Development Scale (PDS) and Sexual Maturation Scale (SMS), two Persian questionnaires were prepared. The face validity, content validity, criterion validity, and reliability of the questionnaire were assessed. We compared agreement of two parent-reported measures of puberty, SMS and PDS, with clinical Tanner stages (TSs) as the gold standard. Percent agreement, Cohen's kappa coefficient, and Kendall's τ b were used to assess the agreement between maternal assessments with clinical TS. The intraclass correlation coefficient (ICC) and the Cronbach's α coefficient were also calculated to evaluate the reliability of the questionnaire.

RESULTS

A total of 150 students aged 6-17 years with mean (SD) age of 10 (2.04) completed this study. The percentages of agreement for the mother-reported SMS in relation to clinical TS for breast stage and pubic hair stage were 60 % and 53.8 %, respectively. The percentages of agreement of the mother-reported PDS in relation to clinical TS for breast stage and pubic hair stage were 55.8 and 66 %, respectively. The weighted kappa coefficients showed moderate agreement, with weighted kappa ranging from 0.52 to 0.61. The mother-reported SMS and PDS showed high reliability. The Cronbach's alpha of the PDS and the SMS was 0.88 and 0.83, respectively. The ICC of the mother-reported SMS and the mother-reported PDS was 0.95 (0.92-0.98) and 0.97 (0.94-0.98), respectively.

CONCLUSIONS

This study indicated that a maternal assessment of sexual maturity using the PDS or SMS can reliably estimate pubertal development in adolescent girls in an Iranian population.

Perceived stress, anxiety, and depression in women with breast cancer: CIBC study

BACKGROUND

Many breast cancer (BC) patients experience psychological reactions and may have psychiatric morbidities, especially anxiety and depressive disorders. The aim of this study was to evaluate perceived stress and factors affecting this stress in women with BC in Isfahan.

MATERIAL AND METHODS

This analytical cross-sectional study was carried out among 197 females with BC who were newly diagnosed and referred to Isfahan Cardio-Oncology Clinic. Stress was measured by the Perceived Stress Scale Standard questionnaire. Generalized linear models (GLMs) with gamma distribution and Log Link Function were used for data analyzing.

RESULTS

The mean age of the patients was 48.9 ± 10.9 years, and mean perceived stress in patients was 42.8 ± 16.5. The GLMs with Gamma distribution and Log Link Function showed interaction between anxiety and surgical type and also between depression and surgical type. Patients perceived stress with anxiety*nonsurgery were significantly 2.5% higher than normal anxiety and none surgery (P = 0.004), and patients with depression*lumpectomy had significantly 2% higher stress score compared to normal depression and nonsurgery (P =0.003).

CONCLUSIONS

Early detection of anxiety and depression can contribute to managing the stress. Coordination between psychologists and oncologists in care and treatment of these patients is important for pursuing treatment and following the recommendations of doctors and ultimately affect the morbidity and survival in BC patients.

The Effect of Add-on Memantine in New Onset Combat-Related Posttraumatic Stress Disorder Core Symptoms: A Pilot Study

Objective: Studies using standard neuropsychological instrumentation have shown memory deficits in posttraumatic stress disorder (PTSD) patients. We examined the efficacy and safety of memantine in new cases of combat-related PTSD in the military by conducting a 16-week prospective double-blind randomized controlled trial. Method : Twenty-six new combat-related PTSD cases were recruited from among the military personnel based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Patients were assigned to memantine and Placebo groups. They were monitored at baseline, week eight, and week 16. Memantine was added to each patient's current medication with an initial dosage of 5 mg/day, raised by 5 mg/day every week until it reached the maintenance level of 20 mg/day. The concurrent drugs were essentially kept unchanged during the trial. The primary outcome was PTSD severity as assessed by the Clinician-administered PTSD Scale (CAPS). The CAPS is a valid and reliable tool for the diagnosis of PTSD and measurement of its severity according to the DSM-4. Results: CAPS mean score in baseline (P = 0.811) and weeks eight (P = 0.389) and 16 (P = 0.066) did not show any significant differences between the two groups. The mean CAPS score in the memantine group significantly (P = 0.006) decreased (Mean differences = -8.79) compared to the placebo group, showing that intervention with memantine was effective. The mean total CAPS in weeks eight (Mean differences = -14.21) and 16 (Mean differences = -27) were less than the baseline, which was significantly meaningful (P < 0.001). Conclusion: Findings of this study suggest that add-on memantine can be effective in veteran patients with PTSD. So our data provide useful insight into the management of new cases of combat-related PTSD.

Psychometrics of the Persian version of the COVID-19-related health literacy in the Iranian population

Background

Since the occurrence of the COVID-19 pandemic, information dissemination has increased rapidly. Promoting health literacy is currently crucial to prepare people to respond quickly to situations, such as the COVID-19 pandemic. Due to the importance of health literacy in this critical situation, we are looking for a questionnaire to measure COVID-19 health literacy. The COVID-19 Germany Health Literacy Questionnaire (HLS-COVID-Q22) is an excellent tool, so the study aimed to create a cultural validity of this questionnaire for the Iranian population.

Methods

In this validation study, 880 samples were enrolled using a convenient sampling method. The questionnaire was translated through a backward forwarding procedure. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were employed for Persian version validity. McDonald's omega (Ω), Cronbach's alpha, and average inter-item correlation (AIC) coefficients were assessed for reliability.

Results

Using EFA on the random half sample (n = 440), the EFA indicated that the scale had four factors: accessing, understanding, appraising, and applying health-related information in the COVID-19 pandemic context, which explained 59.3% of the total variance. CFA was used for the sample's second part (n = 440) to evaluate the goodness of fit of the four-factor solution. CFA showed the model fit. All indices RMSEA = 0.067, CFI = 0.934, IFI = 0.934, PCFI = 0.772, PNFI = 0.747, and CMIN/DF = 2.972 confirmed the model fit. The convergent validity of the HLS-COVID-Q22 was confirmed. McDonald's omega and Cronbach's alpha were very good (α and Ω >0.80).

Conclusion

The Persian version of the HLS-COVID-Q22 had acceptable psychometric properties and is applicable to measure COVID-19 health literacy.

Association between Sleep Duration and Early Pubertal Timing in Children and Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Early puberty increases the risk of diverse health outcomes during adolescence and beyond. Several studies have explored the links between short sleep duration and early puberty worldwide.

OBJECTIVE

The current systematic review and meta-analysis aimed to evaluate the association between sleep duration and early pubertal timing based on published evidence systematically.

METHODS

We searched important electronic databases for articles that reported the association between childhood sleep duration and puberty timing up to October 2020. A total of 848 papers were identified from the databases and manual search. Finally, 10 studies including 23752 participants were included in the meta-analysis. We calculated the pooled effect sizes using a random or fixed effects model as appropriate.

RESULTS

There was a significant inverse association between sleep duration and the risk of early puberty, longer duration of sleep was associated with 0.34% decreased odds of early puberty (OR = 0.66, 95% CI = 0.58-0.77, I² = 96.6%). In a subgroup analysis, when pubertal status was assessed by physical examination compared with Pubertal Development Scale (PDS) or Sexual Maturation Scale (SMS), the associations between sleep duration and age of puberty were attenuated. The pooled OR (95% CI) of studies measuring pubertal timing by PDS/SMS and Tanner stage were 0.50(0.37-0.69) and 0.91(0.77-1.09), respectively. When pooling effect sizes was limited to studies that had BMI level adjustment, the association of sleep duration and early puberty was not statistically significant anymore (OR = 0.95, 95% CI = 0.89-1.01).

CONCLUSION

Longer sleep duration is associated with a lower risk of early puberty in children. The association between sleep duration and risk of early puberty may be modified by other factors such as BMI. To clarify the effect of sleep duration on the risk of early puberty in children, further prospective studies are needed.

Self-Reported safety of the BBIBP-CorV (Sinopharm) COVID-19 vaccine among Iranian people with multiple sclerosis

To affirm the short-term safety of the BBIBP-CorV (Sinopharm) COVID-19 vaccine among people with multiple sclerosis (pwMS), 517 vaccinated and 174 unvaccinated pwMS were interviewed. 16.2% of the vaccinated pwMS reported at least one neurological symptom in their respective vaccine-related at-risk periods (ARP) – a period from the first dose until two weeks after the second dose of the vaccine. In a multivariable logistic regression model, the presence of comorbidities (P = 0.01), use of natalizumab (P = 0.03), and experiencing post-vaccination myalgia (P < 0.01) predicted the development of post-vaccination neurological symptoms. One MS relapse, one COVID-19 contraction, and one ulcerative colitis flare after the first dose, and four MS relapses after the second dose of the vaccine were the only reported serious adverse events during the ARPs. To show if the vaccine provoked MS relapses, we compared the relapse rate of vaccinated pwMS in the vaccine-related ARP with the annualized relapse rate of unvaccinated pwMS in the prior year—a measure of baseline MS relapsing activity in the respective time—using a multivariable Poisson regression model accounting for possible confounders, which failed to show any statistically significant increase (P = 0.78). Hence, subject to replication—as the vaccinated and unvaccinated pwMS differed in baseline characteristics—the BBIBP-CorV vaccine does not seem to affect short-term MS activity. Furthermore, as 83.33% of the unvaccinated pwMS reported fear of possible adverse events to be the reason of their vaccination hesitancy, provision of evidence-based consultations to pwMS is encouraged. Limitations of our study briefly included lack of data for self-controlled analysis of relapse rates, possible presence of recall bias, and lack of on-site validations regarding the clinical outcomes due to the remote nature.

Cutaneous Leishmaniasis Based on Climate Regions in Iran (1998-2021): A Systematic Review and Meta-Analysis

Background

Climate change can facilitate the expansion of leishmaniasis and create the suitable habitat for vector and reservoir species. The objective of this study was to estimate the prevalence of cutaneous leishmaniasis (CL) at the climatic regions of Iran.

Materials and Methods

The literature search was conducted to identify all published studies reporting the prevalence or incidence of CL in humans in Iran. A total of 350 articles that reported leishmaniasis in Iran were retrieved, due to eligibility criteria, only 42 studies were selected to the final systematic review and meta-analysis procedure. Random effects meta-analysis was done with the estimate of heterogeneity being taken from an inverse-variance model. Subgroup analysis was conducted and it stratified the studies according to climatic regions. Between-study heterogeneity was assessed by using I ² and Cochran's Q method I ² value of heterogeneity. Meta regression was used to investigate factors potentially contributed the between-study heterogeneity.

Results

Individual studies showed that prevalence per 100,000 population estimated the range from 1.5 to 318.7 with the overall random pooled prevalence of 83.3 (95% confidence interval 74.5-92.1). Subgroup analysis by climatic regions showed that many studies were conducted in the desert areas and also, it has more prevalent than the other climatic regions.

Conclusions

Leishmaniasis was more prevalent in regions with dry and desert climates than the other climatic regions. One of the advantages of this work is that the majority of selected studies have been conducted on population-base. However, some of the studies have been designed poorly or have had a lack of internal validity.

Relationship between cognitive profile and neuroradiographic parameters in patients with idiopathic normal pressure hydrocephalus

Background: Normal pressure hydrocephalus (NPH) is a reversible type of dementia, which affects 0.2 to 5.9 percent of elders. It manifests with triad of gait disturbances, urinary incontinence, and cognitive decline. In this study, association between cognitive and neuroradiographic parameters of idiopathic NPH (iNPH) was appraised to find out possible biomarkers for preventive intervention. Methods: In a cross-sectional study, 16 patients with iNPH were evaluated for third and fourth ventricle diameter, diameter of temporal horn of lateral ventricle, Evans index (EI), callosal angle (CA), callosal bowing, and ballooning of frontal horn. The Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) was used to take cognitive profile. Relation between brain magnetic resonance imaging (MRI) indices and cognitive domains was extracted, using generalized linear model (GLM). Results: Patients with mild callosal bowing had better function in memory (P = 0.050) and language (P = 0.001) than those with moderate to severe callosal bowing. Negative or mild ballooning of frontal horn was also associated with higher scores in memory (P = 0.010), executive function (EF) (P = 0.029), and language (P = 0.036) than moderate to severe ballooning of frontal horn. Increased 3rd ventricle diameter was associated with decline in total cognition (P = 0.008), memory (P = 0.019), EF (P = 0.012), and language (P = 0.001). Relation between other radiographic indices and cognitive function was not significant. Conclusion: Third ventricular diameter, rounding of frontal horn of lateral ventricle, and callosal bowing are more accurate neuroradiographic parameters to predict cognitive decline in iNPH.

Spatiotemporal analysis of COVID-19, air pollution, climate, and meteorological conditions in a metropolitan region of Iran

The COVID-19 pandemic has a close relationship with local environmental conditions. This study explores the effects of climate characteristics and air pollution on COVID-19 in Isfahan province, Iran. A number of COVID-19 positive cases, main air pollutants, air quality index (AQI), and climatic variables were received from March 1, 2020, to January 19, 2021. Moreover, CO, NO₂, and O₃ tropospheric levels were collected using Sentinel-5P satellite data. The spatial distribution of variables was estimated by the ordinary Kriging and inverse weighted distance (IDW) models. A generalized linear model (GLM) was used to analyze the relationship between environmental variables and COVID-19. The seasonal trend of nitrogen dioxide (NO₂), wind speed, solar energy, and rainfall like COVID-19 was upward in spring and summer. The high and low temperatures increased from April to August. All variables had a spatial autocorrelation and clustered pattern except AQI. Furthermore, COVID-19 showed a significant association with month, climate, solar energy, and NO₂. Suitable policy implications are recommended to be performed for improving people's healthcare and control of the COVID-19 pandemic. This study could survey the local spread of COVID-19, with consideration of the effect of environmental variables, and provides helpful information to health ministry decisions for mitigating harmful effects of environmental change. By means of the proposed approach, probably the COVID-19 spread can be recognized by knowing the regional climate in major cities. The present study also finds that COVID-19 may have an effect on climatic condition and air pollutants.

Evaluation of Cognitive Impairment in Refractory Temporal Lobe Epilepsy Patients With Respect to Structural Brain Lesions

Introduction: Temporal lobe epilepsy (TLE) is the most prevalent form of drug resistant epilepsy with concurrent cognitive impairment. Prevention, earlier diagnosis, and personalized management of cognitive deficits in TLE require more understanding of underlying structural and functional brain alterations. No study has evaluated performance of TLE patients in different cognitive domains based on their structural brain lesions. Methods: In this study, 69 refractory TLE patients have undergone magnetic resonance imaging (MRI) epilepsy protocol and several neuropsychological tests, consisting of Wechsler adult intelligence scale-revised, Rey-Osterrieth complex figure test, verbal fluency test, digit span test, spatial span test, Wechsler memory scale-III, design fluency test, Rey visual design learning test, auditory-verbal learning test, and trail making test. MRI findings were classified to following groups: focal cortical dysplasia, gliosis, atrophy, mesial temporal sclerosis (MTS), tumor, vascular malformation, and other lesions or normal. Results of neuropsychological tests were compared between MRI groups using generalized linear model with gamma distribution and log link. Results: Patients with MTS showed better performance in general intellectual functioning, working memory, attentional span, and auditory-verbal learning compared to patients with non-MTS MRI lesions. Atrophy and focal cortical dysplasia had the largest differences from MTS. Conclusion: Cognitive performance of refractory TLE patients varies with respect to structural brain alterations. Further neuroimaging studies of TLE lead to prevention and more accurate management of cognitive decline in clinical settings.

Incidence and Associated Factors of Major Congenital Anomalies in Newborns in Chaharmahal and Bakhtiari, Southwest of Iran

Background

Congenital anomalies are among the causes of disability and death in infants. This study aimed to determine the incidence of major congenital anomalies (MCA) recorded at birth and also their relationship with some related factors in neonates born.

Methods

In this cross-sectional study, all infants born from March 2016 to March 2017 in the hospitals of Chaharmahal and Bakhtiari Province were evaluated for MCA at birth. Information recorded in the medical file including parent and infant characteristics is extracted from the maternal and newborn electronic files. Data were analyzed using Generalized Linear Model with function of Poisson.

Results

Of the 19666 newborns studied, 63 (3.2 per 1000) had MCAs at birth. Variables such as number of pregnancies, parity, gestational age, neonatal birth weight, height, and head circumference were found to be significantly associated with MCA based on the crude model (P value < 0.05). Using adjusted model 1, the incidence of MCA was found to be significantly related to mother's place of residency and her parity. Finally, in adjusted model 2, the incidence of MCA was found to be related to gestational age, neonatal birth weight, and head circumference.

Conclusions

In some MCA, early diagnosis and treatment can prevent disability. Consequently, the emphasis on public education to consider appropriate gestational age, proper nutrition before and during pregnancy, and prenatal care is necessary to inhibit MCA.

The Effects of Oxytocin on Craving, Mental Health Parameters, and Stress Hormones in Methamphetamine-Dependent Patients Undergoing Matrix Treatment Model: A Randomized, Double-Blind Clinical Trial

BACKGROUND

Methamphetamine (METH) dependence is an increasing public health problem with a wide range of mental and physical adverse effects. Recent studies report that oxytocin (OXT) has potential therapeutic properties in drug dependence. Hence, the present study was designed to evaluate the effects of OXT on craving, mental health (depression and anxiety), and stress hormones (ACTH and cortisol) in METH-dependent patients undergoing matrix treatment model (MTM), an intensive outpatient approach for stimulant abuse treatment.

METHODS

This randomized placebo-controlled clinical trial was conducted in 42 METH-dependent patients undergoing MTM to receive either intranasal OXT 40 IU (n = 21) or normal saline as placebo (n = 21) for 4 weeks. Clinical and biochemical parameters were measured at baseline and end of trials in METH-dependent patients.

RESULTS

Our findings indicated that OXT administration for 4 weeks is associated with a significant improvement in the craving and depression scores, respectively (p < 0.001 and p < 0.001), but there was no significant difference for anxiety scores compared with the placebo group. In addition, OXT administration significantly decreased cortisol (p < 0.001) and ACTH levels (p < 0.002).

CONCLUSIONS

These findings suggest that OXT can be considered as a new potential therapeutic for the treatment of METH-dependent patients undergoing MTM. Further studies are required to explore the effectiveness and safety of OXT.

Factors related to glycemic control in children and adolescents with type 1 diabetes mellitus in Isfahan, Iran

Purpose

Glycemic control is traditionally evaluated by monitoring of hemoglobin A1c (HbA1c). This study aims to explore factors related to glycemic control among pediatrics with type 1 diabetes mellitus (T1DM).

Methods

This cross-sectional study was conducted among 454 students aged 6-18 years with T1DM in 2018. Demographic and disease related information were collected by a validated questionnaire. Generalized Linear Models (GLM) were used to investigate the association of explanatory variables with HbA1c concentration.

Results

The mean (SD) age of the participants was 11.7(± 3.3) years. The overall prevalence of suboptimal glycemic control was 85.5% (HbA1c ≥ 7%). Results showed that post pubertal children experienced a significant decrease in HbA1c levels compared to prepubertal children (β =-0.83, p = 0.003). Underweight children had an increase of 1.32% in HBA1c concentration compared with normal weight children (β = 1.32, P = 0.007). We also found that participants with passive smoking had higher HBA1c levels than those without (β = 0.536, P = 0.022).

Conclusions

The results indicated that age, BMI and passive smoking and were significantly associated with HbA1c levels. It is suggested that glycemic control is related to multiple factors and the interaction of these factors with each other may have positive or negative effects on it which should be investigated in future studies. Improved understanding in this area could lead to prevention of deterioration in glycemic control.

Risk factors of severe COVID-19 in people with multiple sclerosis : A systematic review and meta-analysis

Objectives

To gather, synthesize, and meta-analyze data regarding the risk factors associated with a severe course of COVID-19 among patients with multiple sclerosis (pwMS).

Methods

MEDLINE, Embase, Scopus, and WoS were searched in May 2021. Briefly, the eligibility criteria included: 1) studies assessing COVID-19 severity among adult pwMS; 2) definitive diagnoses or high clinical suspicion of COVID-19; 3) a categorization of COVID-19 severity into at least two categories; 4) quantitative effect size and precision measurements; and 5) English language; and 6) clear effect size/precision measures. internal validity of studies was assessed using the NIH Quality Assessment Tools. A list of possible risk factors was created based on the search results and was later used in extraction, synthesis, and meta-analysis of the data.

Results

Thirteen studies were included in the syntheses. Outcome measures were either extracted from the papers, obtained from the primary researchers or calculated manually. The meta-analyses showed a significantly (P < 0.05) increased odds of a severe COVID-19 in pwMS with all of the assessed risk factors, except smoking and most DMTs.

Conclusion

This study facilitates evidence-based risk/benefit assessments in practice. Older men with progressive MS on anti-CD20 therapies are more at risk of an unfortunate COVID-19 outcome.

GIS-based risk mapping of cutaneous leishmaniasis: a survey in an endemic area of Central Iran

Cutaneous leishmaniasis (CL) is a vector-borne infectious disease that is affected by various environmental agents. The main objective of this study was to determine the spatial distribution of CL incidence by using Geographical Information System (GIS). This is a cross-sectional study that was conducted during 5 years from 2014 to 2018 in Isfahan, Iran. We used the required data on each leishmaniasis patient that were recorded from 44 counties of Isfahan in the databases and archive of the Provincial Health Centre. We used GIS for determining the incidence of CL in the high-risk foci. Moran index was used to identify high risk points (clustering in similar values) compared to the values of neighborhood points. Hot spot analysis was conducted by Getis-Ord-Gi. The highest incidence of the disease occurred in the age group of 18-64 years and 61.6% of patients were male. According to seasonal distribution, autumn (58.6%) had the highest frequency. Time trend of incidence showed that it had both decreasing and increasing, and there was a sudden upward trend of disease in 2018 except only two counties. The hot spots were involved the central areas of the Isfahan province slightly toward to the north and southeast of the province. Moran index showed that the differences for all points were not significant (p-value>0.05). Varzaneh (placed in southeast of Isfahan) was the hottest spot and had the worst position for leishmaniasis compared to all years and all cities.

Comparison of Design Fluency Test Results among Patients with Parkinson's Disease, Frontotemporal Dementia, and the Control Group

Background:

Design Fluency Test (DFT) is a nonverbal frame-free, nonstructured assessment of executive function (EF). Since previous studies evaluating EF in Parkinson's disease (PD) have mainly used verbal assessments for EF, this study aims to evaluate the pattern of executive domains in PD using DFT and to compare it with behavioral variant frontotemporal dementia (FTD) as a prototype for executive dysfunction and also with normal controls (NCs).

Materials and Methods:

Twenty-eight patients with PD, 27 with FTD, and 27 NCs were included in the study in Ayatollah Kashani Neuropsychiatry Clinic affiliated to Isfahan University of Medical Sciences from September 2019 to February 2020. All participants were assessed via semi-structured neuropsychiatric interview, questionnaire for demographic profile (age, handedness, gender, education, and marital status), duration of illness, comorbid medical condition, comorbid psychiatric illnesses and medications, DFT, Short Parkinson's Evaluation Scale, Frontal Assessment Battery, Judgment of Line Orientation, and Neuropsychiatry Unit Cognitive Assessment Tool.

Results:

Fixed condition novelty score was significantly different between FTD and PD (P < 0.001), FTD and control (P < 0.001), and also between PD and control (P = 0.001). When free and fixed condition novelty scores were considered to predict diagnostic attribution, multinomial logistic regression revealed that odds ratio for free condition novelty score was 0.705 (P = 0.005, 95% confidence interval [CI] = 0.553–0.899) and 0.494 (P = 0.001, 95% CI = 0.328–0.744) in PD and FTD, respectively. The odds ratio for fixed condition novelty score was 0.772 (P = 0.011, 95% CI = 0.632–0.942) and 0.449 (P = 0.00, 95% CI = 0.292–0.691).

Conclusion:

DFT subscores can be helpful in diagnosis and differentiation between FTD and PD.

Estimating the Lifetime and Age-Conditional Risk of an HIV Diagnosis in Iran, 2011-2015

Background:

According to the importance of infectious diseases, especially HIV, the purpose of this study was to estimate lifetime and age-conditional risks of HIV diagnosis in Iran.

Methods:

We used vital statistics, HIV surveillance and census data for 2011–2015 to calculate Age-specific HIV diagnosis and non-HIV death rates. These rates then converted to the probability of an HIV diagnosis considering the competing risk. Finally, the probabilities were applied to a hypothetical cohort of 10 million live births. The lifetime and age-conditional risk of HIV diagnosis in the total and general population of Iran were calculated by Dev Can software (version 6.7.4).

Results:

Lifetime risk was 0.084% (95% CI: 0.081–0.088) or one in 1183 for females and 0.21% (95% CI: 0.201–0.211) or one in 483 for males in the total population. In the general population lifetime risk for men was 0.069% (95% CI: 0.066–0.072) or 1 in 1454 men and 0.066% (95%CI: 0.063–0.069) or one in 1523 for women. In the total and general population, the 10-yr age-conditional risk of HIV diagnosis showed that the highest risk of an HIV diagnosis is related to 30-yr -olds.

Conclusion:

The estimated risks differed based on gender, age, and type of population. Paying close attention to these differences is critical for infection control planning and policies.

COVID-19 and the Risk of Relapse in Multiple Sclerosis Patients: A Fight with No Bystander Effect?

Background

COVID-19 is speculated to increase the likelihood of relapsing-remitting multiple sclerosis (RRMS) exacerbation.

Objective

To investigate the association between contraction of COVID-19 and incidence of acute MS attacks in RRMS patients six months post-infection.

Methods

This retrospective cohort study compares the risk of relapse in RRMS patients with (n=56) and without COVID-19 (n=69). Incidence of relapse was recorded for six-month following contraction of COVID-19. Incidence of RRMS exacerbation in patients with COVID-19 was compared to patients without COVID-19 (the independent control group) and the same patients six months prior to the COVID-19 pandemic.

Results

A lower incidence rate of RRMS exacerbation was observed in patients that contracted COVID-19 than in patients who did not contract COVID-19 (incidence rate ratio: 0.275; p=0.026). Self-controlled analysis showed no significant difference in relapse rates before the COVID-19 pandemic and after contracting COVID-19 (p=0.222). The relapse risk was not different between patients who had been hospitalized due to COVID-19 severity and those who had not (p=0.710).

Conclusion

COVID-19 contraction may not increase the risk of acute MS attacks shortly following contraction. We hypothesize that COVID-19-associated lymphopenia may partly preclude the autoreactive memory cells from expansion and initiating relapses through a so-called bystander effect of COVID-19 infection.

Psychometric evaluation of a questionnaire for measuring factors related to mental health of women in an earthquake

The current study was performed with the aim of the psychometric evaluation of a questionnaire for measuring factors related to women's mental health in an earthquake. This descriptive instrumental study was carried out on a population of 378 women with an earthquake experience in Kerman Province, Iran, in 2017-2018. The formal validity, content validity, criterion validity, factor analysis, and reliability of the questionnaire were measured using Cronbach's alpha coefficient. Moreover, descriptive statistics and Pearson's correlation coefficient were used to report data. In the content validity stage, 34out of 85 items of the questionnaire were eliminated. In the exploratory factor analysis (EFA) stage, 2 items out of the remaining 51 items were removed due to weak factor loading and 49 items were defined in 6 factors. The convergent and divergent validities of the questionnaire were confirmed in relation to the General Health Questionnaire (GHQ) (r = -0.23; P = .030) and World Health Organization Quality of Life-BREF ‎(WHOQOL-BREF) (r = 0.32;P = .001). Using Cronbach's alpha coefficient, the reliability of the questionnaire‎was obtained to be 0.91. The reliability and validity of the study questionnaire were at an appropriate level, and thus, it can be used to perform extensive surveys among women who have ‎experienced earthquake.

Efficacy of fresh frozen plasma transfusion in comparison with conventional regimen in organophosphate poisoning treatment: a meta-analysis study

OBJECTIVE

To evaluating the efficacy of fresh frozen plasma (FFP) in comparison with conventional regimen in the treatment of organophosphate (OP) poisoning.

METHODS

PubMed, ScopeMed, Cochrane, Scopus, and Google Scholar databases were searched. The search strategy used the following key words "organophosphate" and "poisoning or toxicity", "(atropine and oxime)", "fresh frozen plasma", "clinical trial", "outcome". The treatment with atropine or/and oxime was considered conventional therapy. The length of hospitalization, the length of ICU admission, need for mechanical ventilation and its duration, clinical recovery point, choline esterase level, mortality rate, and intermediate syndrome (IMS) occurrence were the key outcomes of interest. Databases were searched during the period of 2003-2019. Five studies were included in the analysis.

RESULTS

Pooling of data showed that the relative risk (RR) of mortality in OP poisoning for five included trials comparing FFP-treated group with conventional regimen therapy was [0.563 (95% CI (0.252, 1.255)]. The summary of RR for IMS in two studies was [RR: 1.34, 95% CI (0.655, 2.742)]. In addition, there was a non-significant mean difference (MD) in hospital stay [MD: -0.106, 95% CI (-0.434, 0.223)] in three included trials. A significant MD was observed in the length of ICU admission in two trials between FFP-treated group compared to the conventional treatment group [MD: -2.672, 95% CI (-4.189, -1.154)], but after random effects meta-analysis, the changes were not significant [MD: -2.015, 95% CI (-6.308, 2.277)]. The summary of fixed-effect meta-analysis for choline esterase level in three trails was [MD: -0.117, 95% CI (-0.468, 0.234)]. The RR of ventilation requirement for two included trials in the FFP-treated group comparing to the conventional regimen therapy was [0.84, 95% CI (0.691, 1.022)] while for ventilation duration in two studies was [MD: -0.183, 95% CI (-0.567, 0.201)].

CONCLUSION

The addition of FFP to conventional therapy did not improve the outcomes of mortality, IMS, hospital length of stay, cholinesterase levels, need or duration of mechanical ventilation, and only the length of ICU stay could affect in the treated group.

Socioeconomic status, cardiac risk factors, and cardiovascular disease: A novel approach to determination of this association

BACKGROUND

Socioeconomic inequality is one of the important issues in cardiovascular diseases (CVDs). The aim of this study was to investigate the distribution and relation between selected cardiac risk factors, type of CVD, and the socioeconomic status (SES) in the hospitalized patients with heart disease in Isfahan, Iran.

METHODS

This analytical and cross-sectional study was conducted in Isfahan in 2013. The population consisted of all patients with CVD admitted to the public and private hospitals. The sample size was 721. Data collection was conducted through one researcher-made questionnaire with three sections: demographic, disease, and SES questionnaires. To determine the SES of the patients, the indicators of income, housing status, occupation, family size, and education were used. Data analysis was conducted in two statistical levels of descriptive and inferential.

RESULTS

69.1% of the patients were placed in the poor status, and there was no wealthy status within the subjects. The five most frequent CVDs were chronic ischemia, unstable angina, arrhythmia, congestive heart failure (CHF), and acute myocardial infarction (MI), respectively. The three highest frequent risk factors in the patients were hypertension (HTN) (47.2%), diabetes (33.6%), and hyperlipidemia (32.6%). Regression analysis of the risk factors and the type of heart disease on the SES revealed that there were statistically significant differences between patients who were smokers (P = 0.030) and those who had valve disease (P = 0.010), adjusted for age, gender, and marital status.

CONCLUSION

Our findings showed that the frequency of CVD risk factors were higher in lower SES groups and thus SES can be a strong predictor for the occurrence of the CVD risk factors as well as the CVDs.

The association between demographic and familial characteristics and psychological properties of adolescents

Background:

We aimed to investigate the association between demographic and familial characteristics and psychological properties of adolescents including identity style, spiritual intelligence (SI), perceived parenting style (PPS), family functioning, and mental health.

Materials and Methods:

In this cross-sectional study, high school students aged 15–18 years were enrolled. Demographic characteristics of each student and their parents were recorded. Psychological properties of the students including PPS questionnaire, family assessment device, identity status, mental health status, and SI were assessed. The association between demographic and familial characteristics and psychological properties of adolescents was determined using Multiple Indicators and Multiple Causes (MIMIC) model.

Results:

In this study, 279 high school students (140 boys and 139 girls) were enrolled. The most common forms of identity style were diffusion and foreclosure with a prevalence rate of 49.1% and 39.5%, respectively. Results of MIMIC model showed acceptable fit with comparative fit index = 0.91, Tucker-Lewis index = 0.87, and root-mean-square error of approximation = 0.05 (0.04–0.06). There was a significant positive association between age and family functioning (P = 0.001). There was a significant positive association between age and mental health (P = 0.003). There was a significant negative association between gender and PPS (P < 0.001). The most common forms of PPS in females and males were authoritative form and uninvolved parenting, respectively. There was a significant positive association between father education and PPS (P = 0.001).

Conclusion:

Our findings indicated that there is an association between families’ demographic characteristics and identity style, perceived parental style, family functioning, and SI of adolescence. The association of some factors with mentioned psychological variables is more prominent such as age, gender, and father age.

The effects of concurrent Coenzyme Q10, L-carnitine supplementation in migraine prophylaxis: A randomized, placebo-controlled, double-blind trial

Purpose

The present study aimed to determine the effects of combined supplementation of Coenzyme Q10 with L-carnitine on mitochondrial metabolic disorders marker and migraine symptoms among migraine patients.

Methods

A total of 56 men and women, between 20–40 years of age with migraine headache, participated in this randomized, double-blind, placebo-controlled, parallel study. The subjects were randomly assigned to receive either 30 mg/day Coenzyme Q10 and 500 mg/day L-carnitine at the same time and/or placebo tablets for 8 weeks. The measurements were completed at the beginning and end of the study. The primary outcome was severity of headache attacks. The secondary outcomes included duration, frequency of headache attacks, the headache diary results (HDR), and serum levels of lactate.

Results

A significant reduction was obtained in serum levels of lactate (−2.28 mg/dl, 95% CI: −3.65, −0.90; p = 0.002), severity (−3.03, 95% CI: −3.65, −2.40; p ≤ 0.001), duration (−7.67, 95% CI: −11.47, −3.90; p ≤ 0.001), frequency (−5.42, 95% CI: −7.31, −3.53; p ≤ 0.001) and HDR (−103.03, 95% CI: −145.76, −60.29; p ≤ 0.001) after 8 weeks.

Conclusion

This double-blind parallel study provides evidences supporting the beneficial effects of Coenzyme Q10 and L-carnitine supplements on serum levels of lactate and migraine symptoms.

Trial registration

IRCT20121216011763N21.

Prioritization of factors related to mental health of women during an earthquake: A qualitative study

BACKGROUND

According to the fact that women account for the highest rate of victims of mental health loss during disasters, prioritization of their requirements is of remarkable significance. Therefore, the present study was carried out with the aim to prioritize factors related to women's mental health during an earthquake.

METHODS

This study was conducted using the Delphi method in 2017. Participants consisted of experts including psychologists, counselors and psychiatrists, social medicine specialists, and psychiatric-mental health nurses with experience in service and disaster awareness, especially earthquake. They were selected using purposive and snowball sampling methods. The Delphi method was used in 2 rounds with 21 components and the final attendance of 19 participants and the collective agreement of 75%.

RESULTS

Of the 21 factors related to women's mental health during the earthquake, the following components were, respectively, preferred by the participants: psychological well-being training, group relationships and support of women in emergency situations, fair treatment in the provision of rights and services to women, crisis awareness and management of behavior and difficult conditions, and social security during disasters with the total mean standard deviation (SD) of 13.4 (2.4), 13.0 (2.4), 12.7 (2.5), 12.5 (2.4), and 12.3 (2.2), respectively.

CONCLUSION

Training in the field of psychology and disasters, and social and cultural factors were prioritized among factors related to women's mental health during an earthquake. Therefore, the results of this study can be applied by the planners and executives of mental health, women and disasters, and the women's community itself.

Mapping of Stomach, Colorectal, and Bladder Cancers in Iran, 2004-2009: Applying Bayesian Polytomous Logit Model

BACKGROUND

According to the last report of Iran cancer registry, stomach, colorectal, and bladder cancers are the most prevalent cancers. The present study focused on separating the latent risk surface into shared and disease-specific components.

METHODS

In this study, data consisting of stomach, colorectal, and bladder cancers in 30 provinces of Iran during 2004-2009 are considered. These data are analyzed by polytomous logit model. The incidence of stomach cancer acts as the reference category (the surrogate for smoking). Then, the log odds are decomposed into shared and specific structured spatial and unstructured spatial components. These latent components help to detect spatial patterns of shared and disease-specific risk factors.

RESULTS

Central, Southern, Eastern, and Southwestern provinces are supposed as high-risk regions for shared risk factor for colorectal and bladder cancers. This shared risk factor is slightly associated more with bladder than with colorectal cancer. Northern, northwestern, and central regions and also three borderline provinces in southwestern are high-risk regions for colorectal cancer. Central, eastern, southern, and western strip of the country except Ilam are found as the high-risk regions of bladder cancer.

CONCLUSIONS

After considering known shared risk factor of the three cancers, it turns out that colorectal and bladder cancers have unknown shared risk factor. The significant difference in their lifestyle and eating habits could be an assumption of the risk factor.

Parenting Styles and Psychiatric Disorders in Children of Bipolar Parents

Background

Bipolar disorders (BD) in parents can have different effects on children and perhaps as a reason of the incidence of various psychiatric disorders in them and they may show a particular parenting style due to features of their disease. Given a crucial role of parenting style in upbringing children, this study aimed to evaluate different styles of parenting and its relationship with psychiatric disorders in children of parents with bipolar disorder (PBD) compared with controls.

Materials and Methods

In this case-control study, 500 parents with children aged 6-17 years were included that 250 of them with BD were selected as the case group and 250 of them were healthy as control group. The parents were selected according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) by a physician. Psychiatric disorders in children were assessed by The Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children (KSADS). The collected data were analyzed with SPSS (version 20).

Results

According to KSADS, there was significant difference between two groups of children in depression, mania, attention-deficit hyperactivity disorder, and posttraumatic stress disorder (P < 0.05). In authoritative dimension, parenting styles were effective in the incidence of psychosis (odds ratio [OR] [95% confidence interval (CI)]: 0.775 [0.63-0.95]) and led to a decrease of 0.320 times in the chance of oppositional defiant disorder incidence (OR [95% CI]: 0.320 [0.21-0.74]; P = 0.043) but an increase of 1.129 times in the chance of cigarette/tobacco use (OR [95% CI]: 1.129 [1.02-1.25]; P = 0.016).

Conclusion

The chance of psychiatric disorder's incidence in children of PBD was so far more than children of healthy parents. Hence, the incidence of some psychiatric disorders in children can be associated with parenting styles.

Association between cognitive function and parameters of echocardiography and coronary artery angiography

We aimed to determine whether there is an association between cognition and the results of echocardiography and angiography, based on neuropsychological assessments.

METHODS

We assessed the cognition of 85 patients who had recently undergone coronary artery angiography. We calculated the Gensini score for the coronary artery disease index. We also performed echocardiography to find indices of cardiac functioning.

RESULTS

The lower left ventricular ejection fraction correlated with lower scores on visuospatial, executive function, processing speed/attention and verbal memory capacities (p ≤ 0.05). A higher Gensini score and left atrial size correlated with lower executive function and processing speed/attention (p ≤ 0.05). In the group of patients with an impaired cognitive state, higher Gensini scores correlated with decreased processing speed/attention (p = 0.01) and the e' index was associated with lower capacity of executive function (p = 0.05).

CONCLUSION

Decreased processing speed/attention and executive function may correlate with cardiac dysfunction and coronary artery disease. The Color Trail Test may be considered for simple screening for cognitive problems in elderly patients with coronary artery disease or diastolic dysfunction.

Association between Sun Exposure, Vitamin D Intake, Serum Vitamin D Level, and Immunoglobulin G Level in Patients with Neuromyelitis Optica Spectrum Disorder

Background:

Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system inflammatory disorder in which immunoglobulin G (IgG) autoantibodies possibly play a pathogenic role against the aquaporin-4 water channel protein. Vitamin D may modulate B-cell function and decrease the IgG synthesis and may play a role in NMOSD as a crucial factor. The aim of this study was to investigate the relation between Vitamin D intakes from food, Vitamin D intake from sunlight exposure, blood Vitamin D levels, and IgG-neuromyelitis optica (NMO) level in serum of patients with NMOSD and NMO.

Method:

In this cross-sectional study, food Frequency Questionnaires (FFQ) and Sun Exposure Questionnaire (SEQ) were completed to evaluate of vitamin D intakes from food and sun light exposure. Moreover, serum levels of 25(OH) vitamin D3 and IgG-NMO were assessed in patients with NMOSD and NMO.

Results:

We assessed IgG-NMO levels in 29 patients with NMOSD that nine patients (n = 31%) were positive and for the rest it was negative. Sunlight exposure scale (P = 0.01) and 25(OH) D3 (P = 0.04) in IgG-NMO-negative patients were significantly more than patients with positive IgG-NMO. Age, gender, and latitude were not confounder variables. A positive significant correlation was observed between the sun exposure scale and serum levels of 25(OH) D3 in all participants (r = 0.747, P ≤ 0.001).

Conclusions:

Physiological variation in Vitamin D may apply a significant effect on IgG-NMO synthesis in patients with NMO. Vitamin D may have significant role in pathogenesis of NMOSD and NMO.

The Effect of Atorvastatin on Obsessive-compulsive Symptoms of Refractory Obsessive-compulsive Disorder (Add-on Therapy)

Background

Considering the effect of statins on the regulation of dopamine neurotransmitters and glutamates and importance of the treatment of obsessive-compulsive disorder (OCD) due to its relatively high prevalence and disability of available drugs in treatment of many patients, we came to the point to examine effectiveness of statins in patients with OCD.

Materials and Methods

This study is a double-blind randomized clinical trial, which is done in OCD clinic of Isfahan Shariati in 2014 for 1 year. The target population consists of 64 patients with OCD; one group is given a daily 40 mg atorvastatin tablets and the other group receives placebo. At baseline, 4- and 8-week severities of obsessive-compulsive symptoms are measured using Yale-Brown scale and compared in the two groups.

Results

The study results show a statistically significant difference between the two groups of intervention and control (P < 0.001). Furthermore, the results show the intervention effect at the end of the 4^th week and 8^th week (P < 0.001) that this change is evident in the 4^th week but remained almost constant in the 8^th week.

Conclusion

Overall, the evidences obtained from the study declare the effects of adding statins to treat obsessive-compulsive symptoms.

Hospitals preparedness using WHO guideline: A systematic review and meta-analysis

Background:

Hospitals play a critical role in providing communities with essential medical care during disasters.

Objectives:

In this article, the key components and recommended actions of WHO (World Health Organization) Hospital emergency response checklist have been considered to identify current practices in disaster/emergency hospital preparedness in actual or potential incidents.

Methods:

Articles were obtained through bibliographic databases, including ISI Web of Science, PubMed, Science Direct, Scopus, Google Scholar, and SID: Scientific information database. Keywords were “Disaster,” “Preparedness,” “Emergency Preparedness,” “Disaster Planning,” “Mass Casualty Incidents,” “Hospital Emergency Preparedness,” “Health Emergency Preparedness,” “Preparedness Response,” and “Emergency Readiness.” Independent reviewers (F.R. and M.H.Y.) screened abstracts and titles for eligibility. STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist was used to qualifying the studies for this review.

Results:

Of 1545 identified studies, 26 articles were implied inclusion criteria. They accounted for nine key components and 92 recommended actions. The majority of principles that had been rigorously recommended at any level of the hospital emergency preparedness were command and control and post-disaster recovery. Surge capacity was considered less frequently.

Conclusion:

We recommend considering the proposed disaster categories by FEMA (Federal Emergency Management Agency). In this framework, different weights for nine components can be considered based on disaster categories. Thus, a more valid and reliable preparedness checklist could be developed.

Assessment of the Efficacy of Physical Activity Level and Lifestyle Behavior Interventions Applying Social Cognitive Theory for Overweight and Obese Girl Adolescents

BACKGROUND

Childhood obesity has become a global epidemic and physical inactivity and considered as one of the most important contributing factors. We aimed to evaluate a school-based physical activity intervention using social cognitive theory (SCT) to increase physical activity behavior in order to prevent obesity among overweight and obese adolescent girls.

STUDY DESIGN

Randomized controlled trial study.

METHODS

A seven-month randomized controlled trial based on SCT was implemented with 172 overweight and obese girl students (87 in intervention and 85 in control group), with the presence of their parents and teachers. Activities of the trial included: Sports workshops, physical-activity consulting private sessions, free practical and competitive sports sessions, family exercise sessions, text messages, and newsletters. Body Mass Index (BMI) and Waist Circumference (WC) were measured and questionnaires about duration of physical activity, duration of screen time (watching television and playing computer games) and psychological variables regarding the SCT constructs were obtained.

RESULTS

Duration of physical activity (in minutes) and most of psychological variables (self-efficacy, social support, and intention) significantly increased at post-intervention, while hours of watching television and playing computer were significantly decreased (P<0.001). The subjects' mean BMI and WC reduced in the intervention group from 29.47 (4.05) kg/m2 to 28.5 (4.35) kg/m2 and 89.65 (8.15) cm to 86.54 (9.76) cm, although they were not statistically significant compared with the control group (P=0.127 and P=0.504, respectively).

CONCLUSIONS

School-based intervention using SCT led to an increase in the duration of physical activity and reduction in the duration of screen time in overweight and obese adolescent girls.

Association of urinary concentrations of four chlorophenol pesticides with cardiometabolic risk factors and obesity in children and adolescents

This study was undertaken to determine the association of four chlorophenol pesticides with cardiometabolic risk factors and obesity in children and adolescents. This cross-sectional study was conducted in 2016 on 242 children and adolescents, aged 6 to 18 years. The concentrations of 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (2,4,5-TCP), and 2,4,6-trichlorophenol (2,4,6-TCP) in the urine were examined and their association with indices of obesity and cardiometabolic risk factors was determined. Multivariate linear regression and multinomial logistic regression analyses were applied. Overall, 242 participants with mean (SD) ages of 11.3 (2.5) years completed the survey. After adjustment for confounders, a significant positive association was found between body mass index (BMI) z-score and waist circumference (WC) with 2,5-DCP (0.07 (95% CI 0.04, 0.1)) and 0.79 (95% CI 0.54, 1.03), respectively. A significant association of 2,4,5-TCP was only found with WC (0.23 (95% CI 0.0, 0.46), but the relationship with 2,4-DCP was not significant. 2,5-DCP had a significant relationship only with obesity (1.09 (95% CI 1.1, 1.19)), while 2,4-DCP and 2,4,5-TCP showed no significant correlation with overweight or obesity. 2,4-DCP showed a significant positive relationship with high density lipoprotein-cholesterol (HDL-C). Moreover, 2,5-DCP showed a significant negative relationship only with systolic blood pressure and 2,4,5-TCP had a statistically significant inverse association with total cholesterol and HDL-C (-0.71 (95% CI -0.98, -0.45)). This study suggests potential associations of chlorophenol pesticides with overweight, obesity, lipid profile, and blood pressure in children and adolescents. Longitudinal studies are necessary to assess the clinical impact of these findings.

School-Based Nutrition Education Intervention Using Social Cognitive Theory for Overweight and Obese Iranian Adolescent Girls: A Cluster Randomized Controlled Trial

Background Nowadays childhood obesity has become one the most challenging issue which is considered as a principle public health problem all around the world. This study was conducted with the aim of evaluating the impact of a 7-month school-based nutrition education intervention using social cognitive theory (SCT) to prevent obesity among overweight and obese adolescent girls. Method In this cluster randomized community trial after choosing schools, a total of 172 overweight and obese girl students participated in the study (87 in the intervention and 85 in the control group). A 7-month intervention based on SCT for students, their parents, and teachers was conducted. At baseline and end of the study, body mass index (BMI), waist circumstances (WCs), dietary intake, and psychological questionnaires regarding the SCT constructs were obtained. Results After 7 months, the mean of BMI and WCs reduced in the intervention group from 29.47 (4.05) to 28.5 (4.35) and from 89.65 (8.15) to 86.54 (9.76), respectively, but in comparison to the control group, they were not statistically significant ( p values .127 and .504, respectively). In the intervention group, nutritional behaviors and most of the psychological variables (self-efficacy, social support, intention, and situation) were improved in favor of the study and they were significant in comparison to the control group ( p < .05). Conclusion Although school-based nutrition education intervention using SCT did not change significantly BMI and WCs among the targeted population in this study, dietary habits as well as psychological factors improved significantly in the intervention group. This trial was registered in Iranian Registry of Clinical Trials, www.irct.ir (IRCT2013103115211N1).

Evaluation of Urokinase Plasminogen Activator Receptor, Soluble Urokinase Plasminogen Activator Receptor, and β1 Integrin in Patients with Hodgkin's Lymphoma

Background:

The objective of this study is to indicate the role of urokinase plasminogen activator receptor (uPAR), soluble uPAR (suPAR), and β1 integrin in tumor growth and invasion of lymph nodes from Hodgkin's lymphoma (HL) patients.

Materials and Methods:

In this study, 25 lymph nodes from HL patients were analyzed for the expression of β1 integrin and uPAR on mononuclear cells using two-color flow cytometry and immunohistochemical analysis. Moreover, the levels of suPAR in the serum samples of HL patients were measured and compared with 32 healthy controls.

Results:

Flowcytometry and immunohistochemical results indicated no significant association of uPAR expression with tumor size, different stages, or different histological subtypes of HL; however, an increased expression of β1 integrin was detected in the advanced stages of HL. Higher expression of β1 integrin was detected in nodular sclerosis compared to lymphocyte predominant. No significant difference was observed between the serum levels of suPAR in patients with different stages of HL and healthy controls. Moreover, the levels of suPAR were significantly higher in nodular sclerosis in comparison with other subtypes.

Conclusions:

This study showed that the levels of suPAR and β1 integrin varied between different histological subtypes of HL. Although uPAR may play only a minor role in the growth and metastasis of lymphoma, β1 integrin may be important in predicting prognosis and metastasis in HL.

A comparative study of the effect of green tea and sour tea on blood pressure and lipid profile in healthy adult men

BACKGROUND

Cardiovascular diseases (CVD) are a set of metabolic disorders affecting heart and blood vessels. Green tea and sour tea (Hibiscus sabdariffa L.) have attracted significant attention recently due to their high popularity, nutrient profile and therapeutic effects. The aim of the present study was to compare the effects of green tea and sour tea supplementation on blood pressure and lipid profile in healthy adult men.

METHODS

This randomized, double-blind, placebo-controlled trial included 54 healthy adult men. The participants were randomly assigned to two intervention groups receiving 450 mg green tea or sour tea and one placebo group which consumed 450 mg placebo (maltodextrin) for 6 weeks. Blood pressure, lipid profile, dietary intake and physical activity were measured pre- and post-intervention and compared.

RESULTS

After 6 weeks of intervention, sour tea supplementation led to a significant decrease in systolic blood pressure (SBP) compared with the placebo group. However, we faild to find any significant difference in SBP between green tea and control groups. Also, no significant changes were observed in diastolic blood pressure (DBP) and lipid profile between the three groups. In comparison with baseline, there was a significant increase in the mean level of serum high-density lipoprotein cholesterol (HDL-C) in green tea and sour tea groups. Also, the interventions resulted in significant decrease in the mean levels of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and DBP in the sour tea group compared with the pre-intervention value.

CONCLUSION

On the basis of our findings, sour tea supplementation led to decreased SBP in healthy men compared with the placebo, but there was no significant difference between their effects on DBP and lipid profile.

The effect of add-on memantine on positive, negative and depressive symptoms of schizophrenia: a doubleblind, randomized, controlled trial

treatment of schizophrenia, they don&#8217;t adequately address residual positive, negative and depressive symptoms. The aim of the present study is to assess the effect of adjunctive memantine treatment on positive, negative and depressive symptoms of schizophrenia.

METHODS

This randomized, placebo-controlled study was conducted in Noor Hospital, Isfahan, Iran, 2013-2014; 32 patients in maintenance treatment were included in each group, using block sampling; inclusion criteria were age 18- 65 years, normal intellectual ability, being diagnosed with schizophrenia for the past two years, being treated with fixed doses of atypical antipsychotic for at least three months before randomization. Exclusion criteria were pregnancy, breast feeding, having received electro-convulsive therapy in the past two weeks, drug or substance abuse and dependence, psychiatric/ neurological comorbidities, and sensitivity to memantine. Patients in the intervention group were treated with memantine plus atypical antipsychotic; while in the control group, patients received placebo and atypical antipsychotic. Patients were assessed by Positive and Negative Symptom Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) initially and every four weeks to the end of the 12th week. Data were analyzed in SPSS 17.0 using t-test, chi square, analysis of variance (ANOVA), and analysis of covariance (ANCOVA).

RESULTS

Positive symptoms (p=0.028), negative symptoms (0.004), general psychopathology (p<0.001), depressive symptoms (p<0.001) and total symptom severity (p<0.001) decreased significantly in patients receiving add-on memantine.

CONCLUSION

This study shows that, add-on memantine would be helpful, in the adjunctive treatment of depressive, positive, negative and general symptoms in patients with schizophrenia.

The comparison of printed resources bacterial contamination in libraries of Al-Zahra Hospital and Sciences Faculty of Isfahan University and the determination of their antibiotic sensitivity pattern

INTRODUCTION

During the library loan process, the printed resources can be a carrier of pathogenic bacteria. In this study, it was tried to compare the Bacterial Contamination Rates and their antibiotic sensitivity pattern in printed resources of a hospital and a non-hospital library.

METHODS

This is a cross-sectional study. Returning books from the Al-Zahra hospital library and library of Sciences faculty of Isfahan University provides the research community. The sample size, 96 cases, was calculated using quota sampling. For sampling sterile swab dipped in trypticase soy broth medium and transfer trypticase soy broth medium were used. To identify different type of isolated bacteria from Gram-staining test and biochemical tests such as; TSI, IMViC and etc., were used.

RESULTS

76 (79.2%) and 20 (20.8%) of cultured samples were negative and positive, the respectively. Of 20 positive samples, 11 samples (55%) belong to the family Enterobacteriaceae that after detecting by Differential teste identified all 11 samples of Enterobacter that all of them were sensitive to Gentamicin and Ofloxacin. Also the most resistance to Nitrofurantoin and Amikacin was observed. 9 cases remained (45%) were coagulase-negative Staphylococcus that all of them were sensitive to the Trimethoprim-sulfamethoxazole and Cephalexin antibiotics also the most resistance to Cefixime was observed.

CONCLUSION

Considering that the Enterobacter sp and coagulase-negative Staphylococcus were separated from the books, the books as well as other hospital and medical equipment can transmit the infection to librarians, library users, patients and hospital staff, and also it can produce serious infections in patients with immune deficiency.

The Mediating Role of Mental Health in the Relations between Dietary Behaviors and General Health: A Cross-sectional Study

Background:

The aim of this study is to find a pathway to explaining the relations between dietary behaviors with mental health and psychological functioning.

Materials and Methods:

This cross-sectional study contains 4763 participants from the employees of Isfahan University of Medical Sciences. In this study, four questionnaires were administered which were provided as follows: demographic characteristics, 21-item dietary behaviors questionnaire, Hospital Anxiety and Depression Scale questionnaire, and 12-item General Health Questionnaire (GHQ-12). We started the analysis with the structural equation modeling (SEM) model with 4 unobserved latent and 16 observed variables.

Results:

The results show that the regression coefficient (standard error) of diet behavior on mental health and mental health on GHQ were − 1 (0.37) and 0.02 (0.01) with their P values as 0.007 and 0.01, respectively. For this model, the estimated root mean square error of approximation is 0.062 with 90% confidence interval of (0.060–0.065). In addition, the comparative fit indices (CFIs) were as 0.866 for incremental fit index and 0.866 for CFI. All these indices represent fairly good fit of the model to the data.

Conclusion:

We can conclude that “lower scores on diet behavior – higher scores on mental health problems” and “higher mean scores in depression and/or anxiety – higher scores in GHQ domains.” The SEM results showed that dietary behaviors have significance related to depression and/or anxiety and general health status.

Estimation of burden of ischemic heart diseases in Isfahan, Iran, 2014: using incompleteness and misclassification adjustment models

Background

Over the past decade, cardiovascular diseases (CVDs) have been the leading cause of death in the world. Ischemic heart diseases (IHDs) are the main form of CVDs and are the most important single cause of death around the world. This study aimed to estimate the burden of IHDs in the city of Isfahan by calculating disability-adjusted life years (DALYs).

Methods

This population-based study was conducted on the population living in the city of Isfahan in 2014. Years of life lost due to premature mortality (YLLs) were calculated by multiplying the number of deaths due to IHDs (that was collected from death registration system (DRS) and was adjusted for incompleteness and misclassification) with life expectancy (that was extracted from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2013). Years lived with disability (YLDs) were calculated by multiplying the prevalent cases of IHDs in each age-sex group (that was calculated using the stepwise approach to non-communicable disease risk factor surveillance (STEPS)) with total disability weight of IHDs (that was calculated using the GBD 2013). DALYs were calculated as the sum of YLDs and YLLs.

Results

In 2014, the number of DALYs due to IHDs was 43517.71 years which was formed of 31891.79 years of YLLs and 11625.92 years of YLDs. The rate of DALYs due to IHDs was 4412.33 (95% uncertainty interval (UI): 3636.70–5162.72) person-years per 100,000 persons in males and 3476.66 (95% UI: 2948.95–4010.51) person-years per 100,000 persons in females. The highest rates of YLLs, YLDs, and DALYs due to IHDs in both sexes were occurred in 80 years and older.

Conclusions

The highest proportion of the burden of IHDs in the city of Isfahan was attributed to YLLs in the elderly people. Since the majority of the population of Isfahan is <60 years old and IHDs are long-lasting, the health authorities are recommended to design and implement educational and cultural programs to inform people about the risk factors and the methods to prevent these diseases. These programs can be used as a strategy to reduce the incidence of IHDs from an early age.

The Efficacy of Augment of D-Cycloserine and Cognitive-behavioral Therapy on Adolescent with one Type of Anxiety Disorders: A Double-blind Randomized Controlled Trial

Background:

This study was designed to investigating the effect of combining D-cycloserine (DCS) and cognitive-behavioral therapy (CBT) on adolescent with at least one type of anxiety disorders.

Materials and Methods:

The present study was conducted as a double-blind randomized controlled trial on 36 adolescent with anxiety disorders. Patients were assessed in two groups. In addition to 4 sessions of weekly CBT in both groups; case group, received a 50-mg DCS capsules, control group, received Placebo daily for a month. Patients received DCS capsules or placebo 1 h before sessions of CBT. Age, sex, kind of anxiety disorders “screen for child anxiety related disorders (SCARED)” and “cognitive abilities test (CATS)” scores were evaluated and compared between groups.

Results:

The mean age of the studied patients (29 females (80.6%) and 7 males (19.4%)) was 14.1 ± 1.8 years. The most frequent anxiety disorder among the study population was generalized social disorder (GAD) (77.7%). Age, sex and the frequency of anxiety disorders were not statistically significant between the study groups (P > 0.05). The mean score of “SCARED” and “CATS” at before starting the treatment, after treatment and three month after the treatment were not statistically significant between groups (P > 0.05). Also, decrease in values of “SCARED” and “CATS” during the evaluation time periods was not statistically significant between groups (P > 0.05).

Conclusions:

Findings of this study showed that there has been no difference in symptoms improvement in adolescent with anxiety disorder who received treatment protocol including 4 sessions of CBT, weekly, together with 50 mgs of DCS compared to the patients of the control group.

Association between screen time and snack consumption in children and adolescents: The CASPIAN-IV study

BACKGROUND

The relationship between screen time (ST) and the frequency of snack consumption in a national sample of Iranian children and adolescents was assessed. The present nationwide survey was conducted on 14,880 school students living in urban and rural areas of 30 provinces in Iran. Trained healthcare providers conducted the physical examination and completed the questionnaire of the World Health Organization - Global School-Based Student Health Survey (WHO-GSHS).

METHODS

The association between ST (total time spent watching TV and using a computer in leisure time) and the frequency of snack consumption was determined using ordinal logistic regression analysis. The subjects were 13,486 students out of the 14,880 invited including 50.8% boys. The mean (SD) age of participants was 12.47 (3.36) years.

RESULTS

In multivariate models, for students who had prolonged ST (more than 4 h/day), the odds of daily consumption of sweets (odds ratio, OR 1.25; 95% CI 1.14-1.4), salty snacks (OR 1.6; 95% CI 1.5-1.76), soft drinks (OR 1.52; 95% CI 1.4-1.7), canned fruit juice (OR 1.3; 95% CI 1.2-1.4), and fast food (OR 1.53; 95% CI 1.4-1.7) were higher compared to those with low ST. Furthermore, the odds of daily consumption of milk in students who had prolonged ST (more than 4 h/day) were lower compared to those with low ST (OR 0.9; 95% CI 0.8-0.99).

CONCLUSIONS

Prolonged time spent watching TV and using a computer during leisure time might be associated with unhealthy dietary habits. Moreover, inactivity induced by prolonged ST may also lead to unhealthy dietary habits and in turn excess weight in children and adolescents.

Rehabilitation of vulnerable groups in emergencies and disasters: A systematic review

BACKGROUND

Natural and man-made disasters, especially those occurring in large scales not only result in human mortality, but also cause physical, psychological, and social disabilities. Providing effective rehabilitation services in time can decrease the frequency of such disabilities. The aim of the current study was to perform a systematic review related to rehabilitation of vulnerable groups in emergencies and disasters.

METHODS

The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The key words "recovery", "rehabilitation", "reconstruction", "transformation", "transition", "emergency", "disaster", "crisis", "hazard", "catastrophe", "tragedy", "mass casualty incident", "women", "female", "children", "pediatric", "disable", "handicap", "elder", "old" and "vulnerable" were used in combination with Boolean operators OR and AND. ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar were searched.

RESULTS

In this study a total of 11 928 articles were considered and 25 articles were selected for final review of rehabilitation of vulnerable groups based on the objective of this study. Twenty-five studies including six qualitative, sixteen cross-sectional and three randomized controlled trials were reviewed for rehabilitation of vulnerable groups in emergencies and disasters. Out of the selected papers, 23 were studied based on rehabilitation after natural disasters and the remaining were man-made disasters. Most types of rehabilitation were physical, social, psychological and economic.

CONCLUSION

The review of the papers showed different programs of physical, physiological, economic and social rehabilitations for vulnerable groups after emergencies and disasters. It may help health field managers better implement standard rehabilitation activities for vulnerable groups.

The impact of educational intervention on self-care behaviors in overweight hypertensive women: A randomized control trial

BACKGROUND

The improper control of self-care in hypertension imposes a lot of financial burden on the health-care system. On the other hand, the importance of participatory care and high effectiveness of self-management programs have been confirmed. This study was aimed to examine the effect of an educational intervention on self-efficacy, self-care behaviors and blood pressure (BP) of hypertensive obese or overweight women in the primary health-care setting in Isfahan, Iran.

METHODS

This randomized controlled trial was an educational intervention program. It was performed among 146 hypertensive women of 30-65 age range who referred to 6 health care centers of Isfahan that randomly assigned to a control and intervention groups. The interventional group participated in the 6 weekly sessions including exercises, weight control, medication adherence, and home self-monitoring based on goal setting, and promotion of self-efficacy. The control group received routine care from health-care center and any special intervention has been done for the control group. Output variables were analyzed after intervention, and 6-month follow-up.

RESULTS

There are no significant differences between age, weight, body mass index and BP and biochemical variables except lipids as well as behavioral factors at the baseline. After 6 months intervention self-efficacy (< 0.001) and physical activity (< 0.001) improvement of in the intervention group was significantly different in comparison with the control group. After 6 months, there was a significant reduction in systolic (P < 0.001) and diastolic BP (P = 0.010) in the intervention group.

CONCLUSION

Participatory method of education could help us to convince patients to have better self-care to control disease. Furthermore, since adherence to the treatment of hypertensive patients in our society is low, organizing such courses can teach essential knowledge and skills to lifestyle change and prevention of complications. Performing these courses is recommended for other chronic disease patients in health-care centers to assess self-management programs on self-care behavior.

Efficacy of illness perception focused intervention on quality of life, anxiety, and depression in patients with myocardial infarction

Background:

Myocardial infarction (MI) is one of the major causes of death and disability worldwide, which can reduces quality of life in patients. Some disabilities are depression and anxiety which delay returning to work. The aim of this study was to evaluate the effect of illness perception focused intervention on quality of life, anxiety, and depression in MI patients.

Materials and Methods:

A randomized controlled trial study of 48 recently hospitalized MI patients was conducted (24 in intervention group and 24 in control group). Intervention group was trained to understand the disease by a mental health counselor in three half-an-hour sessions for three consecutive days. Data were collected from three questionnaires: hospital anxiety and depression scale, the World Health Organization Quality of Life Questionnaire (short form), and Illness Perceptions Questionnaire Brief at admission, 1.5, and 3 months postdischarge. Data were analyzed with ANOVA repeated measure.

Results:

The mean duration of returning to work was 28.7 ± 8.1 days in intervention groups and 46 ± 7.6 days in control group which was statistically significant (P < 0.001). Moreover, anxiety, depression, and illness perceptions score were significantly decreased in intervention groups which were 8.3 ± 3.3, 6.8 ± 3.5, and 36.5 ± 5 in intervention groups and 15.8 ± 2.1(P < 0.001), 17.1 ± 2.3 (P < 0.001), and 41.9 ± 4 (P < 0.001) in control group, respectively. Mean of quality of life subscales scores just physical health subscale showed a significant reduction after 3 months in the control group.

Conclusion:

Training MI patients to understand the disease in three half-an-hour sessions for 3 consecutive days can decrease the duration of returning to work, anxiety and depression, and increase illness perceptions which can make a better outcome.

Association between sleep quality and postpartum depression

Background:

The objective of this study was an investigation of the association between depression and sleep quality.

Materials and Methods:

This cross-sectional study was performed on 360 delivered women that referred to thirty health-care centers in Ardabil, Iran. The Standard Pittsburgh Sleep Quality Index questionnaire was used to the investigation of sleep quality. We used the Edinburgh Postnatal Depression Questionnaire to assess postpartum depression. Logistic regression was used to examine the association of sleep quality with postpartum depression.

Results:

Chance of depression in women with poor sleep quality was 3.34 times higher than those with good sleep quality (odds ratio = 3.34; 95% confidence interval: 2.04–5.48; P < 0.001). After controlling for some risk factors, an association observed between sleep quality and depression in postpartum women.

Conclusion:

we found an association between sleep quality in women who had given birth in the last 3 months and symptoms of postpartum depression.

The Effect of Nutrition Consultation on Dietary Diversity Score of Cardiac Patients Referred to Cardiac Rehabilitation Research Center Isfahan Cardiovascular Research Institute during 2008-2013

BACKGROUND

Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose.

METHODS

Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant.

RESULTS

The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001).

CONCLUSIONS

Dietary diversity was increased after nutrition counseling among patients with cardiac disease.