Adjustment for collider bias in the hospitalized Covid-19 setting

Background

Causal directed acyclic graphs (cDAGs) are frequently used to identify confounding and collider bias. We demonstrate how to use causal directed acyclic graphs to adjust for collider bias in the hospitalized Covid-19 setting.

Materials and methods

According to the cDAGs, three types of modeling have been performed. In model 1, only vaccination is entered as an independent variable. In model 2, in addition to vaccination, age is entered the model to adjust for collider bias due to the conditioning of hospitalization. In model 3, comorbidities are also included for adjustment of collider bias due to the conditioning of hospitalization in different biasing paths intercepting age and comorbidities.

Results

There was no evidence of the effect of vaccination on preventing death due to Covid-19 in model 1. In the second model, where age was included as a covariate, a protective role for vaccination became evident. In model 3, after including chronic diseases as other covariates, the protective effect was slightly strengthened.

Conclusion

Studying hospitalized patients is subject to collider-stratification bias. Like confounding, this type of selection bias can be adjusted for by inclusion of the risk factors of the outcome which also affect hospitalization in the regression model.

The trend of marriage, childbearing, and divorce and its determinants of socio-economic factors on divorce in Yazd province 2016-2021: A cross-sectional study

Background

In recent decades, families and their stability as an important social institution have changed significantly.

Objective

This study aimed to investigate the marriage trends, childbearing, and divorce changes in Yazd province from 2016 to 2021 to estimate the effect of socioeconomic factors on divorce.

Materials and Methods

A cross-sectional study was done in 2 phases. In the first phase, an ecological (time trend) was conducted to investigate the 5 yr trend in the occurrence of marriage, childbearing, and divorce, as well as the factors affecting the occurrence of divorce in the second phase. For the second phase of the study, 600 participants were selected. 300 divorced and 300 married applicants were chosen between 2016 and 2021. A binary logistic regression model was used to find the related factors affecting the occurrence of divorce.

Results

The results showed a declining marriage (p = 0.05) and childbearing trend (p = 0.84), as well as an increasing trend in divorces (p = 0.02) in Yazd. Logistic regression analysis showed that college education (OR = 0.22, CI: 0.116-0.430, p < 0.001) and being self-employed (OR = 0.48, CI: 0.255-0.934, p = 0.03) could reduce the odds of divorce. In addition, nonresidents (OR = 2.1, CI: 1.314-3.562, p < 0.001), with > 10-yr age differences (OR = 3.8, CI: 1.803-8.213, p < 0.001) or the woman being older than her husband (OR = 3.4, CI: 1.981-5.848, p < 0.001) could increase the odds of divorce.

Conclusion

Our results confirmed that a combination of socioeconomic characteristics affects the stability of family institutions.

Clinical courses of 24,563 hospitalized COVID-19 patients during the first 12 months of the pandemic in the Central City of Iran

This study was designed and implemented to analyze and establish documents related to the above cases in the first to third COVID-19 epidemic waves for the use of researchers and doctors during and after the epidemic. The current case series study was conducted on 24,563 thousand hospitalized COVID-19 patients by examining their clinical characteristics within a one-year period from the beginning of the pandemic on 02.22.2020 to 02.14.2021, which included the first to the third waves, based on gender and severity of COVID-19. The mean age of the participants was 56 ± 20.71, and 51.8% were male. Out of a total of 24,563 thousand hospitalized COVID-19 patients until February 2021, there were 2185 mortalities (9.8%) and 2559 cases of severe COVID-19 (13.1%). The median length of hospitalization from the time of admission to discharge or death in the hospital (IQR: 13-41) was estimated to be 21 days. The rate of hospital mortality was higher in severe (37.8%) than in non-severe (4.8%) cases of COVID-19, While the risk of severe cases increased significantly in the third (HR = 1.65, 95% CI: 1.46-1.87, P < 0.001) and early fourth waves (HR = 2.145, 95% CI: 1.7-2.71, P < 0.001). Also, the risk of contracting severe COVID-19 increased significantly in patients aged ≥ 65 years old (HR = 2.1, 95% CI 1.1.93-2.72, P < 0.001). As shown by the results, the rates of hospital mortality (9.3% vs. 8.5%) and severe cases of COVID-19 (13.6% vs. 12.5%) were higher among men than women (P < 0.01). In our study, the mortality rate and severity of COVID-19 were within the scope of global studies. Men experienced higher severity and mortality than women. The was a significantly higher prevalence of old age and underlying diseases in individuals with severe COVID-19. Our data also showed that patients with a previous history of COVID-19 had a more severe experience of COVID-19, while most of these patients were also significantly older and had an underlying disease.

Examination of the Topical Effect of the Combination of Plantago ovata and Vinegar on the Improvement of Rural Cutaneous Leishmaniasis Lesions

Background

The present study aimed at investigating the topical effect of the combination of Plantago ovata and vinegar on the improvement of rural cutaneous leishmaniasis lesions.

Materials and Methods

The present randomized double-blind controlled clinical trial was performed on 42 patients with rural skin leishmaniasis. In the case group, in addition to injecting glucantime into the lesion according to the latest national instructions, a combination of P. ovata and vinegar was applied topically twice a day for 8 weeks. In the control group, only glucantime injection into the lesion was performed for 8 weeks according to the latest national guidelines. At the end of the 1^st, 2^nd, 3^rd, 4^th, 8^th, and 12^th weeks after the intervention, the lesion area and improvement were evaluated and recorded.

Results

The results of the present study indicated the lesion area in the case group with the mean of 0.35 ± 0.39 cm and 0.18 ± 0.27 cm in the 8^th and 12^th weeks, respectively was significantly less than that of the control group with the mean of 0.64 ± 0.78 cm and 0.56 ± 0.44, respectively (P < 0.05). Twelve weeks after the intervention, 84.1% of the lesions in the case group and 65.9% of the lesions in the control group were completely improved (P < 0.05).

Conclusion

According to the results of the present study, the improvement of leishmaniasis lesion with the topical application of the combination of P. ovata and vinegar was significantly more than that of the control group in the 8^th and 12^th weeks after the intervention.

COVID-19 vaccine in pregnant women and pregnancy outcomes: A historical cohort in center of Iran

BACKGROUND

Starting vaccination in pregnant women; numerous theories have been proposed that the vaccine might affect the mother or the fetus.

OBJECTIVE

The goal of this research was to see whether there was a link between the Sinopharm vaccination and certain pregnancy outcomes in COVID-19-vaccinated women.

STUDY DESIGN

This is a retrospective cohort study.

METHOD

This study was conducted on pregnant women who delivered from 1 August 2021 to 1 January 2022 in Yazd city. We have followed the STROBE Guidelines when preparing the manuscript. In this period time, all pregnant women were 5787 people in which 5666 were in the second and third trimester. Among these women, 1222 women were randomly selected.

RESULTS

Among 1222 pregnant women, 558 (45.6%) women had received one dose vaccine, 162 (13.3%) people had received two doses, and 502 (41.1%) women had not been vaccinated. On crude analysis, there was no significant difference between vaccinated and non-vaccinated groups. After adjusting for maternal age, maternal body mass index, parity, stillbirth history, abortion history, and gestational diabetes in multivariate analysis, no differences were found between the groups in pregnancy as well.

CONCLUSION

Vaccinations during pregnancy seem to have no negative effects on the mother or the baby. This finding may aid pregnant women in deciding whether or not to take the vaccination.

Risk Factors of Osteoporosis in Females: A Hospital-Based Case-Control Study, Yazd, Iran

BACKGROUND

The aim of this study was to evaluate the predictors of osteoporosis in women in Yazd, Iran.

METHODS

This hospital-based case-control study was performed on 270 women 35-65 yr old (135 case and 135 control) from Mar 2016 to Mar 2017. Case and control were matched in terms of age ± 2 (year) as a group matching. Osteoporosis is defined as a T-score of bone mineral density (BMD) below -2.5 SD. Data were analyzed using SPSS 20 software. Statistical tests included chi-square, student t test and Mann Whitney test .Multiple logistic regression (MLR) which forward method was used for modeling.

RESULTS

Odds ratio (OR) of osteoprosis were menarche age>12 yr (OR=3.37, CI:2.29-15.89), history of hysterectomy (OR=13, CI:3.81-44.82), rheumatoid arthritis (RA) (OR=6.58, CI:2.29-18.91) calcium supplements (OR=0.14, CI:0.04-0.41), menopause age <40 (OR=11.84, CI:1.54-90), second smoking (OR=3.38, CI:1.16-9.81) and increase of weight (OR=0.86, CI:0.80-0.94).

CONCLUSION

Predictors of osteoporosis was menarche age >12 yr (3 times), history of hysterectomy (13 times), RA (6.5 times), menopause age <40 (12 times), second smoking (more than 3 times), calcium supplements and weight (protective).

Burden of severe COVID-19 in center of Iran: results of disability-adjusted life years (DALYs)

The outbreak of COVID-19 disease is an international public health concern. Therefore, the analysis of information related to mortality and disability due to COVID-19 is considered important, so the present study was designed and conducted with the aim of assessing COVID-19 Disability-Adjusted Life Years (DALYs) in Yazd. In Yazd province, all suspected cases of COVID-19 that would be referred to central hospitals in order to get confirmed through PCR or CT scan test, were recruited to our study. The fatality data of COVID-19 was gathered from the forensic medicine organization. The Disability-Adjusted Life Years (DALYs) combines in one measure years of life lost (YLL), the loss of healthy life due to premature mortality and years of life lived with disability (YLD), the loss of healthy life because of disease and disability. The total burden of COVID-19 was 23,472 years. The number of years lost due to premature death was 23385 and the number of years of life with disability due to COVID-19 was estimated to be 87 years. The disease burden was 12992 years for men and 10480 years for women. The overall incidence of COVID-19 was 1411 per 100,000, of which 1419 in men and 1402 in women per 100,000. The outbreak of COVID-19 pandemic affected a large population and the residents of Yazd Province lost many years of their lives due to this disease.

Monitoring of Essential and Toxic Elements in Leaves, Branches, and Stem of Prosopis cineraria (as Anti-Inflammatory) Growing in Iran

Prosopis cineraria is locally grown which scientific literature present evidence for its anti-inflammatory effect. Monitoring the content of toxic elements is one of the most important aspects to consider medicinal plants' safety before evaluating the pharmaceutical use. The aim of present study was to investigate the level of essential and toxic elements in the leaves, branches, and stem of Prosopis cineraria to assess its health risk. Samples were collected around Bandar Abbas, washed several times, and dried in air for 2 weeks. The dried samples were chopped with stainless steel knife to small pieces and powdered by electrical mortar. Some physical and chemical properties of samples were investigated by chemical methods. Samples were ashed by a programmable electric furnace at 650 °C for 6 h. Then samples were dissolved in 30% HNO₃, and the content elements of each sample were determined by inductive coupled plasma optical emission spectrometer (ICP-OES). The tests quality control and the measurement uncertainty were checked through the analysis of certified reference materials of SRM 1515 from NIST and solution standards. Correlation analysis of the obtained results showed a significant difference between leaves, branches, and stem of Prosopis cineraria so that the stem had the high essential and low toxic elements ones in comparison to other parts. The results revealed that the Prosopis cineraria stem is meeting health standards regarding the studied toxic metals.

Population attributable risk of risk factors for type 2 diabetes; Bayesian methods

OBJECTIVE

Demonstrating the risk factors of diabetes can help to plan for prevention of this disease. This study aimed at quantification of the impact of physical activity, hypertension, general obesity, central obesity, high cholesterol, HDL, LDL, triglyceride, smoking, hookah, drug use, alcohol consumption on the incidence of type 2 diabetes at a population level in Yazd, Iran. And this study calculated population attributable risk (PAR) of them.

METHODS

For this study, data from the first phase of the cohort study of chronic diseases in the adults of Yazd city were used, which began in 2016. Data was recorded through a cohort trained team. To calculate PAR and its the Bayesian confidence interval were performed using software R (version 3.4.3).

RESULTS

Of the 9967 subjects studied, age ≥30, 14.67% (n = 1432) has type 2 diabetes. The most common risk factors for diabetes were Inadequate physical activity and central obesity (WHR). The PAR for Inadequate physical activity of diabetes in women was 17.92%, in men 18.53, And PAR for WHR in women was 57.62%, in men 43.03.

CONCLUSIONS

In this study, age was the strongest determinant of diabetes. And then type 2 diabetes is mainly attributable to WHR, significantly more so in women than men. Therefore, central obesity probably should be considered as a major strategy for reducing incidence of type 2 diabetes.

Environmental and behavioral determinants affecting the association of airway macrophages carbon load with distance to major roads and traffic density

Biomarkers are promising indicators to evaluate human exposure to air pollutants and to predict the health outcomes. Area of Airway macrophages that is occupied by Black Carbon could be used as a biomarker of personal long term exposure to traffic related air pollution. Association of airway macrophages carbon load with weighted average distance and environmental and subject-specific behavior are considered in this study. Sputum samples were taken from 160 healthy adult women and airway macrophages carbon load (AMCL) were determined in 93 subjects, which represent a success rate of 62% in sputum induction. Nearest distance of the subjects to major roads and average weighted distance were calculated for each subject. A questionnaire was field according to general and behavioral characteristics of the participants. There was not any significant difference (P-value >0.05) between induced and non-induced subjects. Subjects with indoor kitchen without separation wall, passive smokers and those with longer presence time in high traffic streets showed higher carbon area. Weighted average distance had a better association (β = -0.186, 95%CI: -0.139, -0.230, P-value = 0.00) with AMCL than nearest distance to major roads (β = -0.155, 95%CI: -0.109, -0.201, P-value = 0.19). Association of Weighted average distance with AMCL was interrupted in subjects with a garage connected to house environment, those with IK kitchen, those with a hood above the stove and passive smokers. The findings indicated that more generation and distribution of indoor air pollutants can completely enhance the internal exposure and indoor pollution has the same importance as outdoor pollution.

Air pollution and telomere length in adults: A systematic review and meta-analysis of observational studies

Telomere length (TL) has been suggested to be a surrogate for cellular ageing, and a record of cumulative inflammation and oxidative stress over life. An emerging body of evidence has associated exposure to air pollution to changes in TL. To date there is no available systematic review of literature on this association. We aimed to systematically review and conduct meta-analysis of published studies on the relationship between air pollution and TL in adults. Electronic databases were systematically searched for available English language studies on the association between air pollution and TL published up to 1 July 2018. Meta-analyses were conducted following MOOSE guidelines. The heterogeneity in the reported associations was assessed using Cochran's Q test and quantified as I² index. Publication bias was assessed using Egger's regression. Our search identified 19 eligible studies including 11 retrospective and eight prospective studies of which, four had excellent quality, ten had good quality and five had fair quality. Meta-analysis result of two studies on long-term exposure to PM_2.5 showed an inverse association between these exposures and TL (for 5 μg/m³ PM_2.5-0.03 95% CI; -0.05, -0.01). Meta-analysis of short-term exposure to PM_2.5 with three studies and Polychlorinated Biphenyls (PCBs) with two studies revealed a direct association between these exposures and TL (0.03 95% CI; 0.02, 0.04 and 0.10 95% CI; 0.06, 0.15 respectively). No statistically significant relationship between exposure to PM₁₀ and polycyclic aromatic hydrocarbons (PAHs) exposure and TL were observed. We observed suggestive evidence for associations between air pollution and TL with potentially different direction of associations for short- and long-term exposures.

Mortality and morbidity due to exposure to ambient particulate matter

The aim of this study was to investigate spatial variation and health risk of the exposure to PM_2.5 (particulate matter with a diameter of 2.5 µm or less) and PM₁₀ (particulate matter with a diameter of 10 µm or less) in Sabzevar, Iran. PM_2.5 and PM₁₀ were measured during three campaigns from April to November 2017, in 26 sampling points. Spatial analysis was performed using kriging and autocorrelations (Moran's index) model in Arc GIS software. Relationship between exposure to the PM_2.5 and PM₁₀ and their health impacts were investigated by AirQ 2.2.3 software. The mean concentrations (and standard deviation) of PM _2.5 and PM₁₀ over the entire study period were 32.54 (37.28) and 42.61 (47.76) μg/m³, respectively, which were higher than the guideline of World Health Organization. According to the spatial analysis, the maximum concentrations of PM_2.5 and PM₁₀ were around the main highway (beltway) which placed all over the south of Sabzevar. According to the Moran's index, the emission patterns for PM_2.5 (Z-score = 2.53; P-value = 0.011) and PM₁₀ (Z-score = 2.82; P-value = 0.004) were clustered. The attributable percentage (AP) of total mortality related to PM_2.5 and PM₁₀ were 3.544% (95% confidence interval (CI): 2.623-4.447%) and 2.055% (95% CI: 1.379-2.721%) per increasing each 10 μg/m³ of these pollutants, respectively. According to observed results, it is suggested that the beltway and other pollution sources, such as industries, should be placed at a greater distance from the city, to reduce PM amounts in residential areas.

Salt Content in Traditional and Nontraditional Breads in Yazd City, Iran, 2015-2016

Background: Cardiovascular diseases (CVDs) are the leading cause of premature death in the 21st century. Dietary factors, such as high salt intake, are related to increased risk of CVDs{Akpolat, 2009 #21}. One of the main sources of dietary salt is bread. On the other hand, salt content is a quality indicator of bread. Therefore, this study was conducted to evaluate the salt content in a variety of consumed breads in Yazd city, Iran. Methods: This study was a cross sectional research conducted in Yazd. The list of the bakeries obtained from their industry office. Ten percent of about 600 bakeries in Yazd (62 bakeries; 2 samples in each bakery) were selected using simple random sampling based on sample frame of ID number of each bakery. Finally, 9 types of bread included in this study. Sodium content was measured using flame photometer method. Salt content in breads was reported in each 100 g bread. Results: It was found that Nan-Taftoon Tanuri is the most popular bread among traditional breads in Yazd (45.2%). It had significantly more salt than Nan-Fantezi and Nan-Sangak (P < 0.02). Also, Nan-Sangak had the least salt among traditional breads. However, the mean salt of traditional breads was more than the standard level (1g salt/100g bread (P < 0.0001). Conclusion: The current study showed that the mean salt content of traditional breads was significantly more than the standard level. Furthermore, Nan-TaftoonTanuri had significantly more salt than others, such as Nan-Fantezi and Nan-Sangak.

Environmental determinants of polycyclic aromatic hydrocarbons exposure at home, at kindergartens and during a commute

The aim of this study was to assess the potential health risk of exposure to polycyclic aromatic hydrocarbons (PAHs) at home and kindergarten for pre-school children. The urine samples were taken from 200 pre-school children aged 5-7 years and analyzed for 1-OHP as a biomarker of PAHs. Mixed effect models were applied to investigate the association between effective environmental parameters (mode of transport, distance to major roads, traffic density, greenness, tobacco exposure, home ventilation, and grill foods) and urinary 1-OHP levels. A Monte-Carlo simulation technique was applied to calculate the risk of exposure to PAHs and to check the uncertainty of input variables and the sensitivity of the estimated risk. The median and inter quartile range (IQR) of 1-OHP was 257 (188.5) ng L^-1. There was a positive significant association between distance from the kindergartens to the green space with surface area ≥5000 m² and 1-OHP concentration (β = 0.844, 95% CI: 0.223, 1.46, P-value = 0.009). Also, urinary 1-OHP was found to be inversely associated with the time the window was open at the home (β = -12.56, 95% CI: -23.52, -1.596, P-value = 0.025) and normalized difference vegetation index (NDVI) in a 100 m buffer around the homes. The mean (9.76 E-3) and 95th percentile (3.28 E-2) of the hazard quotient (HQ) indicated that the concentration of urinary 1-OHP is at a safe level for the target population (HQ < 1). According to the sensitivity analysis results, the concentration of 1-OHP is the most influential variable in the estimated risk. Our findings indicated that the proximity of homes and kindergartens to green space areas and their remoteness from the main streets and heavy traffic areas are associated with reduced exposure to PAHs.

Occupations and the Risk of Bladder Cancer in Yazd Province: A Case-Control Study

Background:

Bladder cancer is the most common cancer of the urinary tract, with known occupational causes. The most effective way to prevent occupational cancers of the urinary tract is to prevent exposure to known carcinogens.

Objective:

To examine the relationship between occupation and the risk of bladder cancer.

Methods:

This case-control study was performed on 200 patients with bladder cancer and 200 healthy individuals in Yazd. Data were collected using a researcher-made questionnaire and based on interviews with patients and controls.

Results:

The mean age of cases and controls were 61.5 (SD 13.6) and 61.5 (13.3) years, respectively. Level of education, type of occupation, family history of bladder cancer in the first-degree relatives, and history of chronic and recurrent urinary tract infection, kidney and bladder stones, and using hair dye, were considered the main predictors for bladder cancer.

Conclusion:

There was a significant difference between cases and controls in terms of type of occupation. The risk of bladder cancer was higher among those working in high-risk occupations—metal working, textile, driving, farming, and construction.

Application of novel Modified Biological Aerated Filter (MBAF) as a promising post-treatment for water reuse: Modification in configuration and backwashing process

Biological Aerated Filter (BAF) reactors due to their plentiful biomass, high shockability, high efficiency, good filtration, availability and lack of need for large land areas, are enjoying from great importance in advanced wastewater treatment. Therefore, in this study, Polystyrene Coated by Sand (PCS) was produced as a novel media and its application in a modified down-flow BAF structure for advanced wastewater treatment was assessed in two steps. In step one, the backwash effluent did not return to the system, while in step two backwash effluent returned to increase the water reuse efficiency. The backwash process was also studied through three methods of Top Backwashing (TB), Bottom Backwashing (BB), as well as Top and Bottom Backwashing Simultaneously (TBBS). The results showed that return of backwash effluent had no significant effect on the BAF effluent quality. In the second step similar to the first one with slight differences, the residual average concentrations of TSS, BOD₅, and COD at the effluent were about 2.5, 8.2, and 25.5 mg/L, respectively. Additionally, in step two, the mean volume of disposal sludge/volume of treated water (v_ds/v_tw) decreased a large extent to about 0.088%. In other words, the water reuse has increased to more than 99.91%. The backwash time in methods of TB and BB were 65 and 35 min, respectively; however, it decreased in TBBS methods to 25 min. The concentrations of most effluent parameters in this system are in concordance with the 2012 EPA Agriculture Standards, even for irrigation of Non-processed agricultural crops and livestock water consumption.

PREVALENCE OF OCCULT HEPATITIS B INFECTION IN IRANIAN CANCER PATIENTS BEFORE CHEMOTHERAPY TREATMENT

BACKGROUND

Occult hepatitis B infection is characterized by negative hepatitis B surface antigen (HBsAg) and also detectable hepatitis B virus (HBV) -DNA, with or without hepatitis B core antibody (anti-HBc). HBV reactivation in individuals under immunosuppressive therapy is critical, occurring in occult HBV.

OBJECTIVE

In this study, we aimed to determine the prevalence of occult HBV infection among hepatitis B surface antigen negative in cancer patients before receiving chemotherapy.

METHODS

Sera from 204 cancer patients who were negative for HBsAg, were tested for anti-HBc antibodies. The samples that were negative for HBsAg but positive for anti-HBc also examined for HBV-DNA by polymerase chain reaction (PCR).

RESULTS

Of the 204 HBsAg negative blood samples, 11 (5.4%) samples were positive for anti-HBc antibodies. HBV-DNA was detected in 9/11 (81%) of anti-HBc positive samples. Occult HBV infection in hematological cancers was more than solid cancers, 4.8% and 4.3% respectively. There was no significant difference in HBc antibody positivity based on vaccination, previous blood transfusions, history of familial hepatitis or biochemical parameters (ALT, AST, total and direct bilirubin levels) (P>0.05).

CONCLUSION

Screening of occult HBV infection by HBsAg, HBV DNA and anti HB core antibody should be suggested as a routine investigation in cancer patients before receiving chemotherapy.

Yazd Breast Cancer Project Profile; A Community Based Trial for the Evaluation of Self-Examination and Physical Examination of the Breast Cancer Disease

There is some evidence to suggest that a benefit might be derived from a program that incorporated both annual physical examination of the breast (BPx) and the teaching of breast self-examination (BSE). Current investigation presents the profile of a multicenter community based intervention for evaluating the effect of BSE+BPx on the reduction of morbidity and mortality due to breast cancer amongst women residing in urban areas of Yazd (Iran) from 2008 to 2018. There were three distinctive phases in this trial with 10 years duration: pilot phase with the duration of 1 year, active intervention phase with 4 rounds of annual screening of BPx+BSE and follow up phase with 5 years duration. Tools of enquiry included a pre-tested questionnaire, repeated annual physical examination of the breast and more importantly mammography, sonography, and fine needle aspiration (FNA). Data were analyzed using descriptive statistics such as frequencies, percent, mean (SD), tests of chi-square and student t-test with 95% confidence level. Comparison of socio-demographic and socio-economic factors such as age, age at marriage, family size, number of live births, occupation, education level, total family income and marital status showed that no significant difference was seen between the groups (P>0.05). A response rate of 84.5% was seen by participants of the experiment group visiting the health centers for the first BPx. Our results showed that except for the education and marital status, the difference in other main demographic and socio-economic factors between the groups were not significant, and the response rate of individuals in the experiment group was at an acceptable level.

Determinants of Self-Care in Diabetic Patients Based on Health Belief Model

Introduction:

The aim of this study was to determine self-care predictors in diabetic patients based on health belief model.

Materials and Methods:

The cross-sectional study was conducted on 110 diabetic patients referred to health service centers in Ardakan city, Yazd, Iran. The data was collected by a questionnaire including perceived benefits, barriers, severity, susceptibility, self-efficacy, social support, self-care behaviors and demographic variables.

Results:

Regularly medicine use (mean= 6.48 times per week) and shoes checking (mean= 1.17 times per week) were reported as the highest and the lowest self-care behaviors respectively. Health belief model constructs including perceived benefits, barriers, severity, susceptibility, self-efficacy and social support predicted 33.5% of the observed variance of self-care behaviors. Perceived susceptibility and self-efficacy had positive effect on self-care behavior; whereas perceived barrier’s has negative effect. Self-efficacy, perceived susceptibility and barriers were most powerful predictor respectively.

Conclusion:

The findings approved the efficiency of health belief model in prediction of self-care behaviors among diabetic patients. The findings realized the health belief model structure; therefore, it can be used as a framework for designing and implementing educational interventions in diabetes control plans.

Effect of Omega-3 Supplementation on Visfatin, Adiponectin, and Anthropometric Indices in Women with Polycystic Ovarian Syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is a multifactorial, metabolic disorder. Characteristics are chronic anovulation, polycystic ovaries and hyperandrogenism. The aim of this study was to determine the effect of omega-3 supplementation on visfatin, adiponectin, and anthropometric indices in PCOS women.

METHODS

The study was a randomized double blind placebo-controlled clinical trial. It was conducted on 84 women with polycystic ovary syndrome (26.92±5.05 years, BMI=31.69 Kg/m (2)) who referred to the fertility and infertility research center and Shahid Sadoughi hospital in Yazd. After the examination, evaluation and para-medical assessment by obstetrician, they were recruited. They took 3 capsules of omega-3 (each one contained 180 mg EPA and 120 mg DHA) or placebo (each contained 1 g paraffin) daily for 8 weeks. Statistical analysis was paired T-test and student T-test, and a p<0.05 was considered statistically significant.

RESULTS

After the intervention, visfatin concentration did not change in neither groups. But, at the end of the study, the mean of adiponectin concentration increased (p<0.001) in omega-3 group. Moreover, the mean of changes in this factor was significantly different between groups (p<0.005). FSH did not change in two groups of the study. However, the mean of LH decreased about 1.74 mlU/ml in omega-3 group (p<0.005). The mean of change of LH/FSH ratio between groups was significant (p<0.05). After the intervention, prolactin did not meaningfully change in both groups.

CONCLUSION

Our results showed that 8 weeks of supplementation of omega-3 may have some beneficial effects on PCOS biochemical characteristics such as LH, LH/FSH, and adiponectin.

Prevalence of diabetes in people aged ≥ 30 years: the results of screen-ing program of Yazd Province, Iran, in 2012

BACKGROUND

Among the non-communicable diseases, diabetes mellitus has an important ranking and with annually increasing rate where it is expected the number of people suffering from the disease will reach to 300 million up to 2025 in all of world. The prevalence of type 2 diabetes in Iran is 4-4.5% and in population aged above 30 years is greater than 14%. The present study is attempting to find out the prevalence rate of the disease and its risk factors in Yazd Province, central Iran.

METHODS

This cross-sectional study was carried out in 2012.  A total of 14993 subjects were randomly selected and enquired by a pretested questionnaire. Data were analyzed by descriptive statistics and appropriate statistical tests such as chi-square, and multiple logistic regressions.

RESULTS

The prevalence rate of known diabetes and impaired fasting glucose was 16.3% & 11.9% respectively. Age, sex, family history of diabetes, high blood pressure, BMI, and history of gestational diabetes were significantly associated with diabetes disease (P=0.001).

CONCLUSIONS

The prevalence rate of diabetes is higher than other parts of the world and living in the city. Female gender, increasing age, high blood pressure, increased BMI and positive family history, are independent risk factor for diabetes, therefore performing prevention programs and controlling these high risk groups should be considered as a priority.

Study to evaluate two dosage regimens of vitamin D through an academic year in middle school girls: a randomized trial

Vitamin D is an essential hormone for growth and development of bones in children. There is a lot of evidence for deficiency of this vitamin in Middle East females. This study conduct to find a way to combat deficiency in girls during rapid growth phase of puberty in academic year. One hundred and two Middle School girls who had not consumed any vitamins supplement have been participated in this randomized clinical trial. They allocated randomly in two case groups who received 50,000 or 100,000 IU vitamin D3 in October and three months later in January or in control group who received vitamin E. At the end of winter blood samples for 25-hydroxyvitamin D were checked. The mean of 25-hydroxyvitamin D were 5.5±1.5 ng/ml, 15.2±6 ng/ml, 23.0±6.8 ng/ml in control, 50,000 and 100,000 IU vitamin D groups respectively (P<0.05). Neither dosage of vitamin D could raise 25-hydroxyvitamin D above 20 ng/ml in all cases. However, none of the students in 100,000 IU of vitamin D3 had severe deficiency in winter. Headache, dizziness, and weakness were the most common complain after vitamin D consumption, but no difference between groups detected (P>0.05). Urine calcium/creatinin ratio was equal in case and control groups (P>0.05). 100,000 IU of vitamin D3 every three months (equal to 800 IU/day) can raise 25-hydroxyvitamin D above 12 ng/ml in all cases but for area with high prevalence of sever deficiency, dosage more than 100,000 IU every three months or shorter interval recommended to achieve optimal level.

Coronary artery disease risk factors in urban areas of Yazd City, Iran

BACKGROUND

Coronary artery disease (CAD) is a major cause of mortality and morbidity with high health care cost in both developed and developing countries. CAD accounts for nearly 50% of all yearly deaths in Iran.

OBJECTIVE

The aim of this study is to explore the main CAD risk factors in the urban areas of Yazd in the Islamic Republic of Iran.

METHODS

A hospital-based case-control study was conducted to investigate the role of the important CAD risk factors in urban area of Yazd city from December 2007 to June 2008. A total of 436 subjects in the age group of 30 to 75 years (218 cases and 218 controls) were included in this study. The tools of enquiry were a pretested and precoded questionnaire, physical examination, and laboratory findings. A confidence level of 95% and study power of 80% were considered for the interpretation of possible significant findings. Gender-wise stratified analysis was separately done for men and women using multiple conditional logistic regression.

RESULTS

A total of 75.5% of the participants were men and 24.5% were women. Five variables, including unskilled jobs, physical inactivity, giving positive history of hypertension, high levels of waist/hip ratio, and low levels of high-density lipoprotein (HDL) were the factors that could account for significant predictors of CAD in males on the logistic model (P < .05). No such significant CAD predictors were found for women.

CONCLUSION

The findings showed that categories of nonprofessional, physical inactivity, positive history of hypertension, wais/hip ratio ≥0.9 and HDL levels ≤40 mg/dL are the significant risk factors that can predict CAD in male residents of Yazd.

Combination of bolus dose vitamin D with routine vaccination in infants: a randomised trial

INTRODUCTION

The present study was designed to compare two methods of vitamin D supplementation in infants: every two months as a routine vaccination versus a daily dose.

METHODS

A randomised clinical trial was performed on 120 healthy breastfed infants between January and September 2007 in Yazd, Iran. The infants were randomly divided into three groups with different doses of vitamin D3 supplementation: 200 IU daily, 400 IU daily and a bolus of 50,000 IU every two months. A blood sample was taken and evaluated for 25-hydroxy vitamin D and calcium levels when the infants were six months old. The data was reported as the mean and standard deviation.

RESULTS

No significant differences were observed between the serum level of 25-hydroxy vitamin D in the groups administered with 200 IU and 400 IU vitamin D daily. However, the serum level of 25-hydroxy vitamin D reached significance in the third group (p is less than 0.001). All the blood calcium measured was below 11 mg/dl in the bolus group. A few complications such as diarrhoea and agitation, all of which were self-limited, were seen in the bolus group. No other significant side effects were reported in the other groups.

CONCLUSION

This study demonstrates that a bolus of 50,000 IU of vitamin D every two months with a routine child vaccination program provides the ideal serum level of vitamin D. This method produces no serious side effects and offers a highly convenient way to supply vitamin D, especially among non-compliant parents.