Socio-Economic Status and Prevalence of Self-Reported Osteoporosis in Tehran: Results from a Large Population-Based Cross-Sectional Study (Urban HEART-2)

Osteoporosis is a widespread disease among older peoples. The aim of this study is to estimate the prevalence of self-reported osteoporosis and assessing its association with socio-economic status. A population-based cross-sectional study was conducted in Tehran, Iran in 2011. Participants were 45,990 individuals aged above 20 years from 22 urban districts. Osteoporosis was measured by self-administrative questionnaire. Wealth index was constructed using principal component analysis based on household assets. Chi-square test, chi square test for trend, and crude odds ratio were used to assess associations in univariate analysis. Multiple logistic regression utilized to estimate adjusted associations between self-reported osteoporosis and socio-economic status.The overall estimated prevalence of self-reported osteoporosis was 4% (95% CI 3.88-4.13), 1.19% in men, and 6.84% in women (P < 0.001). The prevalence increased considerably as age increased (P for trend < 0.001). In multivariable analysis, education and wealth status were negative, and smoking was positively associated with the prevalence of self-reported osteoporosis. No association was found between participants' skill levels and Townsend deprivation index with the prevalence of self-reported osteoporosis.The findings of the present study have improved understanding of the association between socioeconomic status and osteoporosis in the Iranian population. It is important to consider socioeconomic status in screening and prevention programs.

Socioeconomic status and prevalence of self-reported diabetes among adults in Tehran: results from a large population-based cross-sectional study (Urban HEART-2)

INTRODUCTION

Diabetes mellitus is an important public health challenge worldwide. The prevalence of type 2 diabetes varies across countries. The aim of this study is to estimate the prevalence of type 2 diabetes and to determine related factors including socioeconomic factors in a large random sample of Tehran population in 2011.

METHODS

In this cross-sectional study, 91,814 individuals aged over 20 years were selected randomly based on a multistage, cluster sampling. All participants were interviewed by trained personnel using standard questionnaires. Prevalence and Townsend deprivation indexes were calculated. Principal component analysis (PCA) was used to construct wealth index. Logistic regression model was used in multivariate analysis.

RESULTS

The estimated prevalence of self-reported diabetes was 4.98 % overall, 4.76 %in men and 5.19 % in women (P < 0.003). In multivariate analysis, age, marital status (married and divorced/widow) and BMI were positively associated with the prevalence of self-reported diabetes. Of the socioeconomic variables, educational level and wealth status were negatively and Townsend Index was positively associated with diabetes.

CONCLUSION

Our study findings highlight low reported prevalence of diabetes among adults in Tehran. Subjects with low socioeconomic status (SES) had a higher prevalence of type 2 diabetes. Weight gain and obesity were the most important risk factors associated with type 2 diabetes. Wealth index and educational level were better socioeconomic indicators for presenting the inequality in diabetes prevalence in relation to Townsend deprivation index.

Comparative effects of conventional hormone replacement therapy and tibolone on climacteric symptoms and sexual dysfunction in postmenopausal women

OBJECTIVE

To compare the effects of tibolone with those of conventional hormone replacement therapy on climacteric symptoms and sexual function in postmenopausal women.

MATERIALS AND METHODS

In a randomized, controlled trial, 140 postmenopausal women were allocated into three groups. Of the subjects included, 47 women received 2.5 mg tibolone + one Cal+D tablet (500 mg calcium and 200 IU vitamin D) daily; 46 women received 0.625 mg conjugated equine estrogen + 2.5 mg medroxyprogesterone (CEE/MPA) + one Cal+D tablet daily; and 47 women received only one Cal+D tablet as the control group. The Greene Climacteric Scale (GCS) questionnaire was used to detect the efficacy of treatment on climacteric symptoms. Rosen's Female Sexual Function Index (FSFI) was used for sexual function evaluation. Sex hormone binding globulin (SHBG), free estradiol index (FEI) and free testosterone index (FTI) were measured before and after treatment. The women were followed up for 6 months

RESULTS

After treatment, all subscores in the GCS improved in the tibolone and CEE/MPA groups (p < 0.01), except the sexual subscore in the CEE/MPA group, compared with baseline. There were significant differences in the FSFI in the tibolone and CEE/MPA groups in comparison to the control group after treatment. Tibolone, in comparison to CEE/MPA, significantly lowered SHBG levels and increased the FTI and FEI and improved the desire, arousal and orgasm sexual domains of the FSFI (p < 0.001).

CONCLUSION

Tibolone may be an alternative to conventional hormone replacement therapy in the treatment of climacteric symptoms and sexual dysfunction in postmenopausal women.

Smoking among male medical sciences students in Semnan, Islamic Republic of Iran

We determined the prevalence of smoking among 320 male medical sciences students (174 studying for a medical degree, 95 a bachelor degree and 51 a associate degree) in Semnan, Islamic Republic of Iran. A self-administrated, anonymous questionnaire was used. The prevalence of smoking was 14.4%; 45.6% of the smokers started smoking between the ages of 18 and 20 years, 43.5% starting at university. There was no significant difference in the prevalence between students undertaking different college degrees and also those having different types of accommodation. However the smoking behaviour of friends and family was significantly correlated with smoking in the students. Smoking amongst medical sciences students, who will become the health professionals of the future, needs to be addressed.

Assessment of marhame-mafasel pomade effect on knee osteoarthritis with non-compliance

BACKGROUND

Osteoarthritis is the most prevalent chronic non-infective joint arthritis. In the present study, the effect of new herbal pomade (Marhame-Mafasel) on knee osteoarthritis was investigated in a randomized trial. The objective of this study was to assess efficacy of Marhame- Mafasel pomade, which was consisted of several medic herbs like Arnebia euchroma and Martricaria chamomilla in pri-mary osteoarthritis of the knee with non-compliance.

METHODS

The 2*2 crossover trial enrolled 42 osteoarthritis patients (Marhame-Mafasel versus pla-cebo) in 2006. The instrument of data collection was Western Ontario and McMaster Universities (WOMAC) LK3.1 standard questionnaires. We used conditional estimation to adjust non-compliance effect.

RESULTS

The participants in each group were 21 patients. About 30 (71.4%) were female. The partici-pants were between 40-76 years old. Positive analgesic effect of herbal pomade "Marhame-Mafasel" on knee osteoarthritis severity was considerable (P < 0.01). After adjusting results to compliance level, the estimators were sharper than crude results.

CONCLUSION

Herbal joint pomade "Marhame-Mafasel" has significant positive analgesic effect on pri-mary knee osteoarthritis.

Comparative effects of continuous combined hormone therapy and tibolone on body composition in postmenopausal women

OBJECTIVE

To compare the effects of tibolone with those of continuous combined hormone replacement therapy (HT) on body composition in postmenopausal women.

METHODS

One hundred and fifty postmenopausal women were enrolled in a randomized, controlled trial to compare the effects of tibolone with continuous combined HT on body composition. Patients were randomly allocated into three groups and followed for 9 months. Of the subjects included, 50 women received 2.5 mg tibolone plus one Cal+D tablet (500 mg calcium and 200 IU vitamin D) daily, 50 women received 0.625 mg conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate (CEE/MPA) plus one Cal+D tablet daily, and the rest (50 women) received only one Cal+D tablet and served as a control group. Body composition was evaluated with measurements of body mass index (BMI), weight, waist-to-hip ratio (WHR), fat mass and fat-free mass (FFM) before and after the intervention. Measurements of body fat mass percentage, fat mass, body fat-free mass percentage and fat-free mass (FFM) were assessed by measurement of skin-fold thickness.

RESULTS

Tibolone significantly increased weight, BMI and FFM and decreased WHR after the treatment in comparison with baseline (p < 0.05). However, only weight and BMI increased significantly in the CEE/MPA group after the treatment (p < 0.05). There were significant increases in weight, BMI and fat mass in the control group after 9 months. In the comparison of the parameters after the treatment between the three groups, tibolone significantly increased FFM compared with the control and CEE/MPA groups (p < 0.01).

CONCLUSIONS

The effect of tibolone on body composition is favorable and therefore tibolone may be regarded as an alternative to continuous combined hormone therapy in postmenopausal women.

Causes and management of nursing practice errors: a questionnaire survey of hospital nurses in Iran

BACKGROUND

Some human error in health care is inevitable. Research into the predisposing factors for these errors is an important step in their management.

AIM

To survey nurse perceptions of the contributing factors to nursing practice errors.

METHODS

A descriptive survey was carried out in three selected educational hospitals in Tehran city. Data were collected by questionnaire and analysed using descriptive statistics. The study sample consisted of 96 nurses and nursing managers. A multistage sampling strategy was used.

RESULTS

Results showed that from nurses' and nursing managers' perspectives, various factors could contribute to the occurrence of nursing errors in the 'management', 'environment' and 'nursing care' sections. In addition, there were differences between nurses working on various wards about the causes of nursing errors in each section.

CONCLUSION

A culture of safety recognizes that safety is 'no accident'. Rather, it requires a change in management practices, providing a suitable environment with the requisite supply of resources and infrastructure, and increasing nurses' knowledge. Outcomes that are identified from the process of practice error management should promote interventions designed to prevent future practice errors based on the above contributing factors.

LIMITATIONS

The study relied on self-report by a sample of nurses. These responses should now be tested by empirical research into actual nursing practice errors in order to test whether the nurses' perceived ideas of causation are substantiated.

A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction

OBJECTIVE

To compare the effect of a whole body vibration training (WBVT) programme with a conventional training (CT) programme on knee proprioception and postural stability after anterior cruciate ligament (ACL) reconstruction.

METHODS

Twenty athletes with unilateral ACL reconstruction were randomly assigned to the WBVT or CT group; all participants received 12 sessions of WBVT or conventional training. Absolute error in joint repositioning for two target angles (30 degrees and 60 degrees ) was measured with the Biodex dynamometer; bilateral dynamic postural stability (anteroposterior, mediolateral and overall stability indices) was measured with the Biodex Stability System pre-intervention and post-intervention.

RESULTS

The improvement in postural stability in the WBVT group was significantly greater than that in the CT group (p< or =0.05). The p values of the changing scores of open overall, open anteroposterior, open mediolateral, closed overall, closed anteroposterior and closed mediolateral stability indices were 0.002, 0.010, 0.0001, 0.001, 0.0001 and 0.046, respectively. In addition, there were significant differences in all averages of absolute angular error at 60 degrees and 30 degrees between the WBVT and CT groups in both knees (p = 0.001 in healthy knees and p = 0.001 and p = 0.0001 in reconstructed knees), apart from the healthy knees at the 30 degrees target position, which was not significant (p = 0.131).

CONCLUSIONS

Whole body vibration training improved proprioception and balance in athletes with reconstructed ACL.

A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin ≥ 13.2 g/dl

OBJECTIVE

To study the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin (Hb) > or = 13.2 g/dl.

DESIGN

A randomised, double-blind, placebo-controlled trial.

SETTING

Routine health services.

POPULATION

Seven hundred and twenty-seven pregnant women with Hb > or = 13.2 g/dl in the early stage of the second trimester.

METHODS

Each woman took one ferrous sulphate [DOSAGE ERROR CORRECTED] tablet (150 g tablet, containing 50 mg of elemental iron) [DOSAGE ERROR CORRECTED] daily in the case group (n = 370) or placebo in the control group (n = 357) throughout pregnancy.

MAIN OUTCOME MEASURES

Pregnancy outcome.

RESULTS

While there were no significant differences in demographic and obstetric characteristics between the two groups before any intervention, small-for-gestational-age birth rate and the number of women with hypertension disorder increased significantly in the case group in comparison with the control group (57 [15.7%] versus 36 [10.3%], P = 0.035, 10 [2.7%] versus 3 [8%], P = 0.05, respectively).

CONCLUSIONS

Our finding proves that routine iron supplementation in nonanaemic women is not rational and may be harmful.

Prevalence of HI antibody titer against rubella virus to determine the effect of mass vaccination in Tehran

BACKGROUND

Rubella is an infectious viral disease, has a worldwide distribution and is normally a mild childhood disease. Infection during early pregnancy may cause fetal death or congenital rubella syndrome. The highest risk of CRS is found in countries with high susceptibility rates among women of childbearing age. In many developed and some developing countries, large-scale rubella vaccination during the past decade has drastically reduced or practically eliminated rubella and CRS. Mass vaccination campaigns and Expanded Program of Immunization (EPI) have increased vaccine coverage in the world with a substantial impact on the reduction of rubella infections, such as CRS.

OBJECTIVE

The present study was preformed to evaluate the immune status against rubella before and after the mass campaign vaccination on 22 December 2003.

STUDY DESIGN

A total of 320 samples were collected from the healthy subjects before and after the vaccination and 80 paired sera were collected and tested for the presence of rubella antibody using HI test.

RESULTS AND CONCLUSIONS

Based on the results, 98.1% of the population has gained anti-rubella antibody, compared with 92.2% before the vaccination. The data revealed that 98.75% of the paired subjects had rubella antibody after mass vaccination which is statistically significant.

Impact of early admission in labor on method of delivery

OBJECTIVE

The effect of the timing of admission in labor unit on the method of delivery was evaluated in a cohort study.

METHOD

Four hundred and sixty six low-risk nulliparous women who were admitted in the labor unit in latent phase (group 1) were compared with 329 parturient women who were admitted in the active phase (group 2) to determine rate of and reasons for cesarean section, cervical dilation at the time of cesarean, and the rate of labor augmentation.

RESULT

The number of cesarean deliveries in group 1 was greater than that in the group 2 (301 vs 80, p<0.0001 ). The main reason for cesarean section in group 1 was dystocia, and in 2, fetal distress. The rate of cesarean section in the women who were augmented was greater in group 1 than in group 2 (54% vs 23%, p<0.0001).

CONCLUSION

Later admission in labor increases the rate of spontaneous vaginal delivery in low risk nulliparous women.

Effect of the sampling sequence on the quality of Papanicolaou smear

The aim of the study was to determine whether the order of cell collection (ie, obtaining either endocervical first or ectocervical cells first) has an effect on the quality of the Papanicolaou smear. 1129 smears were obtained using an Ayre spatula and an endocervical brush. In 564 cases, the endocervical brush was used first, and in 565 cases, the spatula was used first. The number of smears obscured by blood, the smears without endocervical component, and the smears with poor fixation were compared between the two groups. More smears were partially obscured by blood when brush was used first (78, 13.8% compared with 48, 8.5%, P = 0.004). No endocervical component was found in seven (1.2%) smears from the brush-first group compared with five (0.9%) of the spatula-first group, which is an insignificant difference. There were no significant differences in the number of poor-fixated smears, too-thick smears, and satisfactory smears but limited by inflammation between the two methods. The quality of the Papanicolaou smear can be improved by using the Ayre spatula first followed by the endocervical brush. Fewer smears will be contaminated by blood which may result in more squamous intraepithelial lesions being detected.

Relationship between beta-hCG levels in cervicovaginal secretions and labor

OBJECTIVE

To determine whether levels of human beta-chorionic gonadotropin hormone (beta-hCG) in cervicovaginal secretions can predict the labor process.

METHODS

A total of 150 women admitted in active labor to the urgent delivery unit of a university hospital were enrolled in a prospective study. The beta-hCG level of each woman's cervicovaginal secretions was measured by radioimmunoassay on admission; then, beta-hCG levels were compared between 2 groups of 35 women, one in whom labor progressed normally and another in whom augmentation of labor with oxytocin was required.

RESULTS

There were significant differences in beta-hCG levels of cervicovaginal secretions between the spontaneous delivery group and the augmentation of labor group (130.72+/-64.51 mU/mL vs. 93.9+/-65.29 mU/mL) (P<0.05). A receiver-operating characteristic (ROC) curve analysis showed that the optimal cut-off value was 82 mU/mL, with a sensitivity of 66% and a specificity of 60%.

CONCLUSION

beta-chorionic gonadotropin hormone levels were significantly higher in the cervicovaginal secretions of women whose labor was progressing normally than in those who required augmentation of labor.

Effect of the sampling sequence on the quality of Papanicolaou smear

The aim of the study was to determine whether the order of cell collection (ie, obtaining either endocervical first or ectocervical cells first) has an effect on the quality of the Papanicolaou smear. 1129 smears were obtained using an Ayre spatula and an endocervical brush. In 564 cases, the endocervical brush was used first, and in 565 cases, the spatula was used first. The number of smears obscured by blood, the smears without endocervical component, and the smears with poor fixation were compared between the two groups. More smears were partially obscured by blood when brush was used first (78, 13.8% compared with 48, 8.5%, P = 0.004). No endocervical component was found in seven (1.2%) smears from the brush-first group compared with five (0.9%) of the spatula-first group, which is an insignificant difference. There were no significant differences in the number of poor-fixated smears, too-thick smears, and satisfactory smears but limited by inflammation between the two methods. The quality of the Papanicolaou smear can be improved by using the Ayre spatula first followed by the endocervical brush. Fewer smears will be contaminated by blood which may result in more squamous intraepithelial lesions being detected.

Factors associated with unwanted pregnancy

The purpose of this study was to estimate the proportion of unwanted pregnancies (UWPs) and related factors among mothers delivering at all hospitals in Tehran. We investigated, in cross-sectional study 6,394 clients, parental age, education and occupation, interval of live children pregnancies, and rate of abortion. A Chi-square test and Hi-Log linear were used in this study. In this study, 2,443 (38.2%) of all cases were UWPs, of which 4.6% (n = 297) resorted to abortion (p < 0.0001). About 38% of all women had no prenatal care. Seventeen percent of the women under 20 and 66.2% of those above age 35 had had UWPs (p < 0.0001). Forty-one percent (n = 2,640) of all cases were illiterate or had primary education and 28% (n = 1,793) had a high school education or higher (p < 0.0001). Forty-seven percent (n = 18) of mothers were workers and 28.1% (n = 147) were employees (p < 0.0001). Although such variables as age, occupation, level of education, prenatal care, family size, and pregnancy interval affect rates of unwanted pregnancy in developing countries, regardless of the cause unwanted pregnancy and its negative consequences can be prevented by access to health services.

Comparative study and evaluation of side effects of low-dose contraceptive pills administered by the oral and vaginal route

This was a comparative study of side effects and acceptability of low-dose pills administered by the oral and vaginal rout. In an experimental clinical trial study, undesirable side effects of nausea, dysmenorrhea, breast tenderness, gastrointestinal disorders, vertigo, headache, and breakthrough bleeding (BTB) were studied. The participants of the case and the control groups were the same women. The side effects were compared in 143 women using contraceptive pill containing 150 microg levonorgestrel and 30 microg ethinyl estradiol by vaginal and oral route. The efficacy and acceptability were evaluated. The side effects among the patients who used the contraceptive pills orally were significantly higher than among those who used the vaginal route (p < 0.0001). BTB occurred more often with the oral route, but there was no significant difference between their incidences (p = 0.267). Most participants in this study expressed a high level of acceptability with the vaginal route. There was only one unwanted pregnancy, which occurred when the participant used the contraceptive pill vaginally, but used it incorrectly. Using the contraceptive pill administered by vaginal route is a safe method with fewer side effects and more acceptability when compared with the oral route.

A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea

OBJECTIVE

To determine whether vitamin E is effective in the treatment of primary dysmenorrhoea.

DESIGN

A randomised placebo-controlled trial.

PARTICIPANTS

One hundred girls, aged 16-18 years old who suffered from primary dysmenorrhoea, among 1,000 students attending a public high school in Region 5 in the Greater Tehran Municipality.

METHODS

Fifty girls were given 500 units of vitamin E (five tablets) per day, and 50 were given five placebo tablets per day. The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain before and after the treatment was studied. Treatment in both groups was carried out in two consecutive menstrual periods.

RESULTS

The severity of pain in the two groups was reduced after treatment, but the reduction was greater in the group treated with vitamin E. These differences were maintained in the second month of therapy.

CONCLUSION

Both placebo and vitamin E are effective in relieving symptoms due to primary dysmenorrhoea, but the effects of vitamin E are more marked.