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Background: In the studies conducted in Iran, the determining role of lifestyle as a multifactorial concept of infertility in infertile Iranian women has rarely been investigated. Objective: to compare the lifestyles of fertile and infertile women in Iran. Method: This case-control study was conducted on 400 women in 2022. The control group includes women aged 18-45 years, with no history of infertility and who had at least one child. The case group includes women whose primary infertility has been diagnosed and confirmed by a gynecologist and who were referred to the infertility ward in the west of Iran for treatment. The Miller-smith lifestyle assessment inventory was used in this study. We applied a significance level of 0.05 using the Stata ver. 14. Results: In multivariable analysis after adjusting for age, BMI, women's education, husband's education, women's Job, age at menarche, and menstrual cycle, the infertile women had higher scores on the Miller-Smith lifestyle questionnaire than fertile women [linear regression coefficient=21.21; 95% confidence interval: 20.56 to 21.86; p Conclusion: The situations of lifestyle components such as time of rest, attending club and social activities, physical activity, recreation, having close friends, and religious beliefs were better in fertile women, as compared to infertile women.

Background: We aimed to determine the association between maternal infections during pregnancy with risk of Attention-Deficit Hyperactivity Disorder (ADHD) in children. Methods: A systematic literature search was performed utilizing the online databases PubMed, Scopus, and Web of Sciences up to July 2020. Random-effects meta-analyses were applied to estimate pooled relative risk (RR). Heterogeneity, study quality and publication bias were assessed through I2 value, Newcastle–Ottawa scale (NOS) and Egger's test, respectively. Results: Thirteen articles involving 1401904 mother-child pairs were included. The result of meta-analysis showed that the risk of ADHD increased by 30% among children whose mothers took any infections during pregnancy (pooled RR=1.30, 95% CI: 1.14-1.49; I2=85.5, P

Background: The results differ among published studies regarding exposure to meconium and the risk of developing autism spectrum disorders (ASDs).Purpose: The present study pooled all of the epidemiologic studies retrieved from broader databases on the association between meconium exposure and risk of developing ASD in children.Methods: The Web of Science, PubMed, Scopus, and Google Scholar databases were searched without language restrictions for articles published between their inception to February 20, 2020, using relevant keywords. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated as random-effect estimates of the associations among studies. A subgroup analysis was conducted to explore any potential sources of heterogeneity among studies.Results: The pooled estimate of OR reported a weakly significant association between meconium exposure and ASD development in children (OR, 1.13; 95% CI, 1.03–1.24). There was low heterogeneity among the articles reporting risk for ASD among children (I2=19.3%; P=0.259). The results of subgroup analysis based on meconium exposure showed a significant association between a meconium-stained neonate and ASD development (OR, 1.18; 95% CI, 1.11–1.24).Couclusion: Meconium exposure was weakly associated with an increased risk of ASD. However, more evidence based on large prospective cohort studies is required to provide conclusive evidence about whether meconium exposure is associated with an increased risk of ASD development.

Ectopic pregnancy(EP) is the implantation of a fertilized ovum outside of the uterine cavity. The incidence of EP has steadily increased around the world. The present umbrella review evaluated risk factors prior to conception associated with EP based on meta-analyses and systematic reviews.We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with EP were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2).Two risk factors including chlamydia trachomatis (OR: 3.03) and smoking (OR: 1·77) were graded as suggestive evidence (class III). IUD with pregnant control (OR: 10.63) and endometriosis for case-control studies (OR: 2·66) and tubal ligation with pregnant control (OR: 9.3) were graded as risk factors with weak evidence (class IV). Tubal ligation with non-pregnant control was a protective factor (class IV). IUD with non-pregnant control and endometriosis for cohort studies were not as risk factors for EP.Two risk factors involving smoking and chlamydia trachomatis and three risk factors involving IUD use, endometriosis, and tubal ligation were classified as suggestive evidence and weak evidence for EP, respectively. Strong evidence for risk factors of EP was not achieved, indicating the degree of uncertainty and bias, which bring an emergency to conduct further no-bias studies.PROSPERO (CRD42021281632).

Background To our knowledge, no systematic reviews and meta-analyses have yet been published that examine the effect of art therapy (AT) interventions on depression symptoms among older adults, and this study aimed to systematically review and meta-analysis of clinical trials, summarize eligible relevant studies and provide a true effect measure for the association between AT and depression symptoms in older adults. Methods The databases of PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched until 15 February 2022. The methodological quality of the included studies was evaluated by the Delphi checklist. The heterogeneity across studies was conducted by chi-squared test and measured its quantity by the I2 statistic. We performed this meta-analysis to obtain a summary measure of the mean difference in depression scores between AT and control groups using a random-effects model. All statistical analyses were carried out at a significance level of .05 using Stata software, version 14. Results Until 15 February 2022, 222 studies through databases and 199 studies through review of references were included in the present meta-analysis. In total, the analysis covered 8 studies. The difference in mean depression score between the intervention and control groups showed significant reductions in the AT group (MD −.78; 95% CI: −1.17, −.38; I 2 = 67.9%). Conclusion Our findings suggest that AT can be considered an effective intervention for reducing depression symptoms among older adults and art therapists/psychotherapists can use this method to reduce the symptoms of depression among older adults.

Background: Preterm labor (PL) is a leading cause of perinatal morbidity and mortality. Different factors can result in preterm labor, including maternal vitamin D. Objectives: This study aimed to evaluate the level of vitamin D in pregnant women with PL. Methods: This case-control study was conducted on 156 pregnant women (52 cases with PL and 104 controls without PL) in Ali Ibn Abitaleb Hospital, Zahedan, Iran, in 2018. Results: The age was 30.92 ± 5.21 and 29.39 ± 4.86 years in the case and control groups, respectively. There were no significant (P-value > 0.05) differences between the two groups in baseline variables. Vitamin D supplement consumption (P-value = 0.128), sun exposure time (P-value = 0.304), history of admission in pregnancy (P-value = 0.608), and history of vaginal infection (P-value = 0.100) were not significantly different between the two groups. The mean vitamin D level was 30.88 and 31.93 ng/mL in pregnant women with and without PL, respectively, with no significant difference (P-value = 0.591). The mean babies' weight was significantly (P-value > 0.001) higher in the control group than in PL women (3338.75 ± 466.16 vs. 2655.76 ± 393.36 g). Conclusions: Although this study showed no association between vitamin D levels and PL, abnormal vitamin D levels might be related to PL in pregnant women with other comorbidities or risk factors.

Background: Physicians, as the leading decision-makers of the health system, are affected by various clinical statuses. Objectives: This study aimed to compare the clinical skills of medical students as future physicians with the educational standards of Zahedan University of Medical Sciences in 2020 - 2021. Methods: This study was performed on 107 medical students (53 stagers and 54 interns). After obtaining students' consent and recording their demographic and academic information, clinical skills were assessed using the Clinical Medical Skills Questionnaire. The obtained data were analyzed using SPSS software Ver. 20. Results: The least trained skills in the surgical department were suprapubic puncture and thoracotomy with a needle in compressive pneumothorax. In the pediatric ward, no clinical skill training was in good condition, and only practical measures to monitor growth and development were adequately trained. In the internal ward, the least training skill was related to lumbar puncture and aspiration of knee joint fluid. In the gynecology ward, abortion evacuation with pairs of forceps in cases of life-threatening bleeding and postpartum hemorrhage were considered the least instructed clinical skills. Finally, in the emergency ward, nasal bleeding catheter, suprapubic sampling, and cricothyrotomy were the least instructed clinical skill. Conclusions: The results showed a low number of encounters of medical students with the minimum expected clinical skills in the investigated medical school, indicating the poor quality of clinical training. The medical programs should be modified so that learners can be equipped with “the must learn” clinical skills.

This study aimed to investigate the effect of maternal smoking during pregnancy (MSDP) on the risk of bone fractures in the offspring through a systematic review and meta-analysis. The PubMed, Web of Science, and Scopus databases were systematically searched for relevant articles published through July 2019. According to heterogeneity, the pooled risk ratio (RR) and odds ratio (OR) and their corresponding 95% confidence interval (CI) were obtained using fixed or random effects models. The heterogeneity and quality of the included studies were assessed by the I-squared (I2 ) statistic and the NewcastleOttawa scale, respectively. Sensitivity analyses were performed to test the effect of MSDP misclassification on the results. The review of 842 search records yielded 5 studies including 8,746 mother-child pairs that were included in the meta-analysis. Pooling adjusted effect measures showed that MSDP was not associated with a later risk of bone fractures in the offspring (pooled RR, 1.15; 95% CI, 0.84–1.58; I2 =66.8%; P=0.049). After the adjustment for misclassification, MSDP may be associated with a 27% increased risk of bone fracture (pooled OR, 1.27; 95% CI, 1.00–1.62; I2 =0%; P=0.537). After the adjustment for misclassification, MSDP is associated with an increased risk of bone fractures among children whose mothers smoked during pregnancy.

Background: Psychological problems are common among drug users. However, a few studies have investigated the role of psychological factors, including depression, anxiety, and childhood trauma, on sexual dysfunction in MMT patients. Objectives: This study aimed to determine the prevalence of sexual dysfunction and the role of psychological factors, including anxiety, depression, and childhood trauma, on the sexual function of patients on MMT. Patients and Methods: In this cross-sectional study, 100 MMT patients were selected by convenience sampling among patients referring to Baharan Psychiatric Hospital, Zahedan, Iran. All participants completed self-report questionnaires, including the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Childhood Trauma Questionnaire (CTQ), and International Index of Erectile Function (IIEF-15). Statistical analysis was done with Pearson correlation coefficients, and stepwise linear regression models determined the predictors of sexual function. Results: Seventeen percent of participants reported various degrees of sexual dysfunction. Child sexual abuse and depression were significant predictors of sexual dysfunction. The regression analysis showed that 12% of the variance of sexual dysfunction (R2 = 0.12; F = 6.61; P < 0.002) was predicted by an experience of childhood sexual abuse and depression. Conclusions: People on MMT suffer from psychological problems as the risk factors for sexual dysfunction. Thus, mental health care staff should consider psychological factors to prevent and treat sexual dysfunction.

Background and aims: Cutaneous leishmaniasis (CL) is one of the most important parasitic diseases in the world. Sabzevar city is endemic area for CL in the north east of Iran. The aim of this study was to evaluate the time distribution of cutaneous leishmaniasis (CL) in Sabzevar County using the segmented regression model. Methods: This ecological study used the existing data related to the rural districts of Sabzevar County that were obtained from the Health Deputy of this county during 2011-2017. In addition, the segmented regression model was applied to evaluate the time trend of CLs. Finally, Joinpoint software was used for time series analysis. Results: A total of 1912 CL cases occurred in Sabzevar County from 2011 to 2017, with an incidence rate of 93.61 per 100000. The highest and lowest observed incidence rates were in 2011 (25 per 10000 persons) and 2015 (3.24 per 10000 persons), respectively. Based on the results, the annual incidence of CL in the intended region decreased and the annual percent change was equal to -22.40. Further, the time series analysis using segmented regression by rural districts showed a change point in the trend of the incidence of leishmaniasis in three rural districts (Pain Joveyn and Joghatai in 2014 and Qasabeh-ye Sharqi in 2013). In other words, the trend was different before and after the change point in the mentioned districts. Conclusion: In general, the results indicated that interventional, preventive, and therapeutic measures for breaking the chain of CL transmission in Sabzevar have been desirable in recent years. Eventually, it is suggested that further time-series studies be conducted at the level of the month or a longer interval in order to better evaluate the period effect and secular trend.

Objective To determine the maternal risk factors associated with preterm delivery in Iran. Methods A population-based case-control study was conducted including 48 women having preterm delivery (case group) and 100 women having term delivery (control group) between March 2007 and March 2012 in the maternity hospitals of the Selseleh County, Lorestan province, Iran. Information regarding maternal risk factors was collected by structured interview and reviewing the medical records. The maternal risk factors associated with preterm delivery were identified using univariate and multivariable logistic regression analysis after adjusting the sparse data bias. The area under the receiver operating characteristic (ROC) curves was estimated to evaluate the discrimination power of the statistical models. Results Multivariable analysis demonstrated that multiparty (odds ratio [OR], 14.23; 95% confidence interval [CI], 1.60–127.05), history of gestational diabetes (OR, 0.10; 95% CI, 0.01–0.99), thyroid dysfunction (OR, 97.32; 95% CI, 5.78–1,637.80), urinary tract infection (OR, 16.60; 95% CI, 3.20–85.92), and taking care during pregnancy (OR, 0.12; 95% CI, 0.03–0.50) had significant impact on preterm delivery after adjusting the potential confounders. The area under the ROC curve for the aforementioned maternal risk factors was 0.86 (95% CI, 0.80–0.92). Conclusion Our study provides evidence for the associations between multiparty, history of gestational diabetes, thyroid dysfunction, urinary tract infection, as well as taking care during pregnancy, and preterm delivery.

Background: Previous studies have been showed an association between previous abortion history and risk of Autism spectrum disorders (ASD). However, there is still controversy about true effect estimate of the association.Purpose: This meta-analysis aimed to evaluate the association between previous abortion history and the risk of ASD.Methods: A systematic search was performed using PubMed, Scopus, and Web of Sciences databases to identify potential studies published until December 2021. The presence of statistical heterogeneity was determined using the I2 value. In the case of substantial heterogeneity, the random-effects model meta-analysis was used to estimate the pooled relative risks. The publication bias was assessed using the Egger and Begg tests.Results: Thirteen studies with a total of 331,779 children remained in the present meta-analysis. The estimated odds ratio of the risk of ASD associated with previous abortion history was 1.64 (95% confidence interval [CI], 1.28–2.0; I2=61.7%) in adjusted studies and 1.10 (95% CI, 1.01–1.20; I2=0.0%) in crude studies, based on the random effect model. There was moderate heterogeneity in adjusted studies. The p values for Egger and Begg regression among children with ASD were 0.393 and 0.056, respectively.Conclusion: This meta-analysis suggests that children born from mothers with a history of previous abortion have an increased risk of development of ASD compared to children of mothers without a history of previous abortion.

Background: Recognizing the factors affecting maternal death can lead to the adoption of strategies to prevent similar deaths. Objectives: This study was performed to investigate the prevalence and causes of pregnant mothers' death in the population covered by Zahedan University of Medical Sciences. Methods: In this retrospective, descriptive, cross-sectional study, the files of 126 pregnant mothers who died during 2013 - 2017 were evaluated. Demographic and obstetrics information and variables related to maternal mortality, such as maternal mortality ratio (MMR), the cause of mother’s death, the time of mother’s death, and place of death, were evaluated in general and separately in each city (i.e., Zahedan, Khash, Saravan, and Chabahar) based on descriptive statistics and according to the nature of the variables. Results: Maternal mortality ratio in Zahedan was 174.96 per 100,000 case, in Khash 190.56 per 100,000 cases, in Saravan 371.87 per 100,000 cases, and in Chabahar 384.03 per 100,000 cases. Bleeding was the most common cause of death (42.53%), 61.9% of pregnant women were living in rural areas, 80.2% died in the third trimester of pregnancy, and 42.9% died in first 24 hours after delivery. The most common underlying disease was hypertension, 70.6% of mothers died in hospitals, and 47.6% were illiterate. The most common cause of maternal death in Zahedan was cardiac disease, in Khash it was hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, eclampsia, and preeclampsia, and in Saravan and Chabahar the leading cause was bleeding. Conclusions: Maternal mortality ratio was high in Sistan and Baluchestan. The investigation of the causes of maternal deaths showed that some of these deaths are avoidable. It is also necessary to improve midwifery emergencies management with intensive monthly courses to increase team capabilities for making the best use of golden time measures.

We evaluated in this umbrella review a systematic collection from meta-analyses conducted on risk factors associated with placenta previa. We searched PubMed, Scopus, and Web of Science until April 2021 assessing the risk factors associated with placenta previa. We calculated summary effect estimates odds ratio, relative risk, 95% CI, heterogeneity I2, 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with AMSTAR 2. We included nine studies in the present umbrella review. Seven risk factors including prior induced abortion (OR 1·36, 95% CI: 1·02, 1·69), prior spontaneous abortion (OR 1·77, 95% CI: 1·60, 1·94), male fetus (OR 1·2, 95% CI: 1·2, 1·3), smoking (OR 1·42, 95% CI 1·30, 1·54) (RR 1·27, 95% CI: 1·18, 1·35) advanced maternal age (OR 3·16, 95% CI: 2·79, 3·57), cesarean (OR 1·60, 95% CI: 1·44, 1·76) and ART (singleton pregnancy) (RR 3·71, 95% CI: 2·67, 5·16) were graded as highly suggestive evidence (class III). Endometriosis (OR 3·03, 95% CI: 1·50, 6·13) and maternal cocaine use (OR 2·9, 95% CI: 1·9, 4·3) were graded as risk factors with weak evidence (class IV). This study provides suggestive evidence about prior spontaneous abortion, prior induced abortion, male fetus, smoking, advanced maternal age, cesarean section, and assisted reproductive techniques (singleton pregnancy) as risk factors associated with placenta previa.

Co-infection with hepatitis B and C among HIV infected patients are prevalent among high-risk populations. This meta-analysis aimed to estimate the prevalence of HIV, HCV and HBV co-infections among high-risk populations in Iran. We systematically searched the national and international electronic databases until 2016. The primary outcome was the prevalence of HIV, HBV, HCV and HIV co-infections in different high-risk populations in Iran. All English and Persian studies conducted on Iranian high-risk groups were included in the study. The review was reported based on PRISMA guidelines and data were analysed at 95% confidence level using random effect models. Overall, 916 relevant papers were recognised and 14 articles were included in the meta-analysis. The pooled estimates of HBV/HCV, HCV/HIV, HBV/HIV and HBV/HCV/HIV were 1.3% (95%CI: 0.5–2.1), 16.3% (95%CI: 1.1–31.6), 0.5% (95%CI: 0–1.4) and 0.5% (95%CI: 0.2–0.8), respectively. Based on subgroup analysis, there was a higher proportion of all co-infections from the years 2010–2016 as compared to that of the years 2003–2009. Our results highlighted that HCV/HIV co-infection in Iranian high-risk groups including injection drug users (IDUs) and prisoners is common. In addition, the increasing trend of coinfections should be considered alarming for policymakers.

Background Investigations about the impact and consequences of the COVID-19 infection on the mental health of patients with chronic diseases and those with immunosuppressive conditions are growing. The current study aimed to systematically review and meta-analysis of studies that evaluated the level of depression and anxiety in cancer patients during the COVID-19 pandemic. Methods The PubMed, Scopus and Web of Sciences databases were searched to retrieve potential studies from January 2020 to 3 January 2021. Summary data on frequency and mean of depression and anxiety were extracted. Random-effect meta-analysis was conducted to estimate overall prevalence, mean and standardized mean difference. Results Thirty-four studies were included in the systematic review, of them 21 studies included in meta-analysis. Overall depression and anxiety were 0.37 (0.27, 0.47); I2 = 99.05%, P value

Background and aim: The association between maternal infection during pregnancy and the risk of cerebral palsy has been previously reported. However, their results were relatively inconsistent. This systematic review and meta-analysis were carried out to investigate the association between maternal infection during pregnancy and the risk of cerebral palsy in children. Methods: PubMed, Scopus, and Web of Sciences databases were searched from inception to October 28, 2019. Heterogeneity was assessed using the I2 value. In case of substantial heterogeneity (I2 > 50%), a random effects model was applied, otherwise, a fixed effects model was used. The pooled associations were expressed as relative risks (RRs) and 95% confidence intervals (CIs). Publication bias and quality of studies included in the systematic review were checked using the Egger’s regression test and Newcastle-Ottawa Scale (NOS), respectively. Results: Thirty-seven studies were included in the systematic review. Among them, 21 studies were eligible for the meta-analysis. The pooled RR of cerebral palsy risk was 2.50 (95% CI 1.94, 3.21; I2 = 88.7%, P < .001) among children born to mothers who had any infection during pregnancy. The risk was increased to 2.85 (95% CI 1.96, 4.15; I2 = 75.9%, P < .001) when the mother was diagnosed with chorioamnionitis. Publication bias tests suggested no evidence of potential publication bias and 76% of the studies included in the meta-analysis were of high quality (NOS ≥ 6). Conclusion: This systematic review and meta-analysis provides evidence that maternal infection during pregnancy may be associated with an increased risk of cerebral palsy in children.

Intravesical BCG (Bacillus Calmette-Guérin) therapy is indicated as an effective treatment for patients with non-muscle-invasive bladder cancer, despite associate with the side effects. In this study, the incidence of BCG therapy adverse effects was compared among three groups of patients who received celecoxib, phenazopyridine, and oxybutynin with placebo.The randomized controlled clinical trial was conducted on four groups using the parallel group method. A checklist is used for weekly assessment of urinary symptoms, systemic symptoms of BCG therapy, and adverse drug reactions.The study included 120 patients, 10 female and 110 male. The mean age 59.65 ± 6.2 years. The results of multivariate analysis show that there is a significant decrease in urinary frequency for patients who received phenazopyridine (95% CI: 0.09, 0.31, OR = 0.17, P .001) and also celecoxib group (95% CI: 0.10, 0.43, OR = 0.21, P .001) compared to those in placebo group. Patients in celecoxib group (95% CI: 0.02, 0.07 ,OR = 0.04, P .001), phenazopyridine (95% CI : 0.07, 0.37,OR=0.16, P .001) and oxybutynin (95% CI: 0.02, 0.12,OR = 0.05, P .001) were less likely to have urgency than those in placebo. Moreover, significant decrease was found for dysuria in the three treatment groups in comparison with placebo group.According to the results, celecoxib, phenazopyridine and oxybutynin can effectively decrease the side effects of BCG immunotherapy compared to placebo. Among these three treatments, the most effective and safest treatment option is celecoxib.

Background: The relationship between gestational diabetes and postpartum depression (PPD) is poorly understood and seldom studied. Objective: In an effort to explore this issue, the present study investigated the relationship between gestational diabetes and PPD. Methods: The present cross-sectional study was performed with 342 women who were referred to four urban health centers of Hamadan city, west of Iran. We used convenience sampling as a method to recruit women in each health center. We used a researcher-made checklist for gathering data on socio-demographic characteristics and potential risk factors of PPD. The Persian validated version of the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Univariate and multivariable binary logistic regression was applied to estimate the odds ratio (OR) (95% confidence interval [CI]). Results: Gestational diabetes was identified as the most important risk factor for PPD with OR (95% CI) of 2.19 (1.11, 4.31); P-value=0.02 after adjusting for other variables. Moreover, the adjusted odds ratio showed that PPD among lesseducated women (primary school) was 3.5 times higher compared to women with a university education (OR=3.54, 95% CI: 1.27, 9.84; P-value=0.01). Conclusion: Our findings suggested that PPD is more likely among women with gestational diabetes and those who were less educated. Interventional and educational activities for reducing the risk of PPD can be targeted for use with this population.

Current studies have controversial reports about the effect of maternal smoking during pregnancy (MSDP) on the risk of psychiatric disorders among offspring. The purpose of this systematic review and meta-analysis was to assess the effect of MSDP on the risk of Tourette syndrome (TS) and chronic tic disorders (CTD) among offspring. A systematic search using PubMed, Scopus, and Web of Science was conducted up to July 2019 to retrieve potential studies in English. Fixed and random-effects meta-analyses was performed to estimate pooled relative risk (RR) with 95% confidence interval (CI) according to heterogeneity. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Heterogeneity among studies was explored using the I2 statistic. Of the 641 studies from the initial search, 7 were included in the quantitative synthesis (3 cohort and 4 case control studies). Overall, MSDP increased the risk of TS and CTD among the offspring by 35% (pooled RR, 1.35; 95% CI, 1.17-1.56; I2 =45.8%; P-value=0.08). The results of this meta-analysis revealed that there is a significant association between MSDP and the risk of TS and CTD in offspring, and MSDP may be considered a potential risk factor for TS and CTD.

Objective: Effective rehabilitation and better quality of life among stroke patients are functions of several factors such as quality and pattern of sleep. The present study aimed to evaluate sleep quality and related determinants in such patients. Method: The present cross-sectional study was performed from October to December 2019 among stroke patients who were admitted to Sina Hospital, Hamadan, Iran. We used the Pittsburgh Sleep Quality Index (PSQI) questionnaire to determine sleep quality in these patients. Significant determinants of the global score of PSQI were identified via multivariable linear regression. Results: A total of 97 stroke patients (age 67±79 years, 55.7% male) were enrolled into the study. Prevalence of poor sleep was 0.84 (95% CI: 0.75, 0.91) in stroke patients. Patients with nervous tension and those with surgical treatment and with Non-hemorrhagic CT scan had a predicted increase of 1.65, 2.91 and 3.25 in the mean of the global PSQI score (P ≤ 0.05), respectively. Conclusion: Nervous tension, treatment method, results of CT scan and cardiac problems may be associated with post-stroke sleep disorder.

To perform a meta-analysis on the global prevalence of metabolic syndrome (MetS) in postmenopausal women. The meta-analysis also sought to measure the relationship menopause status has with MetS and its components.The Web of Science, Medline, PubMed, Scopus, Embase, CINAHL, DOAJ, and Google Scholar were all searched using the relevant keywords. Articles published during the period 2004 to 2017 that met our inclusion criteria and reported the prevalence of MetS among premenopausal and postmenopausal women were included. In the presence of heterogeneity, random-effects models were used to pool the prevalence and odds ratios (ORs), as measures of association in cross-sectional and comparative cross-sectional studies, respectively.The prevalence of MetS among postmenopausal women (119 studies [n = 95,115]) and the OR comparing the prevalence of MetS among postmenopausal and premenopausal women (23 studies [n = 66,801]) were pooled separately. The pooled prevalence of MetS among postmenopausal women was found to be 37.17% (95% confidence interval [CI] 35.00%-39.31%), but varied from 13.60% (95% CI 13.55%-13.64%) to 46.00% (95% CI 1.90%-90.09%), depending upon the diagnostic criteria used. The overall pooled OR for MetS in postmenopausal women, compared with premenopausal women, was OR 3.54 (95% CI 2.92-4.30), but this ranged from OR 2.74 (95% CI 1.32-5.66) to OR 5.03 (95% CI 2.25-11.22), depending upon the criteria used. Furthermore, the odds of high fasting blood sugar (OR 3.51, 95% CI 2.11-5.83), low high-density lipoprotein cholesterol (OR 1.45, 95% CI 1.03-2.03), high blood pressure (OR 3.95, 95% CI 2.01-7.78), high triglycerides (OR 3.2, 95% CI 2.37-4.31), and high waist circumference (OR 2.75, 95% CI 1.80-4.21) were all found to be higher in postmenopausal women than in premenopausal women.The prevalence of MetS is relatively high in postmenopausal women and was more prevalent among postmenopausal than premenopausal women. Menopausal hormone therapy should be used with caution in patients with MetS, as its safety has not yet been evaluated among MetS patients and meticulous evaluation of each individual patient before starting MHT is needed.

Objectives Determination of the true burden of hepatitis C virus (HCV) infection among high-risk groups relies heavily on occurrence measures such as prevalence, which are vital for implementation of preventive action plans. Nevertheless, up-to-date data on the prevalence of HCV infection remain scarce in Iran. This study aimed to review the relevant literature systematically and determine the pooled prevalence of HCV infection among high-risk groups in Iran. Study design Systematic review & meta-analysis. Methods In 2016, electronic scientific databases including PubMed, Scopus, Web of Science and local databases were searched using a detailed search strategy with language restricted to English and Farsi. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. Results In total, 1817 records were identified in the initial search, and 46 records were included in the meta-analysis. The overall prevalence of HCV among high-risk groups was 32.3%. The prevalence was 41.3% in injection drug users (IDUs), 22.9% in prisoners, 16.2% in drug-dependent individuals and 24.6% in drug-dependent prisoners. Subgroup and meta-regression analyses revealed that geographical location and year of publication were the probable sources of heterogeneity. Conclusion This meta-analysis found a high prevalence of HCV among high-risk groups in Iran, particularly among IDUs. There is a need for prevention strategies to reduce the burden of HCV infection among high-risk groups, particularly IDUs.

Little is known about the social determinants of health (SDH) of taking the prenatal diagnosis (PND) test as a pivotal strategy to prevent occurrences of β-thalasssemia major (β-TM). This study sought to evaluate the relationship between socio-demographic characteristics of parents and taking the PND test at Zahedan, Iran from 2015 to 2016. The design of the present study was a case-control. Data on socio-demographic characteristics of parents including age, education, job, ethnicity, and family relationships, kind of marriage as well as pre marriage test status and PND test status, were obtained from registered medical records. The relationship between socio-demographic characteristics and taking the PND test was evaluated using binary logistic regression. The study included 256 β-thalassemia (β-thal) carrier couples who were referred to the Zahedan Prenatal Diagnosis Center to take the PND test and 47 β-thal carrier couples who already had a newborn with β-TM and had not taken the PND test. Univariate analysis showed that the higher education level of the father, consanguineous parents, official marriages, pre marriage test and consultation, significantly increased the odds of taking the PND test. The significant relationships were not observed in multivariable analysis, however, pre marriage tests and official marriages can be considered as determinants of taking the PND test with odds ratio (OR) [95% confidence interval (95% CI)] of 14.67 (0.64, 334.93) and 3.41 (0.55, 20.94), respectively. Our results provided evidence in which socio-demographic characteristics of the parents may determine their taking the PND test.

Introduction: The objectives of this study were to provide an estimate of the prevalence of metabolic syndrome (MetS) and its components among women with PCOS; and calculate the odds ratio (OR) for MetS (using different definitions of MetS) in women with PCOS, compared to healthy controls. Methods: All of the relevant databases were used to search for appropriate articles that were published during the period 2003-2016. We included observational studies (cross-sectional, comparative cross-sectional) among women who met the inclusion criteria. The random-effect models were used to pool the prevalence of MetS and its components among PCOS women. This model was also applied to the pooled OR assessing the association between MetS and PCOS. Results: The pooled prevalence of MetS among PCOS women was found to be 26.30% (95% CI: 23.68–28.93), but varied from 7.10% (95% CI: 1.64-12.56) to 37.50% (95% CI: 28.84-46.16), depending upon the diagnostic criteria used. Low high-density lipoprotein cholesterol (HDL) - 61.87% (95% CI: 53.31–70.43) and high waist circumference (WC)- 52.23% (95% CI: 43.84–60.61) were the most common components of MetS in PCOS women. Compared to healthy controls, the overall pooled (OR) of MetS in PCOS patients was 2.09 (95% CI: 1.67-2.60), but this ranged from 0.31 (95% CI: 0.13-0.74) to 4.69 (95% CI: 2.09-10.52), depending upon the diagnostic criteria used. Conclusion: Women with PCOS had a much higher prevalence of MetS than was found among the healthy controls. Furthermore, as low HDL and high WC were the most common components of MetS in PCOS women, these two components specifically need to be addressed in prevention strategies.

Background: Regarding the geographical variations of the disease and recent changes of ecosystems, this study aimed to investigate the geographic patterns and trends of human brucellosis in Hamadan province, west of Iran. Methods: This is a cross-sectional study on brucellosis cases recorded by provincial authorities of brucellosis national surveillance system at Hamadan University of Medical Sciences from March 2009 to March 2015. Cochran–Armitage test and Poisson regression models were used to obtain standardised rates for the disease. Results: Of all 9318 recorded cases, 62.83% were female and 81% were rural residents. The observed number of cases exceeded expected in almost all of the cities, except for Hamadan, Bahar and Asadabad. Conclusion: The clusters of disease occurrence were more evident in areas of the province with better agriculture coverage. This finding provides more in-depth clues to detect special transmission routes and would help mobilise educational and preventive measures for specific occupational groups.

SUMMARYDiagnosis of latent tuberculosis infection (LTBI) is a concern in haemodialysis (HD) patients. Many studies have compared QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for detecting LTBI and reported theκstatistic of agreement between QFT-GIT and TST in HD patients. The present study aimed to systematically review this literature and conduct meta-analysis of individual studies that estimated theκbetween QFT-GIT with TST among HD patients. All relevant published studies that were available as full-text were obtained by searching Medline (1950), Web of Sciences (1945), Scopus (1973) through May 2016. Theκwas re-estimated from the individual studies and pooled using random effect meta-analysis. Subgroup analysis and meta-regression were applied to evaluate the effect of Bacillus Calmette–Guérin (BCG) vaccination, TST cut-off points, quality of studies, sample size and age on variation ofκestimate. Eight studies involving 901 HD patients were included in meta-analysis. The pooledκestimate was 0·28 (I2= 18·4%,P= 0·239, 95% confidence intervals 0·22–0·34). The discordance of TST−/QFT-GIT+ was more than TST+/QFT-GIT−. History of BCG vaccination, TST cut-off points and age are related to variation ofκestimates. TST and QFT-GIT are not comparable in detecting LTBI in HD patients. The higher TST−/QFT-GIT+ ratio compared with TST+/QFT-GIT− ratio, may indicate the superiority of QFT-GIT over TST for detection LTBI in HD patients.

Background: Congenital hypothyroidism (CH) is the most common endocrine diseases and one of the major causes of preventable mental retardation. This study was conducted to investigate the prevalence of transient and permanent congenital hypothyroidism in Kurdistan province, Iran.Materials and Methods: In this cross-sectional study, all registered congenital hypothyroidism neonate of health centers of cities covered by Kurdistan University of Medical Sciences during 2006 to 2014 entered to study. Demographic and laboratory information of CH neonates was collected and entered into the Stata-12 and was analyzed using student t-test and Chi-square statistic and P- value less than 0.05 was considered.Results: Overall incidence rate during 2006 to 2014 for province was 1.8, 2.3, 3.2, 4.3, 3.3, 4.0, 3.6, 4.6 and 2.7, respectively per 1000 neonates in this period. The number of diagnosed patients was 855 cases including 519 (60.7%) boys and 336 (39.3%) girls who 516 (60.4%) cases were from urban areas. Of the total patients, 202 (22.6%) were permanent. There was no significant difference between gender, location, type of childbirth, and season of birth with transient and permanent types of disease (P˃0.05); while, there was a significant statistical relationship between consanguineous marriages and congenital hypothyroidism (P

Background: Tuberculosis (TB) despite being preventive and treatable still imposes a huge burden of morbidity and mortality in developing and developed countries. We aimed to investigate the spatial and geographical distribution of TB in Hamadan province during 1992–2013. Materials and Methods: This cross-sectional study was performed in Hamadan province, West of Iran using the surveillance database. We examined the trend for incidence rates of all TB forms including Smear Positive Pulmonary TB (SPPT), Smear Negative Pulmonary TB (SNPT) and Extra pulmonary TB (EPT) per 100,000 populations. Poisson regression model was used to estimate the standardized rates for incidence rate of all types of TB per each county. Results: In this study 3,602 TB patients including 1,359 SPPT, 987 SNPT, and 1,256 EPT were included during 1992–2013. Trend of all types of TB decreased from 1992 to 2013. The Average Annual Percent change (AAPC) for all types of TB was significantly (P

Introduction Identifying factors that delay diagnosis of tuberculosis (TB) are important for the health system when timely patient treatment and reducing TB transmission are desirable goals. Aim of this study was to investigate the prognostic factors that delay TB diagnosis. Material and methods This retrospective cohort study used National TB Program (NTP) data from 1056 TB patients during 2006–2014 in Hamadan province, western Iran. The Cox regression model was performed to determine associations between baseline explanatory variables and survival outcome with Hazard Ratio HRs (95% CIs). Results N (%) of delay in TB diagnosis more than 90 days was significantly higher in male patients, new case patients and pulmonary positive cases. After adjustment for covariates, HR (95% CI) in relapsed TB compared to new cases was 0.67 (0.53, 0.85) and these figures for positive pulmonary cases and extra pulmonary cases in compared to negative pulmonary cases were 0.80 (0.68, 0.94) and 0.84 (0.73, 0.98) respectively. Conclusion A high proportion of patients had delays in diagnosis exceeding three months. Our findings suggest that male gender, new cases, positive and extra pulmonary cases might increase the risk for delayeddiagnosis among TB patients.

Background: Self-medication by people is one of the major issues in the world that can be lead to numerous medical and economic problems, this especially issue in children under 2 years who are at the age of growth and development have great importance. The aim of this study was investigate the effects of model-based educational interventions on self-medication behavior in mothers with children under 2 years of age who referred to the health centers of Firoozkooh city (Iran). Materials and Methods: This study was quasi - experimental interventional study. The study population consisted of mothers with children under 2 years old referring to health centers of the Firoozkooh city, Iran. The data collection tool was researcher made questionnaire which its validity and reliability was assessed than was used. The required information was collected before and after the educational intervention. Then 4 months after the educational intervention, evaluation was done and data analysis was using SPSS-20. Results: Significant difference was not found between mean scores of knowledge, perceived sensitivity, severity, benefits, barriers, self-efficacy with performance (self-medication) before the educational intervention (P>0.05). But after the educational intervention, statistically significant difference was found between mean scores of knowledge, perceived sensitivity, severity, benefits, barriers, and self-efficacy with performance (P