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Background: Diabetes is a chronic disease that leads to numerous complications. To prevent these complications, regular and timely visits of diabetic patients to receive health care services are necessary. Objectives: This study aimed to understand the experience of diabetic patients visiting rural health in Ahvaz. Methods: This qualitative study is a directed content analysis research that was conducted for six months in 2016 - 2017 in rural health centers in Ahvaz. A semi-structured verbal interview was conducted with 14 diabetic patients, 6 health care workers (behvarz), 3 physicians, and 3 family members of patients. The collected data was analyzed by MAXQDA 12 software with the content analysis method. Results: Data analysis resulted in the extraction of 285 initial codes that were categorized into 5 categories of health belief models (perceived threats, perceived benefits, perceived berries, guide to action, and self-efficacy). Conclusions: Findings of this study provide in-depth understanding o factors affecting rural health centers appointments among patients with type 2 diabetes and also can use by decision-makers to choose the most suitable methods and strategies to change these factors and increase the number of regular visits by patients to the health centers to prevent probable complications.

Introduction: Adrenal insufficiency is one of the most important life-threatening disorders with serious complications. Establishing a standard data element can provide earlier diagnosis, timely treatment, and follow-up to reduce disease crisis. Objectives: This study aimed to draft a data set for the registry of patients with adrenal insufficiency. Patients and Methods: The present cross-sectional study developed data elements for the registry of patients with adrenal insufficiency using a two-round Delphi technique of 2015. The informational elements selected by more than 75% of participants with a value of "very high" and "high" were accepted as the main elements. Results: The final data set included four main groups, 15 subclass and 114 data elements for the registry of patients with adrenal insufficiency. Our results have demonstrated that the primary data groups include administrative data; signs, symptoms, medical and family history data elements; paraclinical diagnostic data, treatment, and follow-up data to improve patient management. Conclusion: This study designed data set registry forms for patients with adrenal insufficiency using a standard method. Our finding indicated that, applying a uniform data set can provide better data management, patient care, and prevention of disease complications, especially in adrenal insufficiency disorder.

Despite the increasing prevalence of gestational diabetes mellitus and well-known long-term metabolic consequences, a low rate of postpartum screening in this population is reported. Few studies focused on environmental factors of attending and performing blood glucose screening tests in women with gestational diabetes. This work aimed to assess the proportion of uptake of postpartum follow-up after the first recall and to study the adherence-related factors in women with gestational diabetes. All women with gestational diabetes were recalled for postpartum screening in a tertiary care center as the center of the cohort study in 2016. The postal addresses were geocoded, and precise spatial (x, y) was provided for each mother's home location. SPSS and GIS were used for data analysis. The incidence rate of gestational diabetes was 8.5% (826/9630). Of women with gestational diabetes, 21.3% accepted to return and completed postpartum screening tests in the first recall. The distance from the cohort center, history of diabetes in the family, and a number of pregnancies were significant predictors for return to follow-up using binary logistic regression (P < 0.01). The first 25% of patients had a distance of 2346 m from the cohort center, and all of the mothers referred to the hospital were 0 to 5 km away, i.e., those who did not return were more than 5 km away (95% confidence interval). Overall screening uptake rate was low. Distance from the center of the screening was an essential factor in deciding to return and adhere to postpartum care in women with gestational diabetes. Geographic inequalities must be considered as a risk factor of visiting the healthcare center in addition to individual contributors. A more accessible center may improve the postpartum follow-up rate in women with a history of gestational diabetes.

Aims Child growth is one of the important health indicators in pediatric care. Few studies focused on the impact of prenatal exposure to gestational diabetes mellitus (GDM) on growth trajectories particular in early years of childhood. The aim of this study was identifying growth pattern of GDM exposed offspring's, comparison with new WHO child growth standards. Methods and materials In a population-based Longitudinal study 438 infants exposed to gestational diabetes in utero, aged 0–24 months, born between 2014 and 2016 with at least 9 visits in first 2 years of life were enrolled. Twenty health centers of Ahvaz city (Capital of Khuzestan province, located in south western of Iran) and two referral centers for neonatal hypothyroidism involved the study. Results Of 438 GDM exposed infants, 54.6% were boys. Incidence of low birth weight and macrosomia were 4.6% and 8.7% respectively. Results 4.6% had birth weight less than 2500gr and 8.7% was rate of macrosomia. Boys had higher weight and BMI than girls. Peak of BMI was 17.8 (±2.07) at 6 months after Gender was significant factor in predicted of BMI growth trajectories in GDM exposed children (p = 0.001). BMI in GDM exposed infants, in first 2 years of life was higher than WHO growth standards 2006 (P Conclusion Medians of BMI in GDM exposed infants in all measures was higher than WHO reference data 2006 (P

Aims This study aimed to investigate the relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes. Methods This descriptive-analytical study was conducted using the merging data from two prospective cohort studies that were carried out from 2015 to 2018 in Ahvaz, southwest of Iran. Logistic regression and ROC curves were used to evaluate the predictive power of risk factors. Results Of all 1270 pregnant women studied, 454 (35.75%) had gestational diabetes who were compared with the other 816 (64.25%) healthy women. The area under the curve (AUC) of fasting glucose for the first pregnancy visit was 0.80 (95% CI: 0.76–83), and the optimum fasting glucose cut-off point was 85.5 mg/dL with a sensitivity of 71% and a specificity of 69%. AUC of the combination of fasting glucose at the first visit with body mass index ≥25 kg/m2 and family history of diabetes was calculated to be 0.85 (CI, 0.82–0.88) and 0.84 (CI, 0.79–0.89) respectively. Conclusion Fasting plasma glucose in the first trimester of pregnancy is a relatively good predictor of gestational diabetes. If this factor is combined with other risks, its diagnostic value will increase.

Background and aims Gestational diabetes has serious short and long-term consequences for both mother and child. Designing a standard data set and implementing a recall registry system provides opportunities for early interventions in women with a history of gestational diabetes. The present study aims to draft a data set for the gestational diabetes recall registry and its establishment in urban health centers. Methods To design a data set for gestational diabetes postpartum recall registry a qualitative study has been done from April to June of 2019. In this stage, Information need assessment, Identification of data elements, development of registry software, and field-testing were done. Web-based software was designed in NET language and using a Visual Studio programming environment. Implementation of the postpartum recall registry was started in 6 health centers of Ahvaz city from August 2019. Results During six months 163 women with gestational diabetes in current pregnancy were registered. The final data set for the postpartum recall registry included six main groups, 23 subclasses, and 188 data elements. Mandatory data were included 115 elements. Conclusion A data set was finalized using a standard method and implemented in urban health centers for six months. Implementing a postpartum registry with standard elements can help manage data and plan for future interventions to reduce modifiable risk factors in this population.

Background and aims New clinical approaches are needed to minimize complications of gestational diabetes during the COVID-19 outbreak with timely screening and proper management. The present study aims to highlight changes in the clinical guideline for gestational diabetes during the pandemic. Methods In a narrative review, multiple databases were searched. Furthermore, online searches were conducted to identify guidelines or support documents provided by NGOs, local health authorities, and societies and organizations in the field of diabetes and obstetrics. Results We included five national guidelines that were published in English from Canada, the United Kingdom, Australia, New Zealand, and Australia health agencies. FBG, A1C, RPG were recommended as alternative tests instead of a 2-h oral glucose tolerance test (OGGT) for GDM screening at 24–28 weeks of gestation. Recommendations also included a deferral of postpartum screening till the end of the pandemic, or postponement of testing to 6–12 months after delivery, use telemedicine and telecare. Conclusions Updated temporary changes in clinical guidelines are sensible and accommodates social distancing and minimizes risk of exposure to COVID-19. Despite many unsolved controversies in screening, treatment, and follow-up of gestational diabetes, it seems involvement with novel coronavirus have made a reach to a global agreement simpler., Highlights • There is a consensus on three critical issues in the screening and management of GDM during the COVID-19 crisis. • Replace OGGT with alternative tests (FBG, A1C, RPG) during 24–28 weeks of gestation. • Defer or delay postpartum screening and use telemedicine to discover clinical symptoms. • Compare the benefits of standard care with the risks of exposure to COVID- 19.

Background and aims Diabetes mellitus (DM) is one of the most critical risk factors for complications and death in COVID-19 patients. The present study aims to highlight challenges in the management of diabetic patients during the COVID-19 outbreak in developing countries. Methods We reviewed the literature to obtain information about diabetic care during the Covid-19 crisis. We also seek opinions of clinicians working in undeveloped countries. Results Current challenges faced by clinicians in the management of diabetic patients in developing countries are as follows: lack of preventive measures, inadequate number of visits, loss of the traditional method of communication with the patient, shortage of medications, impaired routine diabetic care, and absence of telehealth services. Conclusions Developing countries are faced with many challenges in diabetes management due to a lack of resources., Highlights • COVID-19 pandemic may be a potentially diabetogenic situation and may worsen hyperglycemia and possibly diabetes-related complications. • Challenges faced by developing countries in managing diabetes during COVID-19 outbreak is different from those in developed countries. • Strategies for better management of diabetes care during current crisis should be based on available resources.

Aims This study aimed to determine the prevalence rate of metabolic syndrome and its potential risk factors, 6–12 weeks postpartum in women with GDM compared to women with normal glucose tolerance. Methods LAGAs is an ongoing population-based prospective cohort study that started in March 2015 in Ahvaz, Iran. During 11 months of study progression, 176 women with GDM pregnancy and 86 healthy women underwent a fasting glucose test, 75-g OGTT and fasting lipid tests at 6–12 weeks postpartum. GDM was defined based on IADPSG criteria. Postpartum glucose intolerance was defined according to ADA criteria and metabolic syndrome using 2 sets of criteria. Results The overall rate of metabolic syndrome at 6–12 weeks postpartum was 16% by NCEP-ATP III criteria (18.2% in women with GDM and 11.6% in controls) and 19.1% by IDF criteria (21% in women with gestational diabetes and 15.1% in controls). Pre-pregnancy overweight or obesity, (OR 1.89, 95% CI: 1.05-3.38, P = .03), pregnancy systolic blood pressure (OR 1.03, 95% CI: 1.008–1.52, P = .006) and requiring insulin or metformin (OR 3.08, 95% CI: 1.25–7.60, P = 0.01), were associated risk factors for the presence of MetS in GDM-exposed women. In women with normal glucose during pregnancy, pre-pregnancy BMI ≥25 kg/m2 was a risk factor of metabolic syndrome (OR 2.82, 95% CI: 1.11–7.15, P = .02). Conclusion The rate of metabolic syndrome in women with or without GDM at 6–12 weeks postpartum is high particularly in women with high BMI. An early postpartum prevention and screening program for cardiovascular risk factors is important for women with GDM.

Background. A history of gestational diabetes is an important predictor of many metabolic disturbances later in life.Method. Life after gestational diabetes Ahvaz Study (LAGAs) is an ongoing population-based cohort study. Up to February 2016, 176 women with gestational diabetes underwent a 75 g oral glucose tolerance test (OGTT) at 6–12 weeks postpartum in Ahvaz (southwestern of Iran). Gestational diabetes was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and the American Diabetes Association (ADA) criteria applied for diagnosis of postpartum prediabetes and diabetes. Univariate and multivariate regression analysis were done.Results. Overall incidence of early postpartum glucose intolerance was 22.2% (95% CI, 16.3–29.0), 17.6% prediabetes (95% CI, 12.3–24.1) and 4.5% diabetes (95% CI, 2.0–8.8%). Independent risk factors for glucose intolerance were FPG ≥ 100 at the time of OGTT (OR 3.86; 95% CI; 1.60–9.32), earlier diagnosis of GDM (OR 0.92; 95% CI; 0.88–0.97), systolic blood pressure (OR 1.02; 95% CI; 1.002–1.04), and insulin or metformin therapy (OR 3.14; 95% CI; 1.20–8.21).Conclusion. Results determined a relatively high rate of glucose intolerance at 6–12 weeks after GDM pregnancy. Early postpartum screening of type 2 diabetes is needed particularly in women at high risk of type 2 diabetes.

The present study aimed at evaluating the effectiveness of an educational intervention via mobile cells on foot care knowledge and foot care practices in patients with type 2 diabetes.This is an interventional quasi-experimental study carried out in 4 community health centers in Andimeshk City in Iran in 2017. Of 160 patients 80 cases were randomly assigned as intervention group and 80 patients as the control one. A three-section questionnaire completed by a face-to-face interviewing used for data collection before and after the intervention and three months after the education. Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1c) tests were done for both groups in a single laboratory before and three months after training.The mean age of patients in intervention group was 48.11 ± 9.7 and control group was 47.3 ± 7.9 years. The awareness of the patients related to diabetes foot care, in the intervention group after the training significantly improved (P 0.001). The mean scores of preventive behaviors of diabetic foot significantly increased in the intervention group (P 0.001).The findings indicate that educational intervention based on short message service (SMS), resulting in improve foot care knowledge, foot care practices and metabolic control in patients with diabetes type 2.

Aims Different approaches for screening and diagnosis of gestational diabetes mellitus(GDM) have great impact on all process of management of gestational diabetes and its future complications. The aims of this study were to evaluate rate, risk factors and outcomes of GDM based on International Association of Diabetes and Pregnancy Study Groups diagnostic criteria. Materials In a prospective study pregnant women attended 5 clinics in Ahvaz, screened for gestational diabetes mellitus using IADPSG criteria and followed up delivery from August 2014 to February 2015. At the first prenatal visit women underwent the fasting blood sugar test. A 75-g oral glucose tolerance test (OGTT) was performed for 750 mothers between 24 and 32 weeks of gestation. Logistic regression test for calculating the odds ratios and 95% confidence intervals was used. Results The mean age of participants was 28.43 ± 5.52 years. The overall rate of GDM in our study was 29.9% (224/750). Incidence of gestational diabetes was associated with age group ≥ 35 years [OR = 1.92(95% CI, 1.19–3.09)], family history of diabetes [OR = 2.47(95% CI, 1.33–4.59)], previous GDM [OR = 3.12(1.35–7.19)], BMI ≥ 25 [OR = 1, 71(1.10–2.67)] Using logistic regression. The most common maternal complication in studied women was cesarean section followed by hypertension and preeclampsia. Conclusion About one third of studied women diagnosed as GDM according to the IADPSG criteria. Risk factors of GDM were maternal age, family history of diabetes, Previous GDM, overweight and obesity before pregnancy, the same reported factors with 2 steps approach. Higher rate of GDM using this criterion may increase concern about healthcare costs and workloads.

Early identification of at-risk groups is an important step in preventing gestational diabetes and its subsequent side effects. This study aimed to evaluate the risk factors of gestational diabetes based on the International Association of Diabetes and Pregnancy Study Groups criteria in Ahvaz.In a cross-sectional case control study, 520 pregnant women involving life after gestational diabetes Ahvaz cohort study (LAGAs) were investigated for risk factors of gestational diabetes mellitus.The prevalence of overweight and obesity were 40% and25.8% in the GMD group and in 35.8% and 16.2% in the control group respectively (p = 0.002). According to NCEP-ATP III criteria, 16.9% of women with GDM and 6.9% of mothers in the control group had metabolic syndrome in first visit of pregnancy (p 0.001. Logistic regression showed that there is a significant relationship between maternal age[OR = 1.05(95% CI, 1.01-1.10)] (p = 0.01), previous GDM [OR = 5.60(95% CI, 2.21-14.18)] (p = 0.001), positive family history of diabetes[OR = 1.86(95% CI, 1.19-2.94)] (p = 0.006), pre-pregnancy BMI [OR = 1.05(95% CI, 1.007-1.11)] (p = 0.04) and metabolic syndrome in first visit of pregnancy[OR = 2.34 (95% CI, 1.038-5.30)] (p = 0.04) with GDM.Factors including maternal age, previous GDM, family history of diabetes, pre-pregnancy BMI reported in previous studies around the world. A significant association between metabolic syndrome in the first visit of pregnancy and GDM is novel finding of this study. Therefore screening of pre-pregnancy metabolic syndrome in women at risk of gestational diabetes is recommended.

Self-care in patients with diabetes reduces the number of hospital admissions, costs and improves their quality of life so that just by training self-care to them can reduce 80 percent of diabetic complications. Therefore, this study aimed to investigate the effect of educational program based on precede-proceed model on improving self-care behaviors in patients with type 2 diabetes referred to health centers in city Bavi in 2016-2017.This quasi-experimental study, conducted on 110 patient women with type 2 diabetes referred to health centers in Bavi city in 2016-2017. The training program was designed based on Precede-Proceed Model. Data collection tools included the Precede researcher-made questionnaire and the Glasgow questionnaire. The duration of the training course was three months. After one month, the effect of this program, and the amount of improvement of the patients' self-care behavior were evaluated. Independent t-test, paired t-test, Chi-square and Fisher's exact tests were carried was used for data analysis.After the intervention, the average score of predisposing factors (knowledge, attitude and self-efficacy), reinforcing factors, enabling factors and self-care behaviors, in the intervention group compared to the control group, significantly increased (P0.05). After the training, the fasting blood sugar (FBS) and body mass index (BMI) decreased in the experimental group, but this reduction was not statistically significant (P0.05).The findings of this research showed that Precede-Proceed Model would be an appropriate framework to educate patients with type 2 diabetes as well as promote self-care behaviors.

Aims Rate of postpartum screening and progression to glucose intolerance (diabetes and/or pre-diabetes) in Asian women with prior GDM and risk factors of diversion to abnormal glucose tolerance were reviewed. Materials and methods We searched Pub Med, Cochrane Library, Web of Science , EMBASE, and Ovid data base. About 1300 studies were screened and 27 articles were selected. Meta-analysis using Comprehensive Meta −Analysis software was conducted. All results were reported at the pooled ORs and 95% CI. Quantitative heterogeneity (I 2 ) was assessed. To estimate the variances between studies, the statistical method “tau-squared” was applied. Statistical models like fixed effect or Mantel-Haenszel, and random effect (REM) or Dersimonian-laird were used for the analysis and integration of results. Results Rate of glucose testing ranged from 13.1% to 81.9%. Prevalence of pre-diabetes was 3.9%-50.9%. Diabetes was reported in 2.8%–58% of women with history of gestational diabetes based on length of follow-up. Factor associated with postpartum diabetes mellitus included family History of diabetes mellitus, gestational age at diagnosis of GDM, insulin use during pregnancy and pre-pregnancy BMI. Conclusions Rate of postpartum screening in most of the Asian countries population is sub-optimal, in spite of high rate of glucose intolerance in this high risk group of women. Risk factors of progression to pre-diabetes and diabetes are similar to previous reported in developed countries.

Introduction: In addition to the annual mortality rate, unintentional home injury may result in temporary orpermanent disability and requires medical attention and continuous care in millions of children. This studyaimed to explore features and risk factors of these injuries. Methods: In this cross-sectional study, demographicvariables and epidemiologic pattern of home injuries among children under 5 years of age were collected via apopulation-based survey in sevenmain cities of Khuzestan province, southwest Iran, during September 2011 toDecember 2012. Developing a risk stratification model, independent risk factors of unintentional home injurywere determined and put to multivariate logistic regression analysis. Results: 2693 children with the mean ageof 27.36 § 15.55 months (1 to 60) were evaluated (50.9% boy). 827 (30.7%) cases had a history of at least onehome injury occurrence since birth to study time. The most common injury mechanisms were burning with 291(38.4%) cases, falling with 214 (28.3%) and poisoning with 66 (8.7%) cases, respectively. The independent riskfactors of unintentional home injury were age ¸ 24 month (pilliteracy (p(p=0. 01). Sensitivity, specificity, and area under the ROC curve of the model designed by multivariate analysiswere 53.5%, 84.8%, and 0.75 (95% CI: 0.73- 0.77; P < 0.001, figure 1), respectively. Conclusion: According tothe findings of this study, 30.7% of the studied children were injured at least once since birth. Burning, falling,poisoning, swallowing objects, choking, and biting were the main home injury mechanisms. Age ¸ 24 months,being the first child, living in a private house, being a resident of Ahvaz city, and having an illiterate mother werefound to be risk factors of home injury.

Aims: Gestational diabetes is a strong risk factor for postpartum progression to glucose intolerance. The aims of the study were to determine rate of postpartum glucose testing , its related factors and rate of progression to glucose intolerance in women who underwent postpartum glucose testing after pregnancy that complicated by gestational diabetes. Materials: this is a retrospective study and women with gestational diabetes who received prenatal care during 2005-2015 in 3 rural health centers of Khuramshahr (southwestern of Iran) were enrolled. Gestational diabetes mellitus diagnosed by FPG test only, 75g OGTT or GCT. The American Diabetes Association(ADA) criteria applied for definition of postpartum glucose intolerance (pre-diabetes or diabetes) . Results: Mean duration of follow-up was 29.7 months. BMI≥ 25 was detected in 73.3% and 78.7% of women during pre-pregnancy and postpartum respectively. Overall 45.8% (60/131) of women received postpartum glucose testing. Rate of progression to abnormal glucose tolerance was 23.3% (8.5% pre-diabetes and 15.2% diabetes). Advanced maternal age was associated with postpartum glucose testing (OR 1.066, CI 1.008-1.128, p=0.02). Discussion: high rate of overweight and obesity, sub optimal rate of postpartum glucose testing and high prevalence of glucose intolerance, highlights the importance of postpartum screening with a more sensitive test and implementation of an intervention program to prevent type 2 diabetes in rural population particularly older women with prior gestational diabetes.

Domestic violence against women is an important health issue, but few studies have focused on city of residence and ethnic differences. To estimate the prevalence of various forms of domestic violence and certain related factors, with a specific focus on city of residence and ethnicity, we studied 1820 married women attending public health centers in 4 large cities in Khuzestan Province, southwestern Islamic Republic of Iran. We used an interviewer-administered questionnaire for data collection. The prevalence of some forms of lifetime domestic violence against women was 47.3%. The prevalence of physical, psychological, and any form of lifetime violence was the highest in Dezful (25.7%, 54.8%, and 57.7%, resp.). For sexual violence, the highest prevalence was reported in Ahvaz (17.7%). The highest prevalence of physical and sexual violence during any point of life was reported by Arab women (25.1% and 16.7%). The experience of all forms of violence was significantly associated with city of residence. Results of regression logistic analysis revealed that all of the forms of violence except psychological violence were statistically significantly associated with ethnicity (P<0.05).

Introduction: Unsafe abortion is one of the most important health problems in many countries. Because of legal and moral issues, abortion is one of the most sensitive decisions. The aim of this study was to understand women's expected gains from undergoing induced abortion. Methods: To explain the factors leading to induced abortion, we collected the stories and experiences of a total of 21 people, including 18 women who underwent induced abortion in their most recent pregnancies, two women's health providers, and a companion of a mother who died after an induced abortion. This qualitative study was conducted in Imam Khomeini and Razi hospital of Ahvaz and also a number of health centers, from February to September 2014. To collect the required data, we used open and semi-structured deep interviews. Content analysis method was used to analyze the data. Results: Three major themes emerged from the analysis of the collected data, which included the following: 1) Expected favorable health-related outcomes, 2) Expected favorable economic outcomes, and 3. Expected favorable outcomes in social level and family relationships. Conclusion: The results of this study showed that the studied women, to achieve to desirable outcomes in areas of health, economic and social, have undergone induced abortion. Hence, to develop programs for the prevention of induced abortion it is necessary to consider the motivations of women to intentionally terminate a pregnancy.

Background: Domestic violence is a risk factor for a wide range of health problems. This study investigated the prevalence of domestic violence and its related factors among women who attending health centers in four cities of Khuzestan provinces.Methods: In a descriptive-analytical study, 1820 women aged between 14-56 years who referred to health centers of Ahwaz, Abadan, Dezful and Andymeshk were studied. An interview-administered questionnaire was used for data collection. Logistic regression model for the calculating the odds ratio was applied. Results: Overall prevalence of physical violence at any time of life was 20.2%. The prevalence of psychological, sexual and any type of violence were 41%, 10.9% and 47.3%, respectively. Logistic regression showed that experience of any type of violence has a significant relationship with literacy, employment, ethnicity, city of residence, age of women and history of psychiatric disorders in husbands. Conclusion: The prevalence of violence in Khuzestan was high. Health centers need to consider routine screening and referring victims of violence.

Background Metabolic syndrome (MetS) is a well-known risk factor for type 2 diabetes and cardiovascular disease. Waist circumference (WC) is an essential component for the diagnosis of the MetS. Objectives The aim of this study was to compare the cut-off points of WC proposed by the international diabetes federation (IDF), adult treatment panel (ATP III), and iranian national committee of obesity (INCO) with that of the present study for predicting the MetS. Patients and Methods This cross-sectional study was performed on 930 individuals (439 males and 491 females) aged more than 20 years living in Ahvaz City, capital of Khuzestan Province in southwestern Iran during 2009 - 2010. Waist circumference cut-off values were obtained using a receiver operator characteristic curve. Optimal cut-off values were calculated by plotting the true-positive rate against the false-positive rate. Also, sensitivity, specificity, and Youden’s Index were calculated. Results The cut-off points of WC, according to a maximum sum of sensitivity plus specificity for detecting at least two components of MetS were found to be 91.5 cm and 85.5 cm in men and women, respectively. Using these values, sensitivity and specificity were 61% in men and 65% in women. The sensitivity of the male population and the specificity of the female population were found to be higher than the values proposed by IDF and ATP III. Conclusions Optimal WC values for defining MetS were 91.5 cm and 85.5 cm in men and women, respectively. The cut-off values recommended by world organizations are not appropriate for an adult population living in Ahvaz City.

Background: The prevalence of unintended pregnancy and associated risks are higher in late reproductive years. Limited studies have focused on contraceptive choices in these women. The aim of the study was to identify contraceptive choices and their related factors in women 35 years or older attending health centers of Khuzestan province. Objectives: Additionally, several line of evidence indicated relationship between increasing maternal age and poor pregnancy outcomes (1, 2). Pregnancies above the age of 35 are accompanied with more risks for complication related to pregnancy as compared to younger women (3 - 5). Risk of spontaneous abortion is 74.4% in mothers aged 45 years or more. Patients and Methods: In a cross-sectional study 1584 women aged 35 years and older attending public health centers of four cities of Khuzestan were studied. We used an interviewer-administered questionnaire for data collection. Women investigators were recruited for interview and filling the questionnaire. Participants were assured of the confidentiality of their responses. Results: The mean age of women was 39.8 ± 4.2 years. The most popular contraceptive methods used in this age group were oral contraceptive pills (31.4%), condom (28.1%), and tubal ligation (14.8%). Less effective contraceptive methods were used in 41.5% of women. Significant associations were found between the use of effective methods and literacy of husband (OR = 0.80, 95% CI: 0.75, 0.91), city of residence (OR = 0, 92, 95%CI: 0.87 - 0.97), women age (OR = 0.97, 95% CI; 0.94 - 0.99), and women education (OR = 0.87, 95%CI: 0.76 - 0.99) (P < 0.01). Conclusions: In spite of risk of pregnancy and unintended pregnancy in this age group, about a half of them used less effective contraceptive methods, hence family planning education, and counseling to older women should be a priority in health centers.

Dear editor; Early postpartum follow-up of women with a history of gestational diabetes mellitus (GDM) provides an opportunity to assess health condition of mothers as well as their offspring health [1]. GDM is considered as the strongest predictor of type 2 diabetes, thus follow-up of women with recent GDM can lead to early diagnosis and management of diabetes and other metabolic disorders outcomes [2]. In developed countries, a low postpartum return rate of women with GDM was reported for assessment of blood glucose [3]. In spite of high prevalence of GDM in Iran [4], evidences about postpartum return rate of women with this disorder and its predicators are not documented adequately. Given the low postpartum return rate of women with GDM for oral glucose tolerance test and high use of mobile phone in Iran, we compared the effects of two methods of Short Message Service (SMS) text and telephone contact reminders on doing of oral glucose tolerance test (OGTT) for diagnosis of type 2 diabetes among women with GDM to design a novel method for recall of postpartum follow-up. We entered all of women with recent GDM who registered for screening of congenital hypothyroidism of their newborn early days after delivery in two main referral centers of Ahvaz, southwestern of Iran. Totally 476 women with abnormal glucose test in their recent pregnancy were evaluated for eligible criteria during January to March 2015. Among those, 156 women (residents of rural area, no available laboratory records of glucose status during pregnancy, cases of pregestational diabetes, early move out of Ahvaz after parturition, women with literacy problem, no access to mobile phone) were excluded and other 320 women that had inclusion criteria were assigned to receive either 4 SMS texts (n= 160) or 4 telephone contacts (n= 160) with the same dialog during 3–5 days to 6–12 weeks after delivery. SMS texts were sent to women, their husband or both. We asked all women in both groups to return for completion OGTT (a 75-g 2-h oral glucose tolerance test) during 6–12 weeks after delivery. Totally, 90 women (28.12 %) returned and performed OGTT during study period. Among those, 55 women (34.37 %) were in telephone contacts group and 35 women (21.87 %) were in SMS texts group. We concluded that postpartum return rate was higher in women with telephone contacts intervention. Based on the results of this study, we continued recalling of women in life after gestational diabetes Ahvaz (LAGA) cohort study (IR.AJUMS.REC.1394.252) to compare potential metabolic outcomes in women with GDM (impaired glucose tolerance, diabetes type 2, lipids abnormality and metabolic syndrome) with healthy women. During 6 months recall from March 2015, we registered 1500 pregnant women (after 30 weeks’ gestation) who were referred for prenatal care to Ahvaz public health centers or Ahvaz private clinics to return for postpartum follow-up early after delivery and 2 years afterwards, in baseline visit. We used different methods of communication to recall women to participate. Invitation was sent via social networks (telegram and what’s up), mobile and direct contact via phone for women, their husband or the first relatives who their phone number was available. The baseline visit took place in 25 public and private health centers, and eligible women were invited to refer to cohort study center (Ahvaz Golestan hospital). Until now, data were collected in the first 6–12 weeks after delivery and data collection will continue until March 2017. Data collection tool in this study is a 180-item questionnaire including socio-demographic details, risk factors of gestational diabetes and its potential outcomes, medical and reproductive history, anthropometric measurements, physical activity, dietary intake, and breast feeding. Blood samples were collected in 6–12 weeks postpartum and will repeat annually within the first 2 years after delivery. After excluded 200 mothers who could not meet study criteria, 1300 eligible women (800 women with GDM and 500 women with normal blood glucose) enrolled. Totally, 230 women (17.69 %) liked to participate in postpartum follow-up. Among those, 180 women (22.5 %) were with GDM and 50 women (10 %) were without GDM. Of women with GDM, 40 cases (5 %) didn’t not return to offered follow-up cohort study center, but reported uptake a test to check their glucose status which ordered by their physician in private clinics. Of those, 32 women (80 %) checked their glycemic status with fasting blood glucose (FBS) and the rest, uptake an OGTT during first weeks after delivery. Overall, return for follow-up and attendance for OGTT was low in early postpartum period in both our studies. It seems that perceived barriers for attendance and checking health status of women with GDM are stronger than the perceived risk of diabetes mellitus and other metabolic outcomes in the future [5]. Based on our experiences, it seems that poor communication between the public and private health sectors, inadequate referral system, lack of a national data registry and integrated health information system in addition to cultural and patient-related barriers are some challenges facing us for follow-up and lead to low rate of follow-up. These problems with controversies in screening, treatment and others concern make this process arduous. So, further research is suggested to explore the influencing factors for postpartum attendance with different methods. Also, it is recommended that with using experiences of other countries in this regard, novel strategies be taken by authorities.